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PERiNIT APPLICAfiION <br /> UTIL.TriES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> �� 5;�� ���, <br /> � <br /> AFFIDAVIf: Application is hereby made to obtain a pertnit bo do wo�lc and installations as indicated. I certify that all foregang <br /> information is aocurabe and that ali worlc will rnmply witli all applicable codes. I understand these codes shall take pr+ecedence over all <br /> approved construction documents,and issuanoe 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 wmplianoe with deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> Ali work shall aomply with the arrent Fbrida Building Code,PuWic 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 /> TECHNIQAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhilis is not responsible for maintenanoe or repairs of driveways. Drivevrays shall not alter/ <br /> interfere with existirg sbormwaber tr+eatmerrt and/or conveya�e. <br /> PROPERTY OWNERS: By signing this appiication: I certify that I have read a understand tl�e ovmerybuilder disdosure <br /> statement. �� (please initial) <br /> CC�ve��f-k'��, �� �/Lf� f� /��.�o�3 <br /> Applicant Print Name Applipnt Signature Date ' <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applicant is( )personaly known to me or produoed as identification. <br /> (type of ide�tification) <br /> Page 2 of 3 <br />