HomeMy WebLinkAbout12-13187 CITY OF ZEPHYRHILLS
5335-8TH STREET �
• � (si3)�so-oo20 1�87
DRIVEWAY PERMIT
Permit Number: 13187 Address: 5806 18TH ST
Permit Type: DRIVEWAY ZEPHYRHILLS, FL.
Class of Work: DRIVEWAY/NEW Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-07600-0150
Improv. Cost: 2,250.00
Date Issued: 6/19l2012 Name: WILLIAMS, STEVEN L. 8� REBA M
Total Fees: 45.00 Address: 5806 18TH ST
Amount Paid: 45.00 ZEPHYRHILLS, FL 33542-4433
Date Paid: 6/19/2012 Phone: (813)313-9088
Work Desc: DRIVEWAY 50 X 12 W/SIDEWALK SIDE OF HOME
HOMEOWNER DRIVEWAY 45.00
�
FINAL -/ �
REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80(2)(c)when extra inspection
trips are necessary due to any one of the following reasons: a)wrong address b)wndemned work resulting
from faulty construction c) repairs or corrections not made when inspections called d)work not ready for
inspection when called e) permit not posted on job site g)work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
�
CONTRACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
PERMIT APPLICATION �
DRIVEWAY PERMIT APPLICATION
CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY
All information must be filled-in completely
City of Zephyrhills
5335 8�' Street, Zephyrhills, FL 33542
Telephone 813.780.0000 Fax 813.780.0005
.a4 a - r`., ,�r��a�.a�'-,x y. ..T: ¢�. .s.. .
p''�# `'.x'.`'�• r6s+� ., .. ,. �
°�.'� 3', r4; � :�'� r .� -i', ����a"fi-'`���`�a° _
�e - ' '�;��:�.;•;,;m g�f l��a. «
PR07ECT �OB SITE: PROPERTY OWNER
Address: 51'cb h �- Name: i �
,/ Unit#: Address: 580 /$�h nit: �
Parcel Identification Number: Ci State Zi 3 S�{Z
Phone: rd�3-313- og Fax: b ,�
-.�_=�.�.-..�.---.__ '�
CONTRACTOR:
Company:
Name:
Contractor's License #: E-Mail:
Phone: Cell: Fax:
ARCHITEGT/ENGINEER:
Name: Firm Name:
Address: City: State• Zip:
State License #: Phone: Cell: Fax:
Descriution of Proiect
Jr��LENGTH OF DRNEWAY CULVERTS NEEDED
� RESIDENTIAL DRNEWAY LWIDTH OF DRIVEWAY ( )REINFORCED CONCRETE
COMMERCIAL DRNEWAY R•O•W EXCAVATION O CORRUGATED MATERIAL
PUBLIC ACCESS DRIVEWAY DEPT LINEAR FEET ( )BOX CULVERT
CONSTRUCTION MATERIAL `CURB CU�RE,OUIRED � )�ER(IXPLAIN)
ASPHALT YES NO
�-CONCRETE
HEADWALL REOUIRED? YES NO �!VS $r!.I� W q I IC �/'�rv� (�-��,�,� Qrp,�� �,J� 1��
5,1c1c o� �1-F�e hc�-e 3x 4 50 �
NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings
will be required.
UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
Page 1 of 3
c�r,�n ro: s�c�ivN ��, Tc�1NNSH�11'26 SC
X STEVEN L. WlLL1AMS & REBA M. WILLIAMS PA$CD COVIVTY,
i, X WELLS FARGO BANK, N.A.
�) X OLD REPUBLIC NATIONAL TlTLE INSUR,4NCE COMPANY
t�l x ATTORNEYS TlTLE FUND SERVICES, LLC
� -*' MERIDIAN TITLE COMPANY, INC.
���b
1.�`,.-
�- •— •— •— • — •—• —•—•—• — •—•—• — •— —•—•—•—• — �— �— �—• —•—
�tj � ��•;���z��
A I W"
s • 6' WDF
� F.I.P. 1/2" � � � � � �-
--� 19.4' N 89'S6'52" E 2.1 141.10�(F�
�
4 � a 29.8' � �.�'G � V
W � � � < - - 24.0' `- �� -�� = ' -
—���L-��-�I��I�-L ��
� °°_ • CO Ca , e �-�L�����I�L_LLL ,-"-,
� ° D�W • a ,; LLLL�LL�I�LLLm , -' '-,,,`
�w LLLL�LLL_l�L �L_� �
Q� Y � LL��LL�L11_ LL_L_ COVERED
3> i� � � � �LLLLL�L � L�'2.y_ CONC
o� ,°° a �� LL I I � i � i _ �
� n �-L 1 STORY _ _ ,.r(16
�_ �,,, EN RRED ��� N-�R£51DENCf- w�
LI
��can ` I_",iE f80d`L I
�Q � a -- — — — — �L��-��-t� — — — — — — — -- — -- — —
�� q o ��LL�L���'
`- o ����LLL� ALUMINUM
Z LLLL��LL SHEDS �1S
� 30.4' �LLl2a.o'L��
�
� A/C L�
� L_LL �L
LL
F.I.P. 1/2" N 90'00'00" W 140.44'(F)
I WOOD & WfRE FENCE
�
� �_��'16 -
� ��� .
