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� i � <br /> �, <br /> 8- . �� . <br /> i� <br /> , PEI�I�'APP�ECA'�IOI� <br /> a II <br /> � <br /> ' �i IITILITIES L�CATE CONFIRMATION IVUNIBER: ; � <br />� PitOVIIDE SKETCH FE1S TFEIS 14REA, EF I�DDITE0119LCL S��tCE IS REQUIIi�ED, /ATTACH TO THIS � <br /> I�PPLICATI0110. <br /> i <br /> � <br /> ��� , <br /> � � �� <br />� <br /> �� � <br /> ; <br />� � <br /> , <br /> II � <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing ; <br /> informati�on is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all ' <br /> approve �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 i <br /> restrictions may apply to this property. <br /> A19 wo�shatl com I with the curr+ent Florida Buildin Cocle Public Works Desi n Manual and FDOT Desi n � <br /> PY 9 . 9 9 <br /> IStandard5(if applic�ble). (Public Works Design Manual online link:www.ci.zephyrhiils.fl.us/public works.asp) � <br /> APPLICATIOIV IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT � <br />' TECHNICIAN OR NOTARY PUBLIC. ' <br /> NOTE: 4he C6ty of Zephyrhills is not responsible for maentenance or repairs of driveways. Drivew�ys shall not alter/ I <br /> interFere with existing sbormwater treatment and/or conveyance. ; <br /> PROPERT'OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure � <br /> statemeii t. (please initial) � <br /> L�-Q �� �wV ,��� �'� � (-2� —��p � <br /> Applicantl Pri t Name Applicant Signature Date <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applican I�is( )personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />