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�.� <br /> 1 <br /> _ - � <br /> , u - . r <br /> . - <br /> PERMIi'A€�PLI�ATIOPi <br /> UtILYTIES LOCATE CC1NF�tiMA'!'I4N NUMSER. . pt+Dfl Y 2�i Q J ! -� .8?t.? <br /> ! <br /> PRO!/ItAf SKETCH IN THIS AREAr I�AD02TIONAL SPA�E IS REQUZR�D,ATTACH TO THYS <br /> APPLICATION. <br /> ������ � <br /> � <br /> : <br /> F <br /> � , <br /> � I' <br /> � � <br /> ' i <br /> AFFIDAVi3�: Applicatl�n is heret�y made to obtaln a perrnit ku do wtrrk and instaliallons as indicated. I ceriify that all forego[ng , <br /> inforrnadon Is accurdbe and that aR wark wi[I camp{y with all applkaate codes. I understand tttese c�des shat!take precedence aver al! <br /> approved construc8on dacurnents,and issuance of this permtt is ve'�f'ication that I will noflfy the propetty owner of FlOrlda L�en Law <br /> rec�.,F.S.7i3. <br /> The iSSU�nce oF fhis permit does not ensure complianoe with deed restrlctions and I understand khat addidonal cteed ' <br /> restrtctians may apply to thls praperty. <br /> A�I wark�h�ll campty wi�h the current Ftorida Building Cade,Publlc Works Design Manual and FDOT Design <br /> Standards(if applicabie). {i�sbiit Worlcs Destgn Manual online link:w►vw,cf.zephyrhilis.fl.usjpublic_works.asp) <br /> APPt,ICATlON IS VOID UNLESS SXGNED V�II'TH PROPER IDENTIFICATION AND WTTNESSED BY A PERMIT <br /> TECHi�ICIAN tJR�JOTARY PUBLIC. ' <br /> idOTE: The Ctty of Zephyrhills is nat responsibfe for maintenance or repairs df driveways. Driveways shall net�fter j <br /> inkerFere with eacisting�tormwater treatrner�#and f or conveyance. <br /> Pi20PERiY C}���EF�: By signEng this appltcation: I oertify that I have read and undersEand the awnerJbuilder dtsdosure . <br /> statement S ,E�, (please 1n(tiai) f�s�d�� �fj <br /> �,Ar.�.t,nrrta'T, l�J��iJltGt.�+�i �8.r{,�.c� ��� � ,��,�f'•u�.� _-Dr�28—2017 � <br /> Applicarst Print Name Appticant Signahtre � Date � " - <br /> Perrnft Techn3dan SPgnature {or)Natary Sic�nature 13ate - � <br /> Appticant is( )persenatly knawn to me nr produced - as Id�tlBcaklon. <br /> �type af Identificatlon) <br /> Page 2 of 3 . <br />