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� � � PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA,IF ADDITIONAL SPACE IS REQUIRED,ATTACH TO THIS <br /> APPLICATION. <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 appliwble). (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 2ephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> interfere with existing stormwater treatment and/or conveyance. <br /> PROPERTY . N : By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> state ent. ' (please initial) <br /> � � V � � � l� <br /> A li nt Print Nam ` Appli t Signaturet Date <br /> � <br /> �t <br /> Perm hnician ign ure (or)Notary Signature Date <br /> pli t is( )persori ly known to me or produced as identification. <br /> (type of identification) <br /> Page2of3 <br />