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FACTOR PSF ADJ.ARE/WALUATION p� OWNER-BL'ILDER DECLAAATION � SFRlADD/HEM O 1 NEREBY AFFIRM UNDEH PEWLLTY OF PEiWRY THAT 1 AM E%EMPT FROM TNE CprtMCTOqS LF GeropelCs�po�t W CEHSEUWFOHTHEFq10WNiGREAAN(SEG7W1.68USINESSANDiROFES510NSC00EANYCT'Oq (n C7 COUNTYWNICHREOUIRESAVERIARTOCONSTAUCT.ALTERIMPROVE.OFAqUSH.ORREPURAHYSTPoIC• W pelio/DeCk Z TIJRE_PHldt TO R4 ISSl1ANCE.AL50 11Ed11RE5 THE AVPLICMlT fOR SUdi VERMIT TO FlLE A SIONED LL� STATENEM TNA7Mf qi SXE IS UCENSED PURSUANT TO TNE GROWSiM15 OF THE COHiRACTOqS L4 W . � CENBE lAW(dWTER 0(COYYENCwO WIT1 SECTION 7000)OF DMSqN 7 OF TME BUaN�E88 MA PHO� � POOVSp! 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