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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 applkable cosies. I understand these codes shall take precedence over all <br /> approved construction documents,and issuance of this permit Is verlficatlon that I will notify the property owner of Florida Uen Law <br /> req.,F.S.713. <br /> The Issuance of this permit does not ensure compliance with deed restrictions and I understand that additional need <br /> restrictions may apply to this property. <br /> All work shall comply with the currant Florida Building Code,Public Works Design Manual and FDOT Design <br /> Standards(ff 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 WIf MESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC, <br /> NOTE: The City of Zephyrhilis Is not responsible for maintenance or repairs of driveways. Driveways shall not alter) <br /> Interfere with existing stormuntlw treatment and I or conveyance. <br /> PROPERTY OWNERS: i3y signing this application: I certify that I have read and understand the owner/builder disdosure <br /> statement._ x ,11��(please initial) <br /> Applicant Print Name Appiicant Signature Date <br /> Permit Technician Signature (or)Notary Signature Data <br /> Appiicant is( )personally known to me or produusat! of( as Identification. <br /> Identification) <br /> Page 2 of 3 <br />