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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 /> 300Sz- 3W30 <br /> C-A-0Ss / 5 <br /> 0 C oMSS <br /> iPT�IN 4S. iOG G2t <br /> so w�Zt ds��a�� r�vvc� �r racy, <br /> 1���5 c�S r osr l <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 co, 'ply 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.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/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 0 : By signing this application: I certify that I have read.and understand the owner/builder disclosure. <br /> statement., (please initial) <br /> Applicant Print Name AppficaiAt 'gnature 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 />