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.PERMIT APPL2CAT.ION <br /> UTILITIES_LOCATE CONFIRMATION NUMBER: <br /> =PROVIDE:SKETCH TN"THIS�AREA,:IF ADDItIONAL SPACE 25 REQUIRED, ATTACH TO-THIS <br /> APPLICAT.ION. <br /> AFFIDAVIf: Application is hereby made to obtain a pertnit b�do work and installations as indipted. I certify that all foregoing <br /> information is accurate and that ail work will comply with all applicable codes. I understand these rndes shall take preoedence 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 does 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 Manual and PDOT Design <br /> Standards(if applicable). (Public Works Design Manual online link:www.a.zephyrhills.fl.us/public woHcs.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNIQAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not atter/ <br /> interfere with existing sbormwaber treatment and/or conveyanoe, <br /> PROPERTY OW.-N�E.� By signing this appiication: I certify that I have read and derstand the owner/builder disclosure <br /> statement.�,���(please initiat) <br /> � � / A <br /> ` - �`{ ' L�l�� <br /> Applicant Print Name Applicant Signature Date <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applicant is( ) personally known to me or produced as identification. <br /> (type of iderrtification) <br /> Page 2 of 3 ` <br />