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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 /> ti <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'ali' <br /> approved construction documents, and issuance of this permit is verification that I will notify the property owner of Florida:Lieri 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'Desig'n <br /> Standards(if applicable). (Public Works Design Manual online link: www.d.zephyrhills.fl.us/public works.asp) <br /> APPLICATION.IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY X 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._ `_�Pi(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 />