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• ' .. . . . . PERMIT/APPLICATION ' • • . • - •.UTILTI/ESILOCATECDNFIRMATIONNLIMBER: • cPROVIDEISKETCH IN 'THIS !AREA, IF ADDITIONAL 'SPACE 25 'REQUIRED, :ATTACH TO 71-1/S APP.I2CATION. - • . • • • • ' . . . . . . . . • . - • . • . . . • . . . • . . • . • . • . • • • . . . . - • ' . • . . • . .• . . • . • - • • c • - ktto4A•se- • • • . - - . • . • . 1 1q 3 ° j_ • • • . - • P ro e_e_c?t • - - - ;47: , —b 6-i-k 6 . . . . • .- • . . . .. • . ...—.-- . , . –_---,------- - • . . . . • - • - . ..6•-t 5 ) • • . .• . . . . • - . . . . . . - . - _ . . „ • • • AFFIDAVIT: Application Is hereby made to obtain a permit to do work and installations as indicated. 1 certify that all foregoing • information is accurate and that all work will comply with all applicable codes. 1 understand these codes shall take precedence over all • approved construction documents,'and issuance of this permit is verification thatl Will notify the property owner of Florida Lien Law . . . • req., F.S. 713. . The issuance of permit does not ensure compliance•with .deed restrictions and I understand that additional deed. • • • restrictions may applyto this property. • • . , • All work.shall comply with the current Florida Building Code, Public Works Design Manual and - MOT Design • Standards-(If applicable): (Public Works Design Manual online link: www.cLzephyrhltls.fl.us/publlc.works.asp) APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT • TECHNICIAN ORNOTARY PUBLIC. • - • • NOTE: The City of Zephyritills is not responsible for maintenance or repairs of driveways. Driveways shall not alter / • interfere with existing stormwatertre-atment and / or conveyance. • PROPERTY OWNERS: By signing this 'application: I certify that I have read and understand the owner/builder disclosure statement. • (please initial) aolle / • - ce • cD Fija hp/ er .0_,,_..,.., • - _ ____A 41,2-te 49 - - • Applicant 'Print Name Applicant Signature ---w Date • . - • Perrntt Technician Signature (or) Notary Signature Data • Applicant is ( ) personally known to me or produced • as identification. - (type of identification) _ - . Page 2 of 3 . - .. . . . _ • . .