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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 ,•�tfat&"to- wi t5.�"C�',�Ct� �S rc n11 eCooCol D`F <br /> ac .r.ecjr CAD_ <br /> F, <br /> (� `�.. <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.whii all applicable Codes.LI understand these codes shall take precedence over all <br /> rL1 t N 1 rnU A'L approved construction documents,and Issuance of.this permit is verification that Twill no tNy the'Properly ovrner of Fioiid3 U6,Lawv <br /> l req:;F.S.713. <br /> The issuance ofthis permit does not ensure compliance With dead restrictions and d 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:vh%w.d.zephyrhitls.fl.us,/pubUc_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED•wITH PROPER IDENTIFICATION AND WITNESSED BYA PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC <br /> NOTES The City of2ephyrhllis is not responsible for maintenanco or repairs of driveways. Driveways shall not attar/ <br /> - interfere with existing stormwater treatment and I or conveyanoa. <br /> PROPERTY OWNERS:-.By,signing this application: I ceMfy•that I have read and understand the owneribuilder disclosure <br /> statement (pleaseintial) <br /> Applicant Piint.flame Applicant Signature- Date <br /> PermitTechnidan Signature (or)Notary Signature Date <br /> Applicant Is( )personalty'.known to me or produced as Identirkatfon. <br /> ,(type of Idenbflcatlon) <br /> Page 2 of 3 <br />