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� _ r _ 7 <br /> �_� � <br />�ER.MIT APPLICATION <br /> UTILTTIES LOCATE CONFIRMATION NUMBER: <br />�ROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO T'HIS <br /> 1PPLICATIOIV. <br /> � � ����1 <br />=FIDAVIT: Application is hereby made to obtaln a permit to do work and installations as indicated. I certify that all foregoing <br /> formation is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all <br />�proved construction documents,and issuance of this permit is verification that I will notify the property ow�er of Florida Lien Law <br /> q.,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 /> II work shall comply with the current Fiorida 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 IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br />�OTE: The City of Zephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alber/ <br /> interfere with existing stormwater treatment and/or aonveyance. <br /> tOPERTY O ERS: By signing this app' . I certify that ave read and understand the owner/builder disclosure <br />�tement. � (ple ' � �a <br /> \ <br />�"� '��' � 2 � <br />�plicant Print Name t Signatur Date <br /> 3- 12-1�j <br /> rmit Technician Signature (or)Notary Signature Date <br />�plicant is(�personally known to me or produced �1��L{(_Q,�"ZSQ as identification. <br /> (type of identification) <br /> "" MIDREA YOI�IG <br /> Page 2 of 3 =`i���: <br /> 3k, ,r_ MY COMMISSION A DD 949059 <br /> �� EXPIRES:January 9,2014 <br /> �:'�,pf .•.' Bonded?hN Notaty P�flc Undetwriters <br /> I <br />