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� - ---- � <br /> - - --- _ ------ ,— <br /> 0 <br /> PER.�aT APPLIGRTIOI�➢ <br /> UTILI!`IES 40CATE CON�IRMATION N47MBER; <br /> PR01/IDE SKETCH IN THIS AREA, IP ADDITIONI�L SPACE IS REQU�RED, I�TTACH TG 'FHIS <br /> A�P�ICATI011f. <br /> � P <br /> c3' � <br /> E �' ' � <br /> . � � � <br /> � <br /> _ � <br /> � � w <br /> _ _ _ _ �, U• <br /> � <br /> �' �` � � � � . � <br /> � <br /> � � � 3 � + �� b � � <br /> .f � � <br /> � � � � � �--j N � � � � � � <br /> � � � �� � <br /> � � � � � <br /> � � ? <br /> i � 4 � <br /> � � ` <br /> � � <br /> � <br /> � V <br /> !�1[1 ����'''��' <br /> 1 � - � <br /> �i <br /> � <br /> � <br /> , � <br /> AFFIDAVIT: Applicatian is hereby made ta abtain a pemtit to do wark and installations as indlcated. I certify that all foregoing <br /> information is accurate and that al)work will comply with ail applicable codes. I understand these codes shatl take precedence over all <br /> approved construction documents,and issuance af this permit is verification that I will notify the property awner of Florida Lien Law <br /> req.,FS.713. <br /> The issuance of this permit does nat ensure compliance with deed restrictions and I understand that additiona!deed <br /> res�rictions may apply ta this property. <br /> Ali work shall comply with the current Florida Building Code, Public Work�Desi�n Ma�nual and FdQT Design <br /> Star�derds(if ap�sicable}. (Public Works Design Manual online link:www.ci.zephyrhiHs.fi.usJpublic wortcs.asp) <br /> APPLICATION iS VOID UNLESS SIGNED iNITH PROPER IDENTIFICATION AND WITNESSED SY A PERMiT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE; '�he City af Zephyr�si[ts is nat r�s�onsible for mait�tenance or repairs of driveways. Driveways s6aE1�not alter J <br /> interfere with existing�tormwater treatment and/or conveyance. <br /> PROPER7Y OWNERS: By sign�ng this application: I certify that I have read and understand the awnerjtauilder disclasure <br /> � Statement. (please initial) <br /> �) <br /> il <br /> Applicant Print Name Applicant Signature Date <br /> Permit Technician Signature (or)Natary Signature pate <br /> Applicant is( ) personally known ta me or produced as ident�catian. <br /> (type of identification) <br /> P�ge 2 a�3 <br />