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PERMIT APPLICATION � � <br /> UTILITIES LOCATE CONFIRMATION NUMBER: <br /> . PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS <br /> �APPLICATION. <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing <br /> information is accurate and that all work will comply with all applicable 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 does not ensure compliance with deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> All work shall 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 2ephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> interfere with existing stormwater treatrnent and/or conveyance. <br /> PROPERIY ERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) � , <br /> � r�,c�' ( �P,t� � ; ' ' <br /> I � � � � r � <br /> q � ��-'� _ 1 D J I <br /> pplicant Print Name j icant ignature Date 1 <br /> �" <br /> .,/�aa�� �'I' :`l-s�._... :�,7� �r/i y <br /> Permit Technician Signature (or)Notary Signature „,J Date <br /> I-INDA M.LYON <br /> Applicant is(UJ'�personally known to me or produced as identification. <br /> (type of identification) <br /> UNDA M.LYON <br /> Page 2 of 3 NOTARY pUgLIC <br /> STATE OF FLORIDA <br /> , Comm#EE224468 <br /> Expires 10/2/2018 <br />