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<br />;PERMn"APPD:CATiON <br /> <br />UT.III[IES,lOCATE 'CONF.IRMATION 'NUMBER: <br /> <br />~PRO:V.IDE:SKETCH;IN 'THIS,~AREA,:IF IADDIT.IONAL 'SPACE:IS :REQUIRED, ATTACH TO "THIS <br />.'APPL'ICAT.ION. <br /> <br />J <br /> <br />.-"""'~~~:~,:.:.::, <br />.----- <br /> <br />i <br />,--II <br />~!,..~ <br />I <br />! <br /> <br />(, <br />II <br /> <br />~/:;;,::- <br /> <br />,/;/ <br />/..;'/ <br />//y <br />.' /..' <br />/ <br /> <br /> <br />tJ ftW <br /> <br />I <br />I <br />! <br /> <br />t: <br /> <br />tJ',J,~~ /1,1 <br />On V'{, uJIX ~ Jl <br />i <br />.1/ <br /> <br />x ;,~ 1 <br />11-'0 <br />cR r-a( <br />~(O~ <br /> <br />- <br />C--i <br /> <br /> <br />410" <br />OIl <br />",,-~-"'1t'.:-> <br />,/ <br /> <br /> <br />J <br /> <br /> <br />(1, ',::2.10-'";> <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 precedence over all <br />approved construction documents,and issuance of this permit is verification that I will notify the property owner of Rorida 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.d.zephyrhills.f1.us/public_works.asp) <br /> <br />APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICIAN OR NOTARY PUBLIC. <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 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. .:::;- ..r....... (please initial) <br /> <br />sad~"6 ~~;y~~ <br />Applicant Print me <br /> <br />~. ::.-----y~ <br />Permit Technidan Signature <br /> <br />~cz-dd~ Gu"t ta vTe <br />Applicant Sig ature <br /> <br />q-~-D7' <br />Date <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 />