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. , <br /> . , <br /> • ;PERMITAF1FLICATION <br /> • 'UTIISIC/ESTOCATE CONFIRMATION - NUMBER: <br /> MROVIDEISKETCH 21■1 THIS :AREA, IF ADDrao NAL 'SPACE IS 'REQ UIRED, :ATTACH TOTH'S <br /> APPLICATION. <br /> . . <br /> • <br /> . . <br /> , • <br /> - . • <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. 1 understand these codes shall take precedence over all <br /> approved construction documents, and issuance of this permit is verffication thatl will notify the property owner of Florida Lien Law <br /> • req., F.S. 713. <br /> The issuance of this permit does not ensure compliance with .deed restrictions and I understand that additional deed <br /> restrictions may applyto this property. <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.dz.ephyrhills.fl.us/public works.asp) , <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICKTION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR 'NOTARY PUBLIC. <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 /> PROPERTY OWNERS: By signing this application: I certify that I have r and understand the owner/bulider disclosure <br /> statement (please initial) • <br /> a.c-rc.-11 Li IseJ (.9 —■ - 7 1 <br /> I pp • nt 'AI t Name • Applicant Signature Data • <br /> i 04 <br /> ; <br /> it Technici iir-ignature - <br /> (or) Notary Signature 10 — • Date <br /> Applicant is ( ) personally known to me or produced as icientlfication. • <br /> • • (type of identification) <br /> Page 2 of 3 . <br /> . . <br />