Laserfiche WebLink
PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN TNIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> �'j �� � �i��,lv�.� � n.l � <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 applicabie codes. I understand these codes shall take precedence over all <br /> approved construction documents, and issuance of this permit is verification that I 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 additiona� deed <br /> restrictions may apply to this property. <br /> All work shali comply with the current Florida Buiiding Code, Public Works Design Manual and FDOT Design <br /> Standards (if applicable) (Public Works Design Manual online link: www.ci.zephyfiills.fl.us/public_works.asp) <br /> APPLICAIION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICL4N OR NOTARY PUBLIC. <br /> NOTE: The City of 2ephyrhills is not responsible for mainbenance or repairs of driveways. Driveways shall not alter / <br /> ir�te�fere with existing sbormwaber treatment and / or aonveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initiai) <br /> I�v� � 2 2w� � ����� � <br /> App�icant Print Name Applicant Signature Date <br /> Permit Technician Signature (or) Notary Signature Date <br /> Applicant is () personalty known to me or produced as identification. <br /> (rype of identification) <br /> Page 2 of 3 <br />