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�E�.�E��,R��E�IITYORt <br /> tt'�I�E�%ES����RTE COIVFIEtWi/AL%ON E�U �E�o <br /> P��VEDE S�CETCF! I� TtiY� �l�El4o %F e�,D��TI�f�I�C �R�CE I� 6�EQBJI�E�, �a'TT�CFf TO TFiIS <br /> ���LEC�TI�I�o <br /> ` � �Q� U <br /> _ ' p V _`�/ <br /> _ � Q � � <br /> �---_��` <br /> - �.. <br /> AFFIDAVTT': 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 comply with all applicabl codes. I understand these codes shall take precedence over all <br /> approved construction documents,and issuance of this permit is verifi tion 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 appl to this property. <br /> ��0��e�kc s6��G0 co�pCy/�n►fiti�th��ca�ro�nt Feorid� Buil�i�g o��, �ub�6c IA�ork� �e�ia�au N&�ruat�eec� ED�T Desi�ro <br /> S�anc�ar�s�6����@ac�b8�)o (Public Works Design Manu I online link:www.ci.zephyrhills.fl.us/public works.asp) <br /> APPLICI�TIO�! IS VOID UNLESS SIGNED WITH PROPE IDENTIFICATION AfVD WITMESSED BY A PERMI� <br /> TECHNICIAfV OR IV TARY PUBLIC. <br /> I��'EE: �h�C6t�o��ep�nyrF�ilBs 6�n�t���pmnsilsBe for re��6��� nce oc r�paio^s of de�ive�+ra��o Driv�wray�sPoaB�not�Ite�/ <br /> a�nteaf��vbigh exi�t�e�g s�ores�wat�r eeataroent a�c9/or cor�vey�r�ce. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) " <br /> ���'r�L l7 � r��'/��fi�.�1�1��tL��(' �- �i � �' �� �� <br /> `�Applicant Print Name Applicant Signatur Date <br /> Permit Technician Signature (or) Notary Signatu e Date <br /> Applicant is( ) personally known to me or produced � l� ��� /�s . as identification. <br /> (type of iden ification) <br /> Pag� � f 3 <br />