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PERMIT APPLICATION �u V✓� 0�r� I.� n�i <br /> , � � <br /> � <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> yo ,_ / .� <br /> i r <br /> y 5 YS <br /> 3� <br /> � <br /> , <br /> f�fST�'� E7Ci$li'u� <br /> Il 1e " <br /> � r S�rNV �j ��� / <br /> � ��`�� <br /> �' i2� <br /> � <br /> 7� <br /> � <br /> � � <br /> 54 �� ,; <br /> ,� p • <br /> � <br /> k <br /> �� 3 <br /> w <br /> � <br /> �J <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 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 Manuai and FDOT Design <br /> Standards (If appliCable). (Public Works Design Manual online link: www.ci.zephyrhilis.fl.us/pub�ic_works.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 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 OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> C�PeS�I ec.t�� p�.z.� ����,..o _� <br /> Ap i nt Print Name Appli t Signature Date <br /> � , �o ---- 3 �� -li <br /> P r it Techn an Signature (or) Notary Signature Date <br /> Applicant is () personall y kn�wn to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />