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, <br /> 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.zephyfiills.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 Zephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> interfere with existing stormwater treatment and /or conveyance. <br /> PROPERIY O ;N—�y signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) � <br /> �� _r� V�L��- - �(l� <br /> Applicant Print Name A ' ant Signature Date <br /> ��r�� 7�r���<-� „�: l/�/i Y <br /> Permit Technician Signature (or) Notary Signature �i,�q M.LYON Date � <br /> Applicant is(�ersonally known to me or produced as identification. <br /> (type of identification) <br /> LINDA M.LYON <br /> Page 2 of 3 NOTARY PUBIIC <br /> STATE OF FLORIDA <br /> � � Comm#EE224458 <br /> Explres 10/212016 <br />