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<br />- P'ERMIT APPLICATION <br /> <br />UTILmES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />s~~ <br /> <br />A+t~ LleJ <br /> <br />AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. r certify that all foregoing <br />information is accurate and that all work will comply with all applicable codes. r understand these codes shall take precedence over all <br />approved construction documents, and issuance of this permit is verification that'! will notify the property owner of Florida Uen Law <br />req,., F.S. 713. <br /> <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 /> <br />All work shall comply with the current Florida Building Code, Public Works Designc Manual and FOOT Design <br />Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.f1.us/public;..works.asp) <br /> <br />APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICIAN OR NOTARY PUBUC. <br /> <br /> <br />NOTE: The City of Zephyrhills. is not responsible for maintenance or repairs of driveways. Driveways shall not alter / <br />interfere with existing stannwater treatment and I or conveyance. <br /> <br />By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> <br /> <br />(p~.;n~:a~ ~ ~ cr/W(P" <br />lOs ,. \ t..f.. A Icant Signature Date <br />L 9 - ...2 tr ot(7 <br />(or) Notary Signature Date <br /> <br />Applicant is ( ) personally known to me or produced <br /> <br />as identification. <br /> <br />(type of identification) <br />Page- 2. of 3; <br />