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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 /> 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/publiiq._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 /> statement. (please initial) <br /> A 1AV1.1A <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 />