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<br />iPERMIT,APPlJ:CAT.ION <br /> <br />.~l1tIL:IT.IES:tOCATE:CONF.IRMAnON?NUMBER: <br /> <br />~PROV'.IDE;SKETCH ;IN "THISiAREA,:IF ,ADDIT.IONAL'SPACE:IS :REQUIRED, ATTACH TO ~THIS <br />'AP.Pl:ICAT.ION. <br /> <br />i <br />/, -t' I <br /> <br />c) I <br />'\ j <br />,--- <br />--- <br />,..\J I <br /> <br /> <br /> <br />I <br /> <br />HO()5't <br /> <br />-- <br /> <br /> 'i- '0 <br /> :;, <br /> (- .-- >--- <br /> " L. <::l <br /> '::L"\-s ~ <br /> '- <br /> _<:::3 I '<., <br /> "-..J )> <br />!3'&,1f u..) !.... <br />\s <br /> <br />~ <br /> <br /> <br />--===--- <br />. .~ .'- <br /> <br />~ <br />- -\J <br />'1l <br />. \J~, <br /> <br />, <br /> <br />t <br />I <br /> <br />~ <br />~ <br /> <br />5 ,'d e Lv Q , ,< <br />/Uor+/J ,R u c . <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 />informationis~a:urpteandthatall work will comply with all appllcablecodesd understand these codes shall take prececlenceover all <br />'approved'constnictiondoaJrnents,and issuance.ofthis permit is verificationthaU will notify the property owner of Rorida 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 />All work shall comp~y with the allTent Florida Building Code, Public Works Design. Manual and 'FOOT Design <br />Standards (if applicable). (Public Works Design Manual online link: www.d.zephyrhills.fI.us/public_works.asp) <br /> <br />APPUCA1l0N IS VOID UNLESS SIGNED WITH PROPER IDENTIACATION AND WITNESSED BY A PERMIT <br />TECHNICIAN 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 stormwat:er'1:reatnient and I or conveyance. <br />PROPERTY P\lV~: By signing this application: I certify that I have read and understand the owner/builder disdosure <br />state~nt. I..'eCnC (p-'lnItiaQ ~~ ~ . . .. <br /> <br />1,ncltL l1efl/;erCJi1 . f!~ ~ . f-/~-t:J 7, . <br />Applicant Print Name \~Applicant ignature . 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 />(type of identification) <br />Page 2 of 3 <br /> <br />as identification. <br />