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<br />",-0.. ~ _.~.... --,.. - <br />I; :r,;, ;.;,~_., <br /> <br />PERMIT APPLICATION <br /> <br />PERMIT h?PL~ _ <br /> <br />..:z.~'- <br /> <br />UTILITIES LOCATE CONFIRMATION NUMBER: <br /> <br />.' , <br /> <br />PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br />APPLICATION. <br /> <br />~~. <br />~ <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 Rorida 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.d.zephyrhills.f1.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 />~.~ ~.~ <br />ermit Technician Signature <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 stormwater treabnent and I or conveyance. <br />PROPERlY O\J\l.N6ij.S: By signing this apPlicac' : I-.certify th.. at I have read and understand the ow ner/buil.der disclosure <br />~ment.. V\~ (please initial) j ^ Q ( CO <br />LCtvDl-t ( ~J~ .~~'\~~ $V'<i)15(3 <br /> <br />Applicant Print Name Applicant Signature Date <br /> <br />Z. f <irl 0 '5 <br />Date <br /> <br />(or) Notary Signature <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 />