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PEF3.F�%Y A�P�LICA'l�I�f� <br /> ` UTILYTEES LOC/6TE CONFYttM TION IVUNI�E6t: � <br /> - �EtO\/IDE SICETCF[ IM TI-II� /BPtE�, IF �DD TFONI�L �R�CE I� REQUIt�E�, ll�»TT�1CYi TO THIS <br /> �PPLICA►TYOI�. <br /> - <br /> , ' ���� <br /> � Car,' ;� <br /> t / . <br /> . � <br /> ,1 <br /> � <br /> � <br /> �� Ex;s <br /> Qr�Q�s�. ` �� <br /> v,,;��:�y �--""�°---� �� <br /> G � <br /> t <br /> �Y�V2`�A�r� ''Q� <br /> � � <br /> ` ^^ �p.cc�srv.1 A-v-t ,A�Q - <br />� <br /> AFFIDAVIT: Application is hereby made to obtain a per it to do work and installations as indicated. I certify that all foregoing <br /> information is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all <br /> approved construction documents,and issuance of this rmit is verification 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 co pliance with deed restrictions and I understand that additional deed <br /> restrictio s may apply to this property. <br /> �90 vvork shall core�epB�y vdith th�caament Florid �uilding Code, PubBic Wo¢�k�DesiQn NGarnuaE an� FDO�Des6g�n <br /> S�n��rc�s(if applicabl�)o (Public Works Design Manual online link:www.ci.zephyrhills.fl.us/public works.asp) <br /> APPLICI�TIOf� IS VOID UNLESS SIGNED W PROPER IDENTIFICATION AND WITNESSED BY A PERMIT <br /> TECHNI IAN OR NOTARY PUBLIC. <br /> �OTE: Th�City of Zephyr�i6los is not responsifsl� or maintenanc�or a�epairs of driv�way$. Drivew�ys shall not alter/ <br /> Bn��u�e�with existing rmw�ter trea�enent and/or conveyance. <br /> PROPERTY OWNERS: By signing this application: certify that I have read and understand the owner/builder disclosure <br /> statement. (please initial) <br /> Applicant Print Name Appli ant Signature Date <br /> Permit Technician Signature (or) otary Signature Date �i <br /> Applicant is( ) personally known to me or produced as identification. <br /> (type of identification) <br /> �ag�e 2 of 3 <br />