Laserfiche WebLink
,.PERMfT AP.PLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> s �i <br /> f( ' � ��� <br /> ' czv...e��..�� o �.m s <br /> � `� s 1�-o V`� ! � � <br /> � � $ j � � - <br /> �er � � j , <br /> ; � �� .�__ � �w � <br /> ' � � � ���C'� i �E ���i' ar <br /> ; �, � � _,: __� _�__� <br /> � � r ��r � � <br /> { ` � � ►��Vi� �� IC <br /> � � ��gE� �cP41JS�DN �0�N� . .'�� . ��i/�/Ul/�_ I <br /> ' ; Az �� o�P�ty�� -� °� _, - � <br /> i l 3'x� � ��� r' . , <br /> � � <br /> `� ( � T��4v6UGae Fu4d� ' `' 2 Z <br /> I ��.,_.�-.,,.�,.,..,.�.. � .r�'4a z�,4.S�p�S> :.�..�.�..,..�_:-.�. - _ <br /> j ._._....��___._..d���- �_._._��-����`�T�..�.P..._.__ .�..��� <br /> b <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing <br /> information is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all <br /> approved construction documents,and issuance of this permit is verification that I will notify the property owner of Florida Lien Law <br /> req., F.S. 713. <br /> The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> All work shall comply with the current Florida Building Code, Public Works Design Manual and FDOT Design <br /> Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.fl.us/public_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> interFere with existing stormwater treatment and/ or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> Applicant Print Name Applicant Signature Date <br /> � <br /> Permit Technician Signature (or) Notary Signature Date <br /> � Applicant is( ) personally known to me or produced as identification. <br /> l <br /> ; (type of identification) <br /> � Page 2 of 3 <br /> l <br /> � <br /> � , <br />