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PEE8.�6IT A�P�IIC/@4�Of� <br /> lD'TILITIES L�C/@TE CONFIitt�/iTYON IVU �Et�: <br /> PitOVYDE SKETCF6 ERl '�BiY� IR,ttEA, IF/ADDIIT�OI�B/A� S��LCE IS l�EQI�IF�E�, l61'TACFI �O �fBIS <br /> �PPi.YC�TI01�. <br /> f� a� Y � <br /> � <br /> << <br /> < < � � <br /> j2 � ` --3 `� ` � � I <br /> � � 1 � � � <br /> 7� l � <br /> _�- � i <br /> t° � l <br /> S ' ` , . <br /> � <br /> ----�-.,__—_____ __, __ � � � , <br /> �����r �� �� � � <br /> � <br /> � <br /> AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I cettify that all foregoing <br /> information is accurate and that all work will comply with all applicabl codes. I understand these rndes 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 wit deed restrictions and I understand that additional deed <br /> restrictions may appl to this properly. <br /> �lO wock shall cor�ply with the cu�rent FloPid� Building ode, Public Work�Design N@anual and FDOT Design <br /> Stae�dard�(if applicablC). (Public Works Design Manu I online link:www.ci.zephyrhills.fl.us/public works.asp) <br /> APPLICATION IS VOID UNLESS SIGNED WITH PROPE IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNICIAN OR N TARY PUBLIC. <br /> Pi0'�E: The City of Zephyrhills is not responsible for mainben nce or repairs of driveway�. Driveways shall not alter/ <br /> interfere witl�existing stormwater reatrnent and/or convey�nce. <br /> PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> D � v �� � C �. S ���� ' �.�;� � � � y - � �f <br /> Applicant Print Name Applicant Signatur Date <br /> Permit Technician Signature (or)Notary Signature Date <br /> Applicant is( )personally known to me or produced as identification. <br /> . (type of iden ification) <br /> P�ge 2 f� <br />