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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> AFFIDAVIT: A accurate and that all work will co permit indicated. <br /> all appli able codes. 1 understand hesecodes shall take precedence over all <br /> information is a <br /> approved construction documents, and issuance of this permit is verification that I will notify the properly owner of Florida Lien aw <br /> req., F.S. 713. <br /> The issuance of this permit does not ensure compliance t rl <br /> with e this property. and I understand that additional deed <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 .fl.us /public_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH <br /> OR NOTARY PUBLIC. ON AND WITNESSED BY A PERMIT <br /> TECHNICIAN <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 1 By signing this applicatir, - certify th• I ha : re••. 4 ' understand the owner /builder disclosure <br /> statement. .i (please initial) A .1 /' I <br /> rrvciA0L-el \A-LA, Y4 ' ,LI iSi.—/ F 9 <br /> Applica t Signature Date � <br /> Permit Technician Signature (or) Applicant Print Name �r �Q 491,9v,s. f f or Notary Signature Date <br /> ) <br /> as identification. <br /> Applicant ispersonally known to me or produced (type of identification) ET'i <br /> 4 " P SCARL SEHAR <br /> MY COMMISSION # OD60842 <br /> Page 2 of 3 ez EXPIRES: November 02, 2010 <br /> AO <br /> 1- 810.3- NOTARY <br /> FL Notary Discount Assoc . Co. <br />