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At <br /> 9 <br /> P <br /> . t e � <br /> F � <br /> ,: <br /> FERMIT AE�PLECATlON . `' <br /> ; <br /> } <br /> UTILTI'IES LOCATE CONFIRMATION AIUMBER: ; <br /> � <br /> PROVIDE SKETCH IN THiS AREA, IF ADDITI�WAL SPACE Y5 itEtQUIREi3, ATTACH TO THIS ?; <br /> �/5�P'Y»»]IC1�Txl�?M. - - - � <br /> � <br /> i� <br /> , <br /> x <br /> r <br /> �; <br /> �; <br /> �� <br /> I' <br /> � <br /> ;'s <br /> a <br /> �,� <br /> 1 <br /> � � <br /> I' <br /> i, <br /> ' �� <br /> t' <br /> 6 <br /> r, <br /> � <br /> i <br /> AFFIDAVTi': Appllcation is hereby made ta obtain a permit to da work and�nsta11at1ans as indicated. I certify that aI1 faregaing ' <br /> Information is accurate and that all work will comply with all applicable codes. I understand these codes shaU take pre�edence o�er all f, <br /> approved construction documents,and issuance of this permit is verification that I wUl.notlfy the prapeRy pwner of�torfda Uen Law # <br /> req.,F.S.7l3. I <br /> The issuance of this permit does not ensure cornpliance with deed restrlctlons and I understand that addirione!deed �, <br /> restrictlans may apply to this property. ;. <br /> All wark shall comply v�rith the current FloNda Building Code, Public lAforks Design Manual and FDaT Design P. <br /> Standards(if app#iCable). (Pubtic Works Design Manua(anline link:www.ci.zephyrhilis.fl.us/pubiic_works.asp) �� <br /> APPLICATTCIN IS VOID UNLESS SIGNEQ WITH PR�PER IDENTIFICATION AND WI7NESSED BY A PERMIT � <br /> TECHNICL4N OR NQTARY PUBLIC. f <br /> NOTE: The C�ttir of Zephyrhtlls Is not respo�slbie for maintenance or repairs af driveways. Dmreways s6a11 not alter j : <br /> intertere wit3�enisting stormwater treatinent and j or conveyance. �! <br /> PROPERTY WNERS: 8y signin�this application: I certify that I have read and understand the owner/builder disdosure �� <br /> s rnefi�t. { lease initiat}�� <br /> G�i"'�G,�°���L/�_����' � , <br /> A tic�ant Print Name ,r� Applicant Signature pate �' <br /> Fermit Terhnician Signature (or)Notary Signature bate ' <br /> � <br /> Applicanfi is{ }persanaliy known ta me or praduced as identificatton. 1 <br /> (type of identification) <br /> P�tge 2 0#3 �, <br /> i, <br /> i <br /> � . �. <br />