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i , . <br /> Oin�,uA 1 H,�YL:iVH Ilt~IIVI <br /> � � UTIt.ITtES LO�ARP C�NFIRMA'fION i�t1MB�ER: , <br /> , PROVIDE SKETCH IIV THIS AREA, I��1DDITIOIVAL SI�ACE IS t�EQUIRED,AT'1"ACfi TQ THIS <br /> , APPLICATION. <br /> ' ��� �c+I 11�1-��:� '. <br /> � <br /> ; <br /> i ' <br /> � <br /> , <br /> AFFIDAYII`: Appliration is hereby made ba obtain a permit ta do work and installetions as indiceted. I certify that ali foregalrtg <br /> infarmation is accuretE and that all work wiil comply'wtth a(I applicable codes. I understand these codes shall take preeedence over afl <br /> approved cvr►structbn dotuments,and IssuanCe of tfi�s permit Is verificatian that I will natify the property owner of Florida Lien Law <br /> � req.�F.S. 7i3. <br /> � The issuance oF tfits perm(t does nat ensure cdnrpllance wlth dead�esttictions and I undersmnd that add�tiana!deed <br /> ' restrictions may apply to this properiy, <br /> 1�11 worEc shall compfy with the current Florida Bullding Cade,Public Wcrks Resign Manaaa!�nd FDOT Resign � <br /> St8rldalyds(if�ppliCc�ble). (Publlc Warks Design Manual online I(nk: www,d.zephyrhffls.fl.LLs/publIc works.asp} <br /> APPLiCATION IS VQIC1 UNLESS SIGNEp W17'M PFtOpER TD�N7TFICA"T'ION AND WITNESSEQ gY A PERMT3" <br /> 'TECHNICI�qN 4R NOTARY PUBLIC. <br /> N�'CE: The City of Zephyrhilis is nat resppnsible for maintanance or r��irs of drfveways. 1DriveYvays shat!not atter/ , <br /> interFere u►ith existing stotmwater treatment and/or oonveyanc�e. <br /> PROPER7Y OWN�RS; By signing this appHcation: I certf�y that I have raad and understand the owner/bullder dl�closure <br /> statement. �please tnitlan , <br /> App#icant Print 1Vame Appltcant Signature Date <br /> Permtt 7echniciart Sigtrature� (or)fV�tary Sign�tu��e � � Date <br /> Applicant is( )personally known to me or produced i as identificatlan. � <br /> ttYAe of Identifica6on) <br /> Page 2 of 3 � <br />