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<br />,PERMIT. APPLlCATION <br /> <br />UTILTrIES.LOCATECONfIRMATIONNUMBER: <br /> <br />;PROV~DESKETCH:IN .THIS'AREA,:IF .ADDITIONALSPACE :IS REQUIRED, ATTACH TO'THIS <br />APPL'ICAT.ION. <br /> <br />~~ <br /> <br /> <br />~v <br />~l){iri <br />9-f'6 Ll'" <br />--;~~ }J___-_.<- f€~ <br /> <br />fl'l' 5') <. . <br /> <br />IJ fP/?afJ <br /> <br />I g Y tfJ <br /> <br />~c, <br /> <br />&JI <br />r~}e:. <;1 at! <br />~(lJc~ <br /> <br />/ <br /> <br />~~.(.\ ~'.r-f;rd' ~ 0s v- <br /><L~ ~1. (/I" dcr' <br />_ _ ~-_ -=- -=- --= [SIt7LEU71UC <br /> <br />.s{f)~~ <br /> <br />10'7" <br /> <br />/l /tp/{.$~ I}/<.. /k-;/f1A ,UJ (i t4 c.c <br /> <br />AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. 1 certify that all foregoing <br />information is accurate and that all work will comply with all applicable cocIes. I understand these cocIes 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 Lien 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 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 IDENTIACATION AND WITNESSED BY A PERMIT <br />TECHNIaAN OR NOTARY PUBUC. <br /> <br />NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter I <br />interfere with existing stormwater b'eabnent and I or conveyance. <br /> <br />PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br />statement. ~~ ~ (please initial)._ A . <br /> <br />,.pack <1. V<JJli5 ddO~ %; :fa/,&l <br /> <br />Applicant Print Name Applicant Signature Date ' <br /> <br />Permit Technidan Signature <br /> <br />(or) Notary Signature <br /> <br />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 />