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:e <br /> PtRwr APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER- <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE I5 REQUIRED,ATTACH TO THIS <br /> APPLICATION. <br /> rt rr . <br /> Ilk <br /> f <br /> t / <br /> r`X??"40N JOT <br /> e. <br /> flF f'4V�.yt�t7 <br /> t4 IV Ito R16 <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 Uen Law <br /> rpq.,F.S:713. '. . <br /> Tile issuance of this permit does not ensure compliance vuith deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> Ali!vsarlr shall carmply�*itih the current Florida Bt�Il�ding Cede,Public Works Design Manual and FDOT Design <br /> Standards(if aPplitoblejo (public Works Design Manual online link:www.ci.zephyrhills.fi.usjpubtic—works.asp). <br /> APPLICATION IS VOID UNLESS SIGNED W]TH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT, <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE, The City oUephyrhllis is riot responsible for niaintenaincs' or repairs of driveways. Driveways shall,not alder <br /> interfere.with.existing stormwrater treatn'oant and(or conveyance: <br /> PROPERTY OWNERS: By signing this application: I ceitify that I have read and understand the owner/bulider disclosure <br /> statement. (please initial) <br /> .r <br /> Appl cant Print Name ppl cant;Signature pate <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 a. <br />