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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 /> See. A'1-�ac�lr¢c� C�!!'ow'� <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 rndes 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 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.ci.zephyrhiils.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 Zephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> �^��ere With existin9 stormwater treatmerit and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the ownerybuilder disclosure <br /> statement. 5-w' (please initial) <br /> S� �it�i��i A�M.t !N� � �l���� <br /> Appl' Pri t Name Applicant Signature Date <br /> . 6-�'���Z <br /> Per i echni ' 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 />