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PERMIT APPLICATYOI� <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THI� AREA, IF ADDITIONAL SPACE IS U R D,Al� CH TO THIS <br /> APPLICATION. <br /> . <br /> � <br /> � � <br /> i ^ <br /> ' �"' I 5�� -�—�' ��.�, C 5�/� <br /> � � <br /> !'Y a � <br /> , �+p�,��; M � u,r���� �,e� <br /> �_ <br /> � , <br /> � ,�,� ' -�" i <br /> � ^ ��1T1�ALL <br /> ��ti1PL`� Bv1LD1N� � <br /> �LL\�Ok�`51�O �S,�LOR1� CODEA�,� �5 <br /> p�VA1��� �Lti��� � , ��S <br /> �� co�E,• �.�x R�11�Lfi-��� �� . ---�...�. <br /> C1T�'��7 <br /> � �� � � <br /> � � _ _ -- <br /> -i�� �/ . �1'E�N �p�,�i��---- ° <br /> ���"�7 � �� ��YRN�ti_� <br /> � � pF ZE �._- <br /> � �C�� P��NS �X�`��N� <br /> AFFIDAVTf: Application is hereby made to ob in aep�rm�t to d�ork and installations as indicated. I certify that all foregoing <br /> information is accurate and that ail work will comply with all applicable codes. I understand these codes shati take p�ence over all <br /> approved construction documents,and issuance of this permit is verification that I will notify the properly 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 /> resfictions may apply to this property. <br /> All work shall comply with the current Florida Buiiding Code, Pubiic Works Design Manual and FDOT Design <br /> Standards(if applicable). (Public Works Design Manual onli�e link: www.ci,zephyrhills.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFIG4TION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of 2ephyrhilis is not responsible for mair�tenance or repairs of driveways. Driveways shall not alber/ <br /> intertere with existing sbormwater treatment and/or oonveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/buiider disclosure <br /> statement. (please initial) <br /> �/��,rr� !1 (.v,�5��r r�,��'�:.�-.�C' ".J�.�� �'�'l�.c.�-� ��-- �— j 3 <br /> Applicant Print Name Applicant Signature Ddte <br /> Permit Technician Signature (or) Notary Signature Date <br /> Applicant is( ) personally known to me or produced as identi�cation. <br /> (type of identification) <br /> Page 2 cf 3 <br />