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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 /> ���--% Si'����' ��"�'L ✓`�j�.;` <br /> .� <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I oertify that all foregoing <br /> inforrriation is aaurabe and that ali work will compy with all applicable oodes. I understand tt�ese oodes shall take preeedence over all <br /> approved oonstruction documents,and issuance of this permit is verification that I wiil notify tt�e prope�ty owner of Florida Lien Law <br /> req.,F.S.713. <br /> The issuance of this permit does not ensure oomplianoe with deed restrictions and I understand that add'�ional deed <br /> restrictions may apply to this property. <br /> All work shall comply with tl�e current Fbrida Building Code,PuWic Worics Design Manual and FDOT Design <br /> Standards(if appliCable). (Public Works Design Manual online link:www.a.zephyrhii�.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED W1TH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR NOTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible�or mainbenance or repairs ot driveways. Driveways shatl not alber/ <br /> i�ertere witl�existing sbormwaber tr+eatrneM and/or oonveyanoe. <br /> PROPERTY OWNERS: By signing this a�lication: I certify that I have read and u nd tt�e owner/builder disdosure <br /> statement. �,"� (Please initial) � � <br /> ��l�f��%V;�J �/�L�� (�L �` ��c� v�lJ�'� <br /> Applicant Print Name Applicant Signature Dabe <br /> �- _��� "� <br /> Permit Technidan Signa (or)Notary Signature Dabe <br /> Applicant is( )personaly known to me or produoed as identification. <br /> (type of identification) <br /> Page 2 of 3 <br />