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<br />PERMIT APPLICATION <br /> <br />P!::EH.f.: <br />ii '--, io.~ -.. <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 />c:zfY' <br /> <br />AFADAVIT: 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 FDOT Design <br />Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.f1.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 I <br />interfere with existing stonnwater treatment and I or conveyance. <br /> <br />PROPERTY OWNERS: By signing this application: rtify that I have read and understand the owner/builder disclosure <br />Qe,m, ent. (please initial) "\ <br /> <br />Q(bk ~~ OL'I~lu~ <br /> <br />Icant Print Name Date <br /> <br />~~...........~ <br />Permit Technician Signature <br /> <br />(or) Notary Signature <br /> <br />2-( R-/O~ <br />Date <br /> <br />Applicant is ( ) personally known to me or produced <br /> <br />as identification. <br /> <br />(type of identification) <br /> <br />Page 2 of 3 <br />