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' PER�NIT APPLICATION <br /> ,s <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH II1! THIS AREA, IF ADDYTIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> AFFIDAVII': Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing I <br /> information is accurate and that all work will comply with all applicable codes. 1 understand these codes shall take precedence over all <br /> approved construction documents,.and issuance of this permit is verifiption 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 /> restricdons 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 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 /> TECHNICL4N OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of drivewa�s. Driveways shall not alt�er/ <br /> interFere with existing stormwater treatment and/or conveyance. <br /> PROPERTY OWNERS: By signing this appiication: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> c�li,�4 � -�!i �t/a��/�o <br /> Applicant Print ame Applicant Si ature Date <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applicant is( )personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />