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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA,IF ADDITIONAL SPACE IS REQUIRED,ATTACH TO THIS <br /> APPLICATION. <br /> 1 <br /> W. 'virPTI;i: ft <br /> r WtWI&) t2t6Kt ol"try�( <br /> 7r <br /> 3'k 7` +%6P tXiTPN gT,+ OP'P�Y&$tt^f11 <br /> Ft.re�. BaTN <br /> AMDAVff: Application is hereby made to obtain a permit to do work and installaU ms as indicated. I certify that all foregoing <br /> lnformatlon Is accurate and that all work will comply with all applicable tomes. I understand these modes shalt take precedence over all <br /> approved corrsmx1lon documents,.and issuance of this permit is verification that I will notify the property owner of Ploft Llen Law <br /> req.,P.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 shalt comply with the current Florida Building code,Public Works Design Manual and FDOT Design <br /> Standards(if applicable). (Public Works Design Manual online rink www.ctaephprhills tus/pubttc_wcec asp) <br /> APPLICATION IS VOID UNLESS SIGNED VOTH PROPER IDEN17FICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC ,. <br /> NOTE:The City of Zephyrhllts is not responsible for maluMnamce or repairs of driveways. Driveways shall not sitar/ <br /> Interfere with e3dcdng stormwwaW treatment and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify at I have rd understand the o7Wn {but! er disclosure <br /> statem�entt (please initial)6 <br /> Applicant Print Name _ ApPi. at Hato Date <br /> Permit Technician Signature (or)Notary Signature pate <br /> Applicant is( )personally known to me or produced as identification. <br /> (type of Identification) <br /> Page 2 of 3 <br /> i <br />