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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> N�sT�.: �R�aEw�*y 13��. �c 10'w <br /> 3' Fu�►a.s �� s�o�, <br /> -,- '1' �r� �aeZµ <br /> R� ��� � <br /> {�ct� (c" �N�Z.1�C <br /> �apPe. �..iH� <br /> � — � � � <br /> � <br /> NoRTN ,o <br /> 13' <br /> ��yN.S/Z>t/ /YI�iZ �L sioawaca <br /> --! Tu STC�. , ��, <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. I understand these codes shall take precedence over atl <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 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 appllCable). (Public Works Design Manuai online link: www.ci.zephyrhills.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED W1TH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for mair�benance or repairs of driveways. Driveways shall not alber / <br /> ir�terfere with existiny stonnwaber treatment and / or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify t I have read and understand the owner/buiider disclosure <br /> st�i ent. (please initial) _ <br /> / � <br /> �. � <br /> Applicant Print Name Ap�lisaiitSi e.__.�._=_�,,,_,� 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 />