Laserfiche WebLink
; <br /> ;' 1,� <br /> i <br /> � _ . �.: ,. ��►��o �o�uN�-rY, �'�.o��DA <br /> �� � : <br /> ..� . . <br /> ....,. ,. � <br /> Permit No, c3 <br /> ' Date Permitted —� —l� , <br /> � � � - <br /> �! PERMTT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF IQ►DDITIONAL 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 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 /> iinterFere with existing stormwater treatment and/or conveyance. <br /> �I PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> � stat ment. (please initial) ` <br /> - 'Y11 I e I►�S ,' � � � �L � <br /> ; Applicant Print Name ,. A I' nt Signatur Date <br /> � �' /�/� �i �� �5 <br /> P rmi Technician Si na ure (or) Notary Signature Date <br /> App icant is( ) personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br /> " , . <br />