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<br />t. .. <br /> <br />PERMIT APPUCATION <br /> <br />UTILITIES LOCATE CONFIRMAnON NUMBER: <br />PROVIDE SKETCH IN THIS AREA, IF ADDmONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />.,' . <br /> ,n,",1 <br /> - ~ <br />I - <br /> .' <br /> c:: -d \. <br />tr ...J Cr:' ~ <br />"" ') (' <br />tJ' l>> ~ \I <:I" <br /> ~ '-J <br /> ...g .> .-t fj <br />t- ~ - <br />~ -\. 1"" ~ - <br />- - I:; - <br /> <d u r- <br /> A Q -.-1 <br /> f" \J <br /> VI I <br /> WI -d ....g VI '3 <br /> tr" "" ~ Q/ <br /> ~ l. 4- ~ :> <br /> Q a <br /> ...J ... <br /> G\- - <br /> _. _w._.. ..... ~_._... ~ <br /> Ar' ~l <J <br /> --0 <br /> QJ <br /> I ~ <br /> <br /> <br />~ 1 <:?J51!" <br />v .- \S )< '3 . <br />:;;. ~ -.J 3 <br />.jl-~x <br />3 _ .~..., <br />Q/ - ... <br />-cI ~ -.I <br />.- ~- \ '" <br />VI ::>.. co ... <br />;t v .'<: Yl <br />-r/ 3' 'IS ~ .../ <br />.~I-I.. Pi._- <br />-i.. v> ~--::; <br />...~ " " <br />>-~ l) .~..f 3 <br />d ",0 o,n--'f/ <br />J ('~ 0" <br />.. f"\ ~ ..n '" <br />01 .... 'l:l.. <br />.~ -:.{ '>.. \ '+ <br /><.. '" .' \u 0 ~ <br />....::::J-...l) <br /> <br />~ :?( <br />j ..! ~ <br />-l" < <br />... .. J ,. <br />V'I)'-I <br />..::I ,,~.... <br />-:;~V1 <br />'3:10- <br />.:; ...\- ~ <br />v.:: ~ <br />:r(VJ <br /> <br />AFFIDAVIT: Application Is hereby made t:c obtain a pennlt t:c do werle and lnstallatlons as IndIcated. I certify that all foregoIng <br />infonnatlon Is accurate and that all werle will comply wIttl all applicable cedes. I understand these codes shall take precedence over all <br />approved construction documents, and Issuance of this pennlt Is verification that I will notltt the property owner of Flortda Wen Law <br />req., F.S. 713. . <br /> <br />The Issuance of this permit does not ensure compliance with deed restrlc:tlons and I understand that additional deed <br />restrtc:tlons may apply to thIs property. <br /> <br />All work shall camply wtth tb. c:IIl'Nnt floria Building Cad., Public Works D8sign M8nual and PDOT Destgn <br />Sblnd8" (I' appilcabl.). (Public WorIcsDeslgn Manual online IInk:.www.d.zl!l:lhymllls.tJ.US/publl-=-wcrlcs.asp) <br /> <br />APPUCATION IS VOIe UNLESS SIGNED wrn; PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br />TECHNICIAN OR NOTARY PUBUC. <br /> <br />NOTE: TIM ctv at Zephyrhills is nat rwpansIbl. far maint8na11Cll or repllirs of drIwwIIys. DrfWWIIYS sh... not alblr I <br />Intllrfere with exiltlng stDmr...6b.r u.trn.nt and 1 orcolMlyllnCII. <br /> <br />PROPERTY OWNERS: By signing thisappllcatfon: I certlfy that I have read and understand the owner/builder disclosure <br />statement. (please Initial) ~ J ! / <br /> <br />J-I..ro\J O~;I~~ ;; ~ ~ 2- 0:7- <br />Applicant Print Na~ Ap llcant Slgnatu Date . . . <br /> <br />Permit Technidan SIgnature <br /> <br />(or) Notary SIgnature <br /> <br />Date <br /> <br />Applicant is ( ) perscnally Known to me or produced <br /> <br />as Ident:ltlcatlon. <br /> <br />(type d Identl1'lt:atlon) <br />P8g.. 2' at 3' <br />