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I <br /> � L <br /> M . <br /> � , . <br /> :� IPM�M`xd���r�a,f${�M� <br /> �➢�39.Y���L��a'f�����g�9dATT'%��9 61Y��7���: �A1��f�'�.��� <br /> P��tVIdA�S��'t��l R�! �P�S�S�A�iE�, ��l�iD�g'��&�t�l��P�i��Y�i �tt�t�B)a���'9, �'�'kl�C� ��i'��� <br /> A6�1�'�IC�a'6'Ifl��. <br /> !'C°� ,� /P'°it�Pd <br /> ; <br /> i <br /> 3 <br /> d <br /> � <br /> � <br /> � <br /> i <br /> 1 <br /> 1 <br /> AFFIDAVIT: Application is here rnade ta a5tain a � <br /> by perm�t ta da�uorlc and ins411atior�s es indka�ed. I certiiy that aII faregoing <br /> information is accurake and that alt work wi(t comply wttfi atl apptir.�ble codes. I uncl�rstand these oodes shall take precedence aver alf <br /> approved construction documents,.and issuance of this.permft is verlHcation that Y will notify the property owner of Horida Lien Lauv r. <br /> req.,F.S.723. <br /> The issuanoe of this permft does not ensure complfance wiCh deed restrictions and I understand that additianal de�d k <br /> resfidivns rrtay appty ta thls property. , <br /> 114111 wcnrk sh�il aorrtply with the cxurent Flmrida BuildBng�de,�ubli�V1iorF€s De�1�n M�ntaa!�nd FD�T[�ign <br /> �#atsd�r+ds(ifapplic.�ble�. (Publie Warks�sign Manuat onllne 11nk:wvv�u.ci.zephyrhilLs.fl.us/pubi�c_warics.asp) � <br /> AppLIC�ATION IS lIOID I�NLESS SYGNED WITH PROPER ICIENTIF�C�1`fIC1N AND WITNESS�D BY A PERM�7' <br /> TECH�dI�IN OR NOT,4�kY PUBIIG � <br /> NOTE: The C�.jt of Z�phyrhills!s not r�pon�itr�e for main�n�a�ce or repa�ia�of t9rhret��y�. Drnreways shaDl reot�ltxr 1 <br /> �i <br /> in#erFere avi#h�acisting�orrnwater#a7eatment ar�ad/�r conv�yance. ; <br /> PROPERTY����s: 8y signing th(s appl(cati�n: T certffy that I have read and understand tfie owner/build�r disclosure <br /> statement. 1�' {please intt3a!} <br /> l�.effi..� r�` .R�,r'��; �s �rP ,i�ia� �. � �� p �/v��l 7 . <br /> Ap�licant Prant t�ame pplicarrx 5lgrrature Date <br /> i <br /> ; <br /> permit Te�nlcian Signature (or)tdotary Signa�ure pate i <br /> Appticant ts( )Personally known ta me or produced as Pdenti�cation, ' <br /> (4ype oP identificatian} ; <br /> ; <br /> P�ge 2 of 8 � <br /> y <br /> � <br /> t,: <br />