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<br />,PERMrr,",PPL:ICAT.iON <br /> <br />'UT.IL:ITIES:tOCATEcCDNF.IRMATION-NUMBER; <br /> <br />~PROY.IDE:SKETCH ;IN 'THIS ~ARE'A,:IF ,-ADDrtIONAL -SPACE:IS 'REQUIRED, ATTACH TO "THIS <br />'APPl:ICATION. <br /> <br />~ ~'flGU\ <br />rf6b ;j) J.J.A- j L ~'1 R. J. <br /> <br />'g;~ G0a. k <br /> <br />~ <br /> <br />AFFIDAVIT: Application is hereby made to obtain a pennlt to do work and installations as indicated. 1 certify that, all foregoing <br />information is accurate and that all work will comply with all applicable codes. 1 understand these codes shall take precedence over all <br />approved construction dOOJments,and Issuance of this pennlt is verification than Will notify the property owner of Florida Wen Law <br />req., F.S. 713. . ' <br /> <br />The issuance of this permit does not ensure compliance with deeclrestrictions and I understand that additional deed, <br />restrictions may apply to this p~perty. ' <br /> <br />All work shall comply with the current Florida Building Code" Public Works Design" Manual and 'FOOT Design <br />Standards{ifapplic:able). (PUblic Works Design Manual online link: www.d.zephyrhllls.f1.us/public_works.asp) , <br /> <br />APPl1CATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BYA PERMIT <br />TECHNICIAN OR NOTARY PUBl1C. <br /> <br /> <br />$/ G <br />Applicant Print Name <br /> <br />NOTE: The City of Zephyrhllls is not responsible for maintenance or repairs of driveways. Driveways shall not alter I <br />interfere with existing stDnnwater treatment and I or conveyance. <br /> <br />: 8"1 signing this 'ap, plication: I ce at I have rf' ' understan, d the owner/builder diSd, osure <br />(please initial) " / " ' nJ1. <br /> <br />Iv. r;-&~- iA/JfI? Iv. yO{) -~ " <br />Date - <br />~J~/()Y <br /> <br />Pennlt Technidan Signature ,.(or) No natu ~ Date <br /> <br />Applicant is ( ) personally known to me or prod~ced cf:( y. -e f's Z/") as identifi""'! '~~~ SUSAN L. BENNbTf <br />type of Identlfica1Jc)i,) ~~ MY COMMISSION # DDJ45265 <br />~A EXJ>lRES: August 11.2008 <br />1~~A1lY , fl, Notary UI_I ~ Co. <br /> <br /> <br />Page 2 of 3 <br />