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<br />PERMIT APPUCATION <br /> <br />UTIUTIES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />s ~..c.e <br /> <br />A -tt ~ ekeJ <br /> <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 all <br />approved construction 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 />, <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 />AU work shall 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.zephyrhills.fI.us/public_works.asp) <br /> <br />APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICIAN OR NOTARY PUBUC. <br /> <br /> <br />NOTE: The City of Zephyrhillsis not responsible for maintenance or repairs of driveways. Driveways shall not alter / <br />interfere with existing stormwater treatment and / or conveyance. <br /> <br />By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> <br />IPleasein~:aht ~ ([#& y /W(P ~ <br />bs (' \ ~ A Icant Signature Date <br />L 9 - ..2. 0 - O!p <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 />