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<br />PERMIT APPLICATION <br /> <br />UTILITIES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />Se~ <br /> <br />A-4~ LleJ <br /> <br />AFFIDAVIT: Application is hereby made to obtain a permitto 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 thatI 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 mayappiy to this property. <br /> <br />All work shall comply with the current Florida Building Code, PublicWorks, Design Manual and FDOT 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 stormwater 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 />(PleaS.ln~:a~ ~ ~ ~ ! wiD {, <br />19s j \ l-( A Icant Signature Date <br />L 9 - .:J. lr IJ~ <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 />