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PER.MI4 APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH �N TF�I� AREA, IF ADDYTIOf�AL SPACE IS REQUIRED, ATTACF� TO TIiIS <br /> APPLICATION. <br /> �tBO� QNM�S�orJ Sou�T ei G'�p�-U �p��?. <br /> , � U <br /> �'� s�°^� <br /> `�XP�o��-r c J� <br /> ---- — <br /> � �� <br /> ,. ,� <br /> � - �,�E <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregang <br /> information is aaurate and that all work will comply with ail applicable codes. I understand these codes shall take precedence over all <br /> approved rnnstruction documents,and issuance of this permit is verification that I wili notify the property owner of Fbrida Lien Law <br /> req., F.S. 713. <br /> The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed <br /> restr�ictions 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 /> APPLICATIOIV IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICL4N OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhilla i�not responsible for maintenanoe or repairs of driveways. Drivewaya shall not�slter/ <br /> i���w�h ex�sti�y sburmwaber treadne�and/or aonveyance. <br /> PROPERTY OWN�i RS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> stdtement.--`C�..- —(please initial) <br /> Vu �-- � f <br /> , �� 4��,��,5��C` C u�C-' ' (�j 5 ... � <br /> Applicant�nt Name Applicant Signature Date r��� <br /> \ <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 />