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t P ERMIT: APP.LI CATI O N <br /> UTILITIES '•LOCAT.E' -CONFIRMATION <br /> e <br /> ;PROVIDE'SKETCH IN •THIS AREA, IF rADDTrIONAL'SPACE IS RF ATTACH TO THIS <br /> APPLICATION. �� t <br /> C . <br /> 0 ‘/L07 P <br /> a ti <br /> 3'1.5`3 <br /> 0 i r rd/ <br /> 64' -/t-z)c <br /> ( 6. <br /> dfir,„„; <br /> 53 <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 verification thatI 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 to 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.d.zephyrhills.tl.us/public_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN ORNOTARY PUBLIC. <br /> NOTE: The City of Zephyrhilis 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 read and understand the owner /builder disclosure <br /> statement - (please initial) <br /> j Ap• signature Date <br /> t (o �-�. Date <br /> • ermit Te- id • n Sig re —. M thry Si -, re <br /> rsonally known to m or produced as identification. <br /> Applicant Is ( Y (type of identification) <br /> Page 2 of 3 <br />