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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 /> APPLZCATION. <br /> ���rS <br /> 0 <br /> �� <br /> �� <br /> �� <br /> z ` � <br /> � , �, <br /> � <br /> � <br /> � . _ _ <br /> r '_ ; � <br /> t � , :_, � , -.r , � � <br /> �_._.___ <br /> _._.._.___ n ,,_,�.,,�. _ . . <br /> _ _._.._._.. <br /> �._ . .. .. . �4.. _..�__. .-_ _ , <br /> E; _. : _. <br /> , , <br /> �- � �°�� � �- � c� � � � �_--� �- <br /> � r' e lK����j� � � f�A�'I�tf�L � <br /> � I � \ /!��X � '�.� � _ <br /> , �, _ <br /> .. , . __ ' � � <br /> _._ _ . _ <br /> , . �'�,.��,,°'_� , { �.r, , � Jo i 1 a 3Z ' ► � - � q 7 <br /> ,, -- _; <br /> . �f , �_' � ,r . <br /> _ /Lr�iv�i+IV,K . •� 4, �✓�✓� <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 rnmply 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 does not ensure compliance with deed restrictions and I understand that additional deed <br /> restrictions may apply to this property. <br /> All work shall compiy with the current Florida Building Code, Public Works Design Manual and FDOT Design <br /> Standal�ds(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 shall not alter/ <br /> intertere with existing stormwater treatrnent and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> Applicant Print Name Applicant Signature Date <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 />