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PERMI7 APP'�ICATIOIV <br /> UTILITIES LOCATE CONFIRMATIOk NUMBER: <br /> PROVIDE SKETCFi IN THIS AREA, IF ADDITIONAL SRACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> i ���jr � ,��, �' <br /> �''t �` , <br /> � / <br /> � ----� <br /> i'��a,�c,� �.____ <br /> � .5��' i�l� cr <br /> � � <br /> � / � �<r�� � <br /> � <br /> r-i vG` t-.4 ,_-- <br /> �. <br /> �C �JC? /1F.�"c� f I <br /> / f �------------------ _ <br /> �� <br /> -� <br /> � <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 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 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 Manuat 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 mair�tenance or repairs of driveways. Driveway�shall not alter/ <br /> intertere with existing stormwater treatme�and/or oonveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. L^ .le (please initial) � <br /> -�.,!'� �u oi� �,� ,,� ���/� <br /> Applicant Print Name Applicant ' nature Date <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applicant is( ) personally known to me or produced as identification. <br /> (rype of identification) <br /> R�g� � o� 3 <br />