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PERMIT APPLIGTION <br /> U'RLITIES LOCATE OONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS RfQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> �� S ;� r°�� <br /> AFFIDAVIT: Application is hereby made tio obtain a permit to do work and�StaBations as indicated. I oertify that ali foregoing <br /> infom�ation is aoairatie and tlwt al)vvak will oomply wiifi all appiitable oodes. I understand these codes shatl take preoedence over ali <br /> approved oonstruction documeMs,and is�anoe of this permit is v�ificalion tt�at I wili notify the property owner af Rorida Lien Law <br /> req.,F.S.713. <br /> The issuanoe of this permit does nat ensure oompiianoe with deed�ictions and I unde�stand that additional deed <br /> restricdons may apply bo it�is property. <br /> All work shall aompl�l with tlte ame�tt Floride Bt�1ldi�fg Code,Public Worlas Design Manual and FDOT Des6gn <br /> Standards(if sppliCable). (P�Ik Worics Design Manual onli�e link:www.d.zephyrhilis.fl.us/public works.asP) <br /> APPLICATION IS VOID UNLESS SIGNED WIfH PROPER iDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICL4N OR NOTARY PUBLiC. <br /> rrOTE: rne c�ty ar zepnyrnii�is noc r�po�ibie nor n�sH�enanae or repairs o�f ariveways. Dri�►eways shaN not aiber� <br /> interfere wit�f�ng sbonxwabar tr+e�nt snd/or aonveyanoe. <br /> PROPERTY OWNERS: By signing this application: I aeitify that I have read and u nd tl�e owner/builder disdosure <br /> statemertt v�'�`- (piease initia!) <br /> � �DYI�ES L� -G'l/ � 6 �/_.� <br /> Ap ' nt Prirrt Na Appi'�cant Signatt�e Date <br /> s " � z—" /—/0—�,5� <br /> t Technidan Sig re (or)Notary Signature Dafie <br /> APPtkant is( )Personaily Ivwam b�me or produoed as identification. <br /> (h�Pe af ide.�ttifitation) <br /> Paye2of3 <br />