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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 /> a V' <br /> el <br /> 2� <br /> ft, fill <br /> 391�yrG;uS 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 wdrk 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.1 will notify the property owner of Fiorlda Len Lew <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 compty.wtth the current Florida.Building Code,,Pubilo Works Design Manual and FID Design <br /> Standards(if applicable). (Public Works Design Manual online link:www.a.zephyrfmllls.fl.us/public_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMrr <br /> TECHNICIAN OR NOTARY PUBLIC <br /> NOTE: The City of Zephyihllls is not responsible for maintenance or repairs of driveways.. Driveways snail not alter-j <br /> Interfere with'ex-luting stormwater treatment and J 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 /> -21 <br /> Applicant PrintName* Applicant Signature Date <br /> Pdrmit Technician Slgnature (or)Notary Signature Date <br /> Applicant is( )personally known to me or produced. as Identitication. <br /> (type of Identification) <br /> Page 2 of 3 <br />