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<br />PERMIT APPLICATION <br /> <br />UTILmES LOCATE CONFIRMATION NUMBER: <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION, <br /> <br /> <br />o:ft(J-ckcI <br /> <br />AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing <br />information is accurate and that all work will comply with all applicable codes. I uilderstan(lthese 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 Ronda 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 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.fJ.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 stonnwater treabnent and lor conveyance. <br /> <br />By signing this application: I certify that I have read and understand the owner/builder disclosure <br />(please initial) <br /> <br /> <br /> <br />Date <br /> <br />f ~rJ7 <br /> <br />~I(}O~.L <br />Permit Technician Signature <br /> <br />(or) Notary Signature <br /> <br />Date <br /> <br />1/ 2:2-/ cq <br /> <br />Applicant is ( ) personally known to me or produced <br /> <br />(type of identification) <br /> <br />as identification. <br /> <br />Page 2 of 3 <br />