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<br />,PERMIT.APPLJ:CATiON <br /> <br />UTILTlIES_LOCATECONFIRMATIONNUMBER: <br /> <br />~PROV~DE:SKETCH ;IN 'THIS 'AREA, :IF ,ADDITIONAL SPACE :IS REQUIRED, ATTACH TO -THIS <br />APPL'ICAT~ON. <br /> <br />~ <br /> <br />-E-- J (J I --'7 <br /> <br />,If... <br />I <br /> <br />~ <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. 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 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 />APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIACATION AND WITNESSED BY A PERMIT <br />TECHNIQAN OR NOTARY PUBLIC. <br /> <br />PROPPT OWNERS: <br />sta~~nt., <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 treatment and / or conveyance. <br /> <br />By signing this application: I certify that I have read and understand the owner/builder disclosure <br />lease' tial) <br />" <br /> <br /> <br />Applicant Signature <br /> <br />1(~{,~00 <br />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 /> <br />Page 2 of 3 <br />