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PER.MIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> / � , � <br /> � <br /> / // � <br /> �� ' �� � <br /> � , <br /> ;% ' ��- C <br /> � <br /> Z�E S�W t�f <br /> �p w 3`u'j � TQ►r�uc..�� �u42�S �a(c� s�DEs. <br /> D r i v E cc�u c.( <br /> : � <br /> l SawC�T �oC� oF P�u�,�.ouT 4Np s�f-r�c� <br /> r <br /> l� � � �(3FQ exP�u suoN �►uz �4T �oF �,���7 � NEw ea �, <br /> , C H�� D�PrA !✓��� �lG�fT o�w�f! I 8 �� S T <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. 1 certify that ali foregoing <br /> information is accurete and that all work will comply with all appiicable codes. I understand these codes shall take precedence 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 dces not ensure compliance with deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> All work shail comply with the current Florida Building Code, Public Works Design Manual and FDOT Design <br /> Standards(if appliCable). (Public Works Design Manual online link:www.ci,zephyrhilis.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shail not alter/ <br /> interfere with euisting stormwater treatme�rt and/or conveyance. <br /> PROPER7Y OWNERS: By signing this application: I certify that I have ead and understand the owner/builder disclosure <br /> Stdtement. (please initial) <br /> i� T(J!/1/1 ( 9 j-C � l�r� ✓ ���1'� �G!/� � � - z 3 1� <br /> Applicant Print Name Applicant Signature Date r <br /> Permit Technician Signature (or) Notary Signature Date <br /> Applicant is( ) personally known to me or produced as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />