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d , ' <br /> ° PERMIT APPLICATIOId <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br />� PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS i <br /> APPLICATION. � <br /> i <br /> I <br /> I <br /> I <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 ali 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. I <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 /> PROPER7Y O RS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> stat ment. (please initial) , � <br /> , , � <br /> ��� . � ,, lC� ►�S �' ' ''� �ri� � �5 <br /> Applicant Print Nam ! Ap licant Sign�uy Date <br /> �'` `rl�(�,4`, �:11 , <br /> .� � � , ,v-_� <br /> ,''Per it Technicia� Sigi ature (or)Notary Signature Date <br /> � <br /> Applicant is( )personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />