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i <br /> . • ;PERMIT APPi ICATION <br /> • <br /> 'UIILTQESIXICATE :CONFIRMA "NUMBER: <br /> cP ROOD ESICErC H ZIWTHIS AREA, IF TADDITID NAL 'SPACE ZS 'REQUIRED,:ATTACH TOITHIS <br /> APP.LZCATLON. .14 <br /> t f r /_ <br /> • • Fx rn"1 AP ) SotNT <br /> • • p v.e.Iiiio • 0 . (3o .Ctpar . <br /> • <br /> • S i4i� id L le - m�X Gloss sue, a/ • <br /> • <br /> :!otoc' <br /> „ <br /> ge m f .... C4- . . <br /> • <br /> • <br /> � i �dr 4 ` '' t . P• /CUT *VD N!%u Toin rc <br /> A y � it IPi d • .. . - • <br /> ,P <br /> AFFIDAVIT: Application is hereby made to obthin 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 documen sand issuance of this permit is veriftcation thatT will notify the property owner of Rorida Lien Law . <br /> req., F.S. 713. • <br /> • . T issuance of permit does not ensure compliance•wlth deed .restrictions and I understand that.addttional deed. <br /> - • restrictions may applyto this property. . <br /> All workshall comply with the current Florida Building Code, Public Works Desiign.Manual and'PDOT Design <br /> • Standards-Of applicable). (Public Works Design Manual online linic worlcs.asp) . • <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR"NOTARY PUBLIC. - • <br /> NOTE: The city of Zephyrhllis is not responsible for maintenance or repairs of driveways. Driveways shall not alter / <br /> • interfere with existing stonnwater treatment and / or conveyance. <br /> PROPERTY 0 :. By signing this appiicatio • that I have read and understand the owner /builder disclosure <br /> statement " • (please initial) • NW- in . A •GCS -� id/A0//d - <br /> • h-IO�► n v Da <br /> APpl- + 'Print Name plicant Signature . <br /> • i ,` I ' Name <br /> Date <br /> P - , - n Signature O (or) Notary Signature • <br /> known to me or produced C -- as identMcation. <br /> Applicant () personally (type of identification) <br /> Page 2 -of 3 <br />