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- ' PERMIT APPLICATION <br /> .n <br /> UTILITIES LOCATE:CONFIRMATION NUMBER: <br /> PROVIDE SKETCH:IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED,,ATTACH TO THIS <br /> APPLICATION. <br /> AFFIDAVIT:.Application is hereby made to obtain a permit to do work and installations as indicated. I certify that alLforegoing <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 constriction 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 properly. <br /> All.work shell 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.iephyrhills.fi.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 Ze h rhills.is not res responsible for maintenance or re airs of driveways. Driveways shall not:alter <br /> • Py, P p ' y . y <br /> interfere,with wdsting stormwatertreatrnent and I or conveyance: . ' <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 the or produced as.identification. <br /> (type of identification) ' <br /> Page 2 of 3 <br />