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<br />:PERMIT ,APPLICATION <br /> <br />UTILITIES .LOCATECONFJRMATlONNUMBER: <br /> <br />PROVIDE~SKETCH:IN THIS AREA, :IF ,ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />CI'\J .c- <br />o (/\ <br /> - . <br />c -\ p....- <br />o r. ,. <br />-0" e <br />V""" ~ <br />rl j(' <br /> [ fl) <br />h' -\""" - <br />.) r ~ <br />'" <br />.. <br /><'\) ~ <br />~ lQ <br /> <br />o ~ iT1 <br />+-.. .,., <br />cr-'"t) <br />VI Q ,.. <br />.. ..... ;> <br />0- T '!'. <br />ca Cl <br />to ~ ~ <br />~~':' <br />F '" ;. <br />~ <br />...... <br /> <br /> <br />~ <br />(b <br />~ <br />~ . <br />('" <br />~ <br /> <br />I- <br />f ~ ~ <br /> <br />- ~ +- <br />....,~ <br />~V\ <br />- -", <br /> <br />I <br />14t.( - <br /> <br />f. \;' C7 <br />:.!-- 0 '") <br />5" II' <' <br />\to 10 <br />...,)' E- <br />o V' ~ <br />Cl "< <br />Q {l- <br />~? ~ <br />1"') ~ :> <br />(, """ <br />("I,. <br />F" Cl~ V\ <br />;> :> <br />~ p. ~ 6'_ ~ <br />~ ~ ~ -4- ~ <br />3;: [~ <br />c ,. <br /> <br />< _'-13'_ <br /> <br />~. J : <br /> <br />..c ~ <br />..... ;: <br />p _ 10 <br />) <br />~ <br /> <br />I <br /> <br />.J;) <br /> <br />\::1 <br />Cl ,. <br />,;) ~ <br />to> P c..S' <br />~ -- ,... <br />~J <br />1- <br />~ ;c1 <br />p.. <br /> <br />.~ <br />-SJ <br /> <br />...., <br />,;..: <br />... <br /> <br /> <br />- <br /> <br />- <br />- <br /> <br />J'ilf' <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 aCaJrate and that all work will comply with all applicable CDdes. I understand these codes shall take prececlence over all <br />approved construction documents, and Issuance of this permit Is ver1flc:at:ion 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 restrlcl:Ions and I understand that additional deed <br />restrlcl:lons may apply to this property. <br /> <br />All work shall comply with the CUlT8nt FlDrida Building Code, Public WDrks DesIgn Manual and FOOT DesIgn <br />standards (If applicable). (Public Works DesIgn Manual online link: www.d.zephyrhllls.f1.us!publlc_works.asp) <br /> <br />APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION 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 drivewltys. Driveways shall not alter I <br />interfere with existing stDrmwater treatment and I or conveyance. <br />PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br />statement. (please Initial) a ' . <br /> <br />~r<~'\~ (//!_~ rlhlOt <br /> <br />Permit Technician Signature <br /> <br />(or) Notary Signature <br /> <br />Date <br /> <br />as identification. <br /> <br />Applicant is ( ) personally known to me or produced <br /> <br />(type of Identification) <br /> <br />Page 2 of 3 <br />