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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA,IF ADDITIONAL_SPACE IS REQUIRED,_ATTACK TO THIS <br /> APPLICATIOTi. ;:: : 2 <br /> _ "/ 0 hf %: %Y <br /> ' .. � r ' . <br /> � 01 o M o <br /> oi , <br /> T rN7 ��. <br /> / . <br /> ,r �� u4asS. <br /> i AFFIDAVIT: Applicatipn is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing <br /> Information is acd6rate„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 Florda Llen Law <br /> req.,F.S.713. <br /> The Issuance of this'permit does not ensure.compliance with deed.restrictlons'and I.understand that additlonal deed - <br /> restrictions may apply tb this property <br /> All wokkAhall comply vgith the cunent Florida.Building,Code,Public Works Design Manual and FDOT Design <br /> Standards(if applicable). (Public.Works Design Manual online link:www.cl.iephyrhflls•fl.us/public_works.asp) <br /> APPLICATION IS.VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND wrmESSED BY.A PERMTf <br /> TECHNICIAN OR'NOTARY PUBLIC. <br /> NOTE: The City of.Zephyrhilis Is not responsible for maintenance or repairs of driveways.-®thieways shall not biter/ <br /> interfere with existing stormwater treatment and/or conveyance: <br /> PROPERTY OWNERS: By sign,ng tills application: I certify that I have read and understand the ownerybullder disdosure <br /> statement. (please initial) <br /> Applicant Print.Name Applicant Signature Date <br /> Permit Technician Signature (or)Notary Signature Date <br /> -Applicant is( .)personalty.known to me or produced . as identification. <br /> (type of Identification)' <br /> Pagel of 3 <br /> i <br />