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� ' <br /> PERMIT APPl.ICATION <br /> UTILITIES lOCATE CONFIRMATION NUMBER: <br />� PROVTDE SKETCH TN THIS AREA, IF ADDITIONAL SPACE IS REQUYRED, ATTACH TQ THIS <br /> APPLICATION. <br /> ���' <br /> �,,6� �� <br /> �j�,c�� � j a � u c.r�� <br /> � <br /> S� X � <br /> � � <br /> � <br /> . <br /> ��� � <br /> � <br /> �� � <br /> �- c�� �.�e.r <br /> 4 � , <br /> I <br /> (�C� ' <br /> AFFIDAVIT: Apptication is hereby made to obtain a psrmit to do work and installations as indicated. I certify that all foregoing <br /> infarmatian is accurate and that ali work will camply with alI applicable codes. I understand these codes shall take precedence over all <br /> approved consfiruction dacuments,and issuance of this permit is verificatian that I wil(natify the property owner of Fiarida 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 /> ' restrictEons may appfy to this property. <br /> I Aii work shalt compty with the currenfi Ptorida Building Code, Public Works Design M�nual and FDOT Design � <br /> Sfiandards(if appliCable). (Pu6(ic Works pesign Manual on(ine link:www.ci.zephyrhii(s.fl.usJpub(ic works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMTT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhitls is not responsible for maintenance or repairs of dr�veways. Driveways s4ha11 nafi alter/ <br /> interfere with existing stormwater treatment and(or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner(builder disclosure <br /> statement,",_�'�_(please initial) J <br /> �'t�.'G r?1'a � � ,���f�� <br /> t'�����1 G i r��' <br /> � Applicant Print Name Applicant Signature Date <br /> � <br /> Permit Technician Signature (or}Notary Signature Date <br /> i <br /> ` Appticant is( )Qersonally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br /> � -- — <br />