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PEftMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> ��...� �rp�2C9c�e ci, �: TL= D�it� <br /> ( � <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 properly. <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.zephyrhills.fl.us/public_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 /> ppli nt Print Nam Applicant Signature Date <br /> � 3-��-�Z <br /> Pe Tech ' n Signature (or)Notary Signature Date <br /> Applicant is( ) personaily known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />