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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER. Sunshine 811 Design Ticket 240702605 <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED,ATTACH TO THIS <br /> APPLICATION. <br /> Refer to attached Drawings. <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. i <br /> The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed 1 <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.cl.zephyrhills.fl.us/public�_worksasp) <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 W <br /> y signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> John Bostic III.City ofZephyrhiils Utilities Director <br /> Applicant Print Name App' nt 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 />