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• PERMIT APPLYCATION <br /> UTILITIES LOCATE CONFIRMATI N NUP9BER: <br /> PROVIDE SKETCH IN THIS AREA,IF EIDDITI PIAL SPACE IS REQUIRED,ATTACt9 TO THIS <br /> APPLICA7IOfd. <br /> �t=� �' �� � � i� � d� <br />� <br /> AFFIDAVIf: Applimdon is hereby made to obtaln a permt to o work and installatfons as fndicated. I certify that ail foregoing <br /> informa[ion is accurate and that all wark will wmply with all a plicable codes. I understand these cndes shall take precedence over all <br /> approved construction doaiment;,and issuance of this permit is verification that I wfll notify the property owner of Florida Lien Law <br /> req.,F.S,713. <br /> ihe issuance of this permit does not ensure complian with deed restrictions and I understand khat additional deed <br /> resMctions m appty to this property. <br /> All work shall comply with the current Florida Bui ding Code,Publ(c Works Des(gn Manual and FDOT Design <br /> Standar'ds(if applit�ble). (Public Worics Desi n Manual online link:www.ci.zephyrhilis.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLE55 SIGNED WITH P OPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHIdICIAN OR NOTARY PUBLIC. <br /> NOTE: Ti�e City og Zephyrhills is not respansible for m intenance or repairs of dNveways. Driveways shall not alter/ <br /> i�Crfere wfth existing storm r treatment and/or mmreyance. <br /> PROPER7Y O R5: By signing this application: I ce fy that I have read and understand the owner/builder disciosure <br /> stdtement. (please inidal) <br /> i 2 iG�nS � <br /> Appllcant Print Name � pl nt Ignatur Date <br /> . tf'1 <br /> P i Technician S ture (or)Notary ignature Date <br /> cant is( )personally known to me or produced as identificatlon. <br /> (type of identification) <br /> P ge2of3 <br />