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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 /> i-' G1 )c,S <br /> ---------------------- <br /> 0ftuy� CSR� to e �✓1 — i � <br /> AFFIDAVIT: Application is he reby.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.zepliyrhills.Fl.us/public_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 O By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statem nt. (please initial) <br /> Applicant Print Name Applicant Si attire 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 />