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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 />D r;vel.cJA.-Y c.. "\ C. s: Jt wew\\<.. <br />~d. ~)(")(IOWWM <br /> <br />riff I / I-l b" -rt.:"k <br /> <br />€ I l"'" <...llt'lL..;vk w:R sOcJD ref (oroo.""e-le <br />;)I.ael.JlA,,.... 1 <br />J'ill Tk: '- k <br /> <br />." <br /> <br />(low <br /> <br />i~ <br /> <br />~ 1/ +k: "k <br /> <br />c.v: .(.1.. <br /> <br />701)0 y~:r <br /> <br />(.of\ Gre~ <br /> <br />5' P\c...lr Are. c.. h/"" r,'dt.w,llt <br /> <br />~/~ <br />C, " ,k: c k. <br /> <br />0. c..t' & ~ s D ,.,'~ 4f f <br /> <br />.. <br />... <br /> <br /> <br />\ I'" c...w-" I <br />f", fl4"',s I 01'1 . <br />A \ \ 1"hrt( Loc."',l.;~., <br /> <br />Pro ftr3.y L;(lt <br />S' S:de.lJ6.\x.,---- <br /> <br />1~ <br /> <br /> <br />/"I\..e. A..; c.. <br /> <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 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 Florida 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 FOOT Design <br />Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.f).us/public_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 driveways. Driveways shall not alter / <br />interfere with existing stormwater treatment and / or conveyance, <br /> <br />PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> <br />U~~:~J a, :I~'ease inical) Q {{ /9/07 <br /> <br />Applicant Print Nam~ Date f I <br /> <br />~ciJt //-P-tf7 <br /> <br />Per Technician Sign (or) Notary Signature. Date <br /> <br />Applicant is~rSOnallY known to me or produced as identification, <br />(type of identification) <br /> <br />Page 2 of 3 <br />