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�ERP+IEF�.P�LIC�TION � <br /> - UTILITIE�i.0�4E CONFIRR�I TIOII�@ NU6WI�fR: <br /> P(tOVIDE St�ETCFi IfV TFBIS QeRE�i,, IF �D I'9�OP9�L SPACE IS REQUIR��, IA'TTIB,CH TO TtiIS <br /> I�PPLICATYOtaI. <br /> �� �.��� � �.t� �',t,���v� �r�- /����5 <br /> J <br /> AFFIDAVIT: �pplication is hereby made to obtain a per it to do work and installetions as indicated. I certify that all foregoing <br /> information is accurate and that all work will comply wit all appiicabie codes. I understand these codes shall take precede�ce over all <br /> approved construction documents, and issuance of this et�mit is verification that I will notify.the property owner of�lorida Lien Law <br /> req., F.S. 713. <br /> _,The issuance of this permit does nat ensure co pliance with deed restrictions and I understand that additional deed <br /> restrictio s may apply to this property. ' <br /> All rarork shall c�enply v�6fh Yh�current�oorid �uil�Bing C�e, Pubiic�V�cks Design twaeaeeat and FDOT D�si�n <br /> St�otdarti5(if�pple�ble). (Public Work Design Manuai oniine link: www.ci.zephyrhilis.fl.us/public_works.asp) <br /> �4PP�IG4TION IS VOID UIVLESS SIGN�D W PROPER IDENTIFICATION AND WITNE5SED BY A PERMIT <br /> TECHM CIAiV OR 1�OTARY PUBLIC. <br /> NAYE: Th�C6ty of Zephyrh6lis is not re��nsible for m�iret�nance or repairs of drivew��s. Drive�taays shall not alter/ <br /> interFere with exi5tin� rmwrater$reatment and /or conveg+arece. <br /> PROPERTY O �.ERS: By sf�ning this application: I ce ' that I have read and understand the owner/builder disclosure <br /> statement.����(PI ase initial) �I ,� 1 <br /> � <br /> �s�� � - —. � � .! � <.----��� 1 C> ►t--i �4 y <br /> Applicant Print Name `i AQp icant Signat�� Date <br /> Permit Technician Signature (or) otary Signature Date <br /> Applicant is( ) personally known to me or produced as identification. <br /> (type of identification) <br /> �ag� � of3 <br />