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PERMIT APPLICATION <br /> NEW <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH-TO THIS. <br /> APPLICATION. <br /> ze <br /> q- .-.=�)Coe_OA6aZ <br /> RoAa <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated: I certify that all foregoing <br /> information s;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 /> reti,F.S.713. <br /> The Issuance of this permit does not ensure compliance with deed restrictions and-1 understand that additional deed <br /> restrictions may apply to this property: <br /> All work.shiall cd.mply with the current Florida Building Code,Public Wdrks Design Manual sand FDOT Design <br /> Standards(it applicable).. (Public Works Design Manual online link:www.ci.zephyrhills.fl.us/publicLworks.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 drivewaeya. Driveways shall not alter <br /> interfere with existing stormWater treatment and!or wnveyanae. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> Applicant Print Name- Applicant Signature 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 />