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<br />iP.ERMrT:APPl:ICAT.ION <br /> <br />~UT.IlI[IES~l.'OCATE 'CONF.IRMATION'NUMBER: <br /> <br />,PROV.IDESKETCH lIN 'THIS/AREA,:IF ,ADDIT.IONAL 'SPACE:IS:REQUIRED,ATrACH TOTHIS <br />;AP.POCA'1:ION. <br /> <br />~~~ <br /> <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 codes. 1 understand these codes shall take prececlence over all <br />approved construction documents, and issuance of this permit is verification thatI Will notify the property owner of Rorida Uen Law <br />~q~~7D. . <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 CXJmp~y with the current Florida Building Code, Public Works Design . Manual and 'FOOT Design <br />Standards (If applicable). (public WorksDesjgn Manual online link: www.d.zephyrhIlIs.f1.us/publicworks.asp) <br /> <br />APPLlcA1l0N IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNlOAN OR NOTARY PUBLlC. <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 stDrmwat:er treatment and I or conveyance. <br /> <br />PROPERTY OWNERS: By signing this application: I certify at I have read and nd the owner/buIlder disdosure <br />statement. . C ,~, (please initial) <br /> <br />~~;./rf '. Iv/-r' . ;/t:<Jf' ~~.-7 <br />Applicant Print Name . ~ .' / . .-f <br />. '.... <br /> <br />.~ <br />Permit Technidan Signature <br /> <br />(or) Notary Signature <br /> <br />t r? '-tIc::. 7 <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 />