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tPERMX T:APP.L'ICATION <br /> UTILMES'_LOCATE'CONF.IRMATION "NUMBER: <br /> :P. ROVIDE'.SKETCH IN 'THIS AREA, IF ADDITIONAL 'SPACE IS 'REQUIRED, ATTACH TO'THIS <br /> APPLICATION. <br /> /- <br /> SotIV An* .CR.05s 96 / <br /> Cc-e S4&. Car w,/ <br /> &(AWS/l.N/ iltlf reg /#4. (86: <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that,ail 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 verification that' 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 apply 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 Zink: www.ci.zephyrhllis.fi.us/public_worics.asp) <br /> APPLICATION IS V.OID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhiils is not responsible for maintenance or repairs of driveways. Driveways shall not alter / <br /> interfere with existing stormwater treatment and / or conveyance. <br /> PROPER W F ERS: By signing this application: I certify that I have read and understand the owner /builder disclosure <br /> statement • • (please initial) <br /> Cu Ej /Le r //- 3D -D9 <br /> Applicant P 'nt Name App nt Signature Date <br /> Cu- 11(1/1_540/ f / / -JO - a1� <br /> Permit Technician Signature (or) Notary Signature Date <br /> Applicant is ( ) personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />