Laserfiche WebLink
• P.ERMITAPPLICAT/ON • <br /> 'UTILITIESIOCATE CONFIRMATION NUMBER: <br /> =PROVIDE SKETCH IN 'THIS AREA, IF iADDr130 NAL 'SPACE IS 'REQUIRED, ATTACH TO "THIS <br /> APPLCA'TION. • <br /> • • <br /> Ne. <br /> POActi <br /> • <br /> • <br /> 19'41161 I <br /> • <br /> r <br /> • <br /> 13 • <br /> it..4 /pia - <br /> i New p41/40-s /f/Z /g(9114 if1-21151 <br /> /0 ; elYbPOS&O <br /> 414 e, p_i p ,til 4.1- <br /> ; frt,A)C, kn./frig - FAVEk 5 GU (T4W e.o.uo,(cloodte 0g (4-1-of avt), <br /> ., Ex u r b., G. <br /> goill St oE5 A, a <br /> • - <br /> Adelpf•i <br /> 5.4 At / e.4.)7 &/ ;09(e-39oltriav - <br /> AFFIDAVIT: Applicaeon 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 thatl will notify the property owner of Florida Lien Law <br /> req., F.S. 713. • <br /> The issuance of this permit does not ensure compli 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 'MOT Design <br /> Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.fi.us/public_worics.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION 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 0 VERS: By signing this . application: I certify that I have read and understand the owner/builder disdosure <br /> statement. 1 - ) - (please initial) • leVIZZ-( - 'del la <br /> ,03 21 —2.6) <br /> Applicant Print Name Applicant Signature Date <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 /> — _ _ <br />