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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 /> L -7b .ln <br /> fj <br /> Lis <br /> ` ) <br /> 1 TZ17-t <br /> , <br /> 134h j4vc�u�- <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 Uen taw <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/public_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/builder disclosure <br /> statement.&L it Q (please Initial) <br /> Applica t Print Name Ap licant Signature 156fe <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 />