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� <br /> PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. ' • <br /> ���3y �``� � <br /> ` �v�s��- �x�Sfl�- <br /> C�^��e <br /> ,� �� � <br /> �� � ��U �i��., � �� �- <br /> � � `x `� � � '"�� <br /> � �! t' � � �n�Gr�,l� <br /> a.n , -�.� �. <br /> � "�' N�ui _ �h a O� �" <br /> ! coNc�� v� <br /> �i�2 ��(!c� S�����1� <br /> . � � <br /> b 1����� � �- <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 existing stormwater treatment and/ or conveyance. <br /> PROPERTY O E • By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> �Ofr/b//� �`/f�✓� �d,J � �GL i /� �.� �� <br /> Applicant Print Name Applicant Signature Date � <br /> Permit Technician Signature (or) Notary Signature Date <br /> Applicant is( ) personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br /> 1 <br />