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, <br /> i , - i . . <br /> ' � PERMTT 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 properly 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 com I with the current Florida Buildin Code Public W r <br /> p Y g , o ks 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 /> PROPERTY O . By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> state ent. (plea e initial) � <br /> � 1 � <br /> � <br /> � � , <br /> I <br /> App ican Name. , Appli ant Signatur Date <br /> y� ` �c �vs <br /> Permit T Fhn cian Signa u e (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 /> �...L�.__ .,=..e.,.�.,z-, .__.- „�-:_���,.h.__�.r.�.e.�a-_-����.,;—..-.��_�,r�R_. �-���,-__-.�-.._..-._�...__�. .r��..�__�_._,9 r��.-�-.�,,.�,.�-s...���_��,r-� <br /> � <br /> I <br /> I i I <br /> � � <br /> i <br />