Laserfiche WebLink
PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <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 Fbrida 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 wo�ic shall compiy with the curnent Florida Building Cade, Pubiic Works Design Manual and FDOT Design <br /> Standards(if applicable). (Public Works Design Manuai 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 2ephyrhilis is not responsible for mainbenance or repairs of driveways. Driveways shall not alter/ <br /> inberfere with existing stormwater treatment and/or oonveyance. <br /> PROPERlY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> /�e,�t.CY()74'.. E�I�CL A �Q� �C yrt'��L1�LLL? �� 1 '�`t � �7—�°2' <br /> Applicant Print Nam Applicant Sign�ture Date <br /> �. ���,�- ��1�� G���%t..S�u/ oZ --7—/a-- <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applicant is( ) personally known to me or produced ��— as identification. <br /> (type of identification):�'o�r��.`;;=� .. ? -; , ,i,��DA <br /> Page 2 of 3 .:���, ---�'' .,.1r.�:,�!,`,)8926]64 <br /> ;� s, � ,,�i 16,2C13 <br /> Bo��r::�:.:r. - ..�r���-�*�cco„itic <br />