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i <br /> � e <br /> , � <br /> � PERMIT APALICATION <br /> ' UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> I <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregaing <br /> informatian is accurate and that ali work will comply with all applicable codes. I understand these codes shaN take precedence over a11 <br /> approved construction documents,and issuance of this permit is verification that I will notify the properly 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 wark shall camply with the current Florida Building Cade, Public Works Design Manual and FDOT Design <br /> Standards(if applicabte). (Public 1Norks Design Manual anline 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 PUSLIC. <br /> NOTE: The City of Zephyrhills is no#responsible for maintenance or repairs of driveways. Driveways shall not alter( <br /> interfere with exis#ing stormwater treatment and j or canveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement.� (please initial} _ n <br /> I� �- � � �������- � �r l� - <br /> A ic�Name A I' ant Si nature Date <br /> ( P _ PP 9 <br /> f� <br /> rmi. echnician Sig at re (or}Notary Signature Date, <br /> Appl9cant is( )personally known ta me or produced as identificatian. � <br /> (type of identification) <br /> Page 2 of 3 <br />