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,P@RM�'APPLICATION <br /> I <br /> UTILITIES LOCATE CONFIRMATION NUMBER: I <br /> I <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS j <br /> APPLICATION. � <br /> I <br /> I <br /> I <br /> I <br /> � I <br /> • I <br /> i <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 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 <br /> restrictions may apply to this property. <br />� All work shall comply with the current Florida Building Code, Public Works 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 existin stormwater treatment and/ or conveyance. <br /> PROPER7Y OWNERS: By signing this applica on I certify tha rea and understand the owner/buil y discl sure <br /> statement. CC (please initial) <br /> Cecilia K. Coleman � � � <br /> Applicant Print Name Applicant Signat re Date � <br /> � <br /> Permit Technician Signature (or)Notary Signature Date j <br /> i <br /> Applicant is( )personally known to me or produced as identification. ; <br /> (type of identification) I <br /> I <br /> Page 2 of 3 i <br /> � <br /> i <br />