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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 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.zephyrhills.fl.us/publii:L-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 Zephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alter <br /> interfere with existing stormwater treatment and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement.__,4.,-_.­- (please initial) <br /> Applicant Print Name Applican fInlre Date <br /> 16161 <br /> ry gri6tur <br /> Permit Technician Signature (or)Notary Date <br /> Applicant is personally known to me or produced as identification. MICHAEL JOHNSTON <br /> N N <br /> State of Florida <br /> 2022 <br /> #GG 67 <br /> Notary pub c_ 20 55 <br /> (type of Identification) Notary Public,state of <br /> :n, C cornmisson 3 0,2022 <br /> mmission#GG 206755 <br /> e,A r <br /> Corn xp p ksn. <br /> y I otary <br /> My COMM.Expires Apr 30,2022 <br /> Page 2 of 3 N <br /> t ou <br /> Bonded through National Notary Assn. <br />