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PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indipted. 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 construcdon 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 Manuai and FDOT Design <br /> Standards(if appliCable). (Public Works Design Manual online fink: www.ci.zephyrhills.fl.us/public_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECNNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> intertere with existing stormwater treatment and/or conveyance. <br /> PROPERTY O_�Y signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) 1/� ! 'i <br /> ��-�,F\A-U� � ,rIC`11i� ��a .'C iW'fy�,-.� i �� R <br /> Applicant Print Name ApRlicant Signature � Date� � � � <br /> i•. , <br /> e <br /> '•} �`.r-�':}--� �` � -� i -1, <br /> �J �_i .1 �^� t,_•�,```'1'� <br /> Permit Technici n 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 .�h":F:'ej,� �US,4N G.WILLIAMS <br /> � M"COMPdISS10N#EE 003240 <br /> � � * EXPIR�S Juiy 11,2014 <br /> PNTE�`oa=°` Bonded Thru B�.idget NoGarq Services <br />