Laserfiche WebLink
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 /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and instaliations 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 dces not ensure compliance with deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> All worlc shall comply with the current Florida Building Code, Public Works Design Manual and FDOT Design <br /> St�ndards(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 Zephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alter/ <br /> interfere with e�cistin4 stormwater treatment and/or oonveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> Statement. (please initial) <br /> "�. � <br /> GUi�5" l� C�G�,o�'1�#'�/,�' �uu� . C <br /> APDIICent Drinr t��me / � ��r���C`� <br /> licant Sign ure Date <br /> Permit Technician Signature (or) Notary Signature Date <br /> Applicant is( )personally known to me or produced as identification. <br /> (rype of identification) <br /> Page 2 of 3 <br />