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PERMIT APPLIGTION <br /> UTILITIES LOCATE�ONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> S�� S,�e %,�v <br /> AFFIDAVIT: Applicadon is herehy made tn�tain a permit b�do woric and installations as indicabed. I oertify that al!foregoing <br /> infomwdon is aoairabe and ti�at all work will oomply w�h atl applicable oodes. I undetstar�d these codes shail take preoedence over all <br /> appronred oor�on documents,and iss�snoe of tl�is perm�is v�tlon that I will notify ti�e property owner of Rorida Lien Law <br /> req.,F.S.713. <br /> The issuanoe af this permit does rwt�re campliance with deed r+�ictions and I unde,rstand that additional deed <br /> r�estrictions may apply to this propert.y. <br /> All work shall oomply with tl�e current Fbrida B�ild"n�g Code,Pubiic Works Design Manual and FDOT Design <br /> Standa�+ds(if applicaWe). (Pe�lic Worlcs Design Manual online link:www.a.zephyrhills.fl.us/pubiic worics.asP) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFlCATION AND WITNESSED BY A PERMIT <br /> TECHNIQAN OR NOTARY PUBLIC. <br /> 1�7'E: The Cit�l of Zepliyrhiils is no#r�spor�sible for mainbenanae or repairs of drivewa�rs. Driveways shall nat atber/ <br /> inberfer+e vrith�ng sbortrmrs6er tr+esbnent and/�aonveyanoe. <br /> PROPERTY OWN�RS: By signing this application: I oertify t I have read and u nd tl�e owner/builder disdosure <br /> statetrtent (Please ir�Uia� <br /> �"c�t/2NCl� ll�rj9c�'S, ��I,�. ._._ G , iG_ ,(� ! ld �013 <br /> 7/ v <br /> APPIi Prhtt Name Applicant Signat�e Dat+e <br /> E. � �/0- <br /> Perm nician Signat.ure (or)►+b�ry Si9natune Date � , <br /> Applicant is( )Per'sona�lY Iviown b�me or Produoed as identification. <br /> {type�ide�ificabor�) <br /> Paye 2 of 3 <br />