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. <br /> I � <br /> � f 5 <br /> '� .-�PERMIT APPLICATION � <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAU SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. I <br /> . ,� <br /> � <br /> I <br /> i <br /> � <br /> I <br /> �; <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 properly. <br /> All work shall comply with the current Florida Building Code, Public Works Design Manual and FDOT Design <br /> Standards(If appllCable). (Public Works Design Manial 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 Itreatment and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify thai I have read and understand the owner/builder disclosure <br /> stat ment. (please initial) � <br /> in5 ' � l � <br /> < J�Y��I�l� 4 I <br /> Applicant Print Name A I' nt Signatur Date <br />' � � �' I l �5 <br /> P rmi Technician Si na ure (or) Notary Signature Date <br /> i <br /> App icant is( ) personally known to me or produced ' as identification. <br /> (type of identification) <br /> Page 2 of 3 <br /> I <br /> I <br />