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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE.SKETCH IN THIS AREA,IF ADDITIONAL SPACE tS REQUIRED, ATTACH.TO THIS <br /> APPLICATION, <br /> pq <br /> 3�x kwGvc.�tl� 4D , <br /> i <br /> } <br /> i <br /> AFFIDAVIT: Application is hereby made to obtain a permit to.do work and.Installations as indicat.ed. -I certify thatall foregoing <br /> Information Is accUrate and that all work will comply:with"all applicable codes. I understand these codes shalt take preoedenod over all" <br /> approved constriction documents,;and Issuance of this permit Is verification that I will notify the property owner of Florida Uen'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 /> restricfions may apply to this property. <br /> All work shall comply with the current Florida Building Code,Public Works Design Manual and FQOT Design <br /> Standards(if applicable). (Public Works Design Manual online link www.cl,zephyrhllls.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 aephyrhills Ts not.hesponsible for'mairrbenance or re <br /> paits of driveways. Driveways shall not alter I <br /> Interfere with existing stormwater treatrnent and I or conveyance. <br /> PROPERTY OWNERS: By signing this application: I oerlify that I have read and understand the owner/builder disclosure <br /> statemerit (please Initial) r <br /> Applicant Print Name Applicant Sign at re 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 />