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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 /> �Icl SSL3 rem <br /> S S 2— <br /> 1 . <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 overall . <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 ohline'link:www.ci.zephyrhilis.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 11 E By signing this application: I certify that I-have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> Applicant Print Name- Applic nt ignature 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 />