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4p: <br /> t <br /> PERMIT APPLICATION <br /> Y <br /> 1� <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> -76 <br /> !l pia I c 1/ <br /> — .vI l <br /> I <br /> 3 <br /> q , <br /> 4 io;g'La <br /> IN <br /> � t <br /> Ave �J <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.fi.us/pubiic_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 Zephyrhills 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/buiider disclosure <br /> statement.A✓P (pleaseital <br /> et Yi e- f1in <br /> tY <br /> LtJL Al /a,2- <br /> 1 _ <br /> Applichfit Print Name Applant Signature Dfite <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 />