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�. . <br /> • PERMIT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION N MBER: <br /> PROVIDE SKETCH IN THES AREA, IF ADDITION L SPACE IS REQUIRED, ATTACH TO THIS � <br /> APPLICATION. <br />� <br /> I <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do wo k and installations as indicated. I certify that all foregoing <br /> information is accurate and that all work will comply with all applica le codes. I understand these codes shall take precedence over all <br /> approved construction documents,and issuance of this permit is veri ication 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 wi h deed restrictions and I understand that additional deed <br /> restrictions may app y 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 Ma ual online link:www.ci.zephyrhills.fl.us/public_works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH,PROP R IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR OTARY PUBLIC. <br /> NOTE: The City of Zephyrhills is not responsible for mainte ance or repairs of driveways. Driveways shall not alter/ <br /> intertere with existing stormwate treatment and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: I certify th t I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> Applicant Print Name Applicant Signat re Date <br /> Permit Technician Signature (or) Notary Signa ure Date <br /> Applicant is( ) personally known to me or produced as identification. <br /> (type of ide tification) <br /> Page of 3 <br />� <br />