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PER�IT APPLICATION <br /> UTI�ITiES LOCATE OONFIRMATION NUMBER: <br /> PROViDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> �C-�� S',�° N L�-� <br /> AFFIDAVIT: Application is hereby made bo oMain a perntit bu do work and ir�allations as indicabed. I certify that all foregoing <br /> irrtorrtiation is aowrabe and tf�at atl work Nn'il aomply w�fi all applicable oodes. I understand these codes shall take preoedence over ail <br /> appronred wr�ion documer�Cs,and issuanoe af tfiis permit is verification tl�at i wiH notity the property owner of Rorida Lien law <br /> req.,F.S.713. <br /> The issuanoe�this permit doe.s not er�ure o�mplianoe witt�deed restrictions and I understand that additional dced <br /> re.sbicdons may apply tio this property. <br /> All work shall comply w�th the ament Florida Building Cod�puWic Wq1cs pe�gn Manuai and FDOT Design <br /> ����aPP���)• (�+�Wa"ks Design Manual online link:www.a.zephyrtuils.fl.us/public works.asp) <br /> APPLICATiON IS VOiD UNLESS SIGIVED WiTH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNIQAN OR NOTARY PUBLIC. <br /> NOTE: The�SLy of Zeptryrhiiis is nat respo�ible fiur ma�benanae or�ep�rs of drnrevrays oriveways shatl not atter J <br /> inber�ere witl�ex�tlng sdoimwater tr�eatme�rt and/or aonveya�e. <br /> PROPERTY 0�1IN�RS: By signing this application: I ' that I have read and nd the owner/builder disdosure <br /> statement �`� (Please irotiat) <br /> �v�/P��� �fa�1�. G/� �i�G!/ - � � � ��f3 <br /> Pr�►t Nar►� App�Carrt SignaturP Datie <br /> Technician /J�� �� <br /> Sig�al�re {or)I�ary�i9na� Dat;e <br /> Applicarrt is( )persona�N Ivwwn t�me or produced as identification. <br /> (LYPe�iderrtifiWtion) <br /> P�ye 2 of 3 <br />