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I <br /> � <br /> 6 � `PERMIT APPLICATION i <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> I <br /> i <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do worlt 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 verifcation 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 Man i al 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 fVOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintedance or repairs of driveways. Driveways shall not alter/ <br /> interfere with existing stormwater treatment and/or conveyance. <br /> PROPERTY O . By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> state ent. (please initial) � � <br /> ' ` '1���ZS �.!l�vh `� 21 <br /> Appli t Print Nap�e � � ppl' ant Signatu�e Date <br /> � � � � J <br /> P rm Technician Sig ure (or) Notary SignatUre Date <br /> Applicant is( )personally known to me or produced as identification. <br /> (type of identification) <br /> Page2of3 <br /> I <br />