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.� <br /> d"' � <br /> PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <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 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 /> interfere with existing stormwater treatment and/or conveyance. <br /> PROPER7Y 0 . By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> state ent. (please initial) � ^ <br /> �I S � ' 2� <br /> A ' a rint Na � ppli nt Signatu Da� <br /> � 1� <br /> Per ' echnician Si n ture (or)Notary Signature Date <br /> pl" ant is( )personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 '' <br /> - �; =--P • ~-�- ----_-.�_ _,�. --_-_- �-�-:.._.__._. -o._ -_-__.�.� �-- -:�T_az.=.�.e.n-=,.�--w.---=r_r,.�—=-�_�.-�__ --_�-„��---�_--z.�.�.,., <br /> I <br /> I <br />