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PIERPHIT APPLICATION <br /> ' UTYLITIES LOCATE CONFIRMATIOi!! PlUP�BER: <br /> � PROVIDE SKETCH Ifo! THIS ARIEA, IF ADDITIOI!!Q►L SPp+CE IS REQUIRED, ATTACH TO THIS <br /> APPLICATIOfd. <br /> Lo�- � �C � <br /> g'� �� � <br /> �d.ls�rv�-#�-�� <br /> �r��-� L�e�r- <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 properly. .. _ <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/pubfic_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 OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> i statement.�_(please initial) . <br /> I ��G�n�`�.���h� ;,,� � 1/ 1��/7 � <br />� <br /> il 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 identificabon) <br /> Page 2 of 3 <br /> - � <br />