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i � <br /> . � <br /> � PERMTT APPLICATION <br /> UTILITIES LOCATE CONFIRMATION N MBER: <br /> PROVIDE SKETCH IN THIS AREA, IF ADDITIONA SPACE IS REQUIRED, ATTACH TO THIS <br /> APPLICATION. <br /> � <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 ail applica le codes. I understand these codes shall take precedence over all <br /> approved construction documents,and issuance of this permit is ver fication 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 ap ly to this property. <br /> All work shall comply with the current Florida Buildin 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 maint 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 /> state ent. ( I ase initial) <br /> � �I'�'1 I �_ �l I`�5 ' � I � �' 1�1 <br /> Applic nt Print hlame ppl ant Signat r Date <br /> �� � '�' V "- <br /> P rm' echnician S'g ture (or)Notary Sign ure Date <br /> Applicant is( )personally known to me or produced as identification. <br /> (type of id ntification) <br /> Page of 3 <br />