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PERMIT A�PPLICA�TION <br /> UTILITTES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> S C' � � I�a ��c� I��I rf 5 <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 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 dces 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 <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter / <br /> intertere with existing stormwater treatment and / or conveyance. <br /> PROPERTY O ERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. please initial) <br /> �f, � ¢� /� �.�.�.� ��f f�'���' � °'��_1� <br /> Applicant Print Nam Applica gnature 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 />