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PERINIT pPPLICd1TION <br /> UTIL,ITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN TNIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> ��.��� � � � <br /> � \ \ <br /> � ��\ <br /> f-�.i � <br /> � � �� J <br /> \� � <br /> �.1 F� I� � <br /> 5TA• !+� 0 � <br /> � l� � �v J <br /> r � � <br /> �, 's � c - <br /> � � � � . <br /> � <br /> v <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 aaurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all <br /> approved construdion 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.ci.zephyrhills.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDEMIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for mainbenance or repairs of driveways. Driveways shall not alter/ <br /> ir�terfere with existing sbormwater 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 /> o ���� �,� � T � �-�=_- �-;�- � 3 <br /> Applicant Print Name Applicant Signature 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 />