� z
. �
� — •— — • — • —• —•—• — •— •—•—•— • — •—• —• •—• —• —• —• —• —•—•-►�Y.
I
':'
DESClt1rT1A1H:
tOTS 15, 16 AND TNE SOUTH 1/2 OF LOT 17, BLOCK 76, CITY OF
ZEPHYRHlLLS, AS PER THE PLAT OF TOWN OF ZEPHYRHILLS, ACCORDlNG TO
MAP OR PIAT THEREOF AS RECORDED IN PLAT BOOK 1, PAGE 54, OF THE
PUBUC RECORDS OF PASCO COUNTY, FLORIDA.
CfRT1�D TO: s�rnv�v». rvw�vsr�rn 26
a' STEVEN L. WILLIAMS & REBA M. WlLLIAMS PA$CO Cvt/NT
� -�' WELLS FARGO BANK, N.A.
W -�' OLD REPUBLIC NATIONAL T1TLE INSUR.4NCE COMPANY
t��� X ATTORNEYS TITLE FUND SERVICES, LLC
� X MERID/AN TITLE COMPANY, INC.
5��
'4a ���16
� �,�7..�-
E°'� .- � - �- �- -� - � -�- �-�- �- �- �- .�._. _. _ ._._ ._. _..
'� �''�`�,� ,�2
,� y"�5'� j ����
s � 6� WDF
� � F.I.P. 1/2" � � � � �
19.4' N 89'56'S2" E 2.1_ 141.10'(�
� 2s.8' ' JxG ,rb �
� � . - —, — , — - , -- -
�" � _�L��L-�L�I�-�4d-� '-�,� , ,-'
� "� a CD CeQ e �L�LLLL�I�L_I-L.L ,-'"��>�` ' �,
D�W � LLLLLLLLI�LLL�
-� �-----�-- ' L��L L L L L_I� L L L_� ,- -,
3W � Y � � �LLLLLLL(�LI_� COVERED
� i,� �'''' i i L�L L L��L'� Li�z.z'- CONC
1►�o a ,°,° o '�' �L � i i i i i �
� W' �b
�Q W EN RRED ���, �i R iD�NC£-
�a -
N � L`�'1�f806`LI
"°Q � o -- — — — — �L��-��t� — — — — — — -
�" Q b ��L�LLL��' - — -
� �LL��LL� ALUMINUM
:., � L��LL�LL
Z L�L�LLL� SHEDS
� 30.4' L.L�l24.o'L�L ��(1S
� A/C _ L L
� L_l_ L L
�L_
F.I,P. 1/2" N 90'00'00" W 140.44'(F)
I WOOD & WIRE FENCE'
�
� W'_��16
� ��• _
�
h.. '— '_'_ '— '—• — �— •— •— •— •—•—•— • —• — • —• —• —. _ . _. —._._
I
D�SCRIPTI(�lV:
LOTS 15, 16 AND TNE SOUTH 1/2 OF LOT 17, BLOCK 76, CITY OF
ZEPHYRHILLS, AS PER THE PLAT OF TOWN OF ZEPHYRHILLS, ACCORDfNG TO
MAP OR PLAT TNEREOF AS RECOROED IN PLAT BOOK 1, PAGE 54, OF THE
PUBUC RECORDS OF PASCO COUNTY, FLOR/DA.
, � : � jk. ` � x _ TZEw. -..
�� '{'�� !�I `� R1#"F. , . � I
t � f} ` 1 . � n � t 4� ,��`�" r
� i{ ��' ' �. j�,• �• ' _ .. -
k �` � � ` ��� 1 r . rC � <
1 � + 4 'l'�'�3 '. .� � f�
, , � �T� t q' �`t:w �.•`.r �1k' .�► e
1 � � }� rt ; 4 i'
, M • t �, �!' a' };��".£,�,,: : "r„ � f- '' F
! e t �FA d'�- �.:. M : .1`��"
t ' , `�/ . ��� t � �,... T� � ` G ��* i� .
� �. � ! ti..s�'�t *
` r � " + ,1. ' y�4�j t �i�,�i�i.�.a��`y��j,{; �,�� ' .......+.�— :* �-�' �i
` ' � � , �;,��;�,��°i '_ .{:�,��'i'�i`;"�":.:,= ' � `g _ a
" �1 �{ �� •�!` =',``''�t�'�'._{4�'�"�a'�-�, 4 � l � � 's� }
? �� , �'�� .k�4a1�' 4 k. �'4.�;;,� k ... 2. :�J, ,
�� 1 y P t �:��r�"y` 4.�{� # �"�q
,'e ^ ' j•, i k:,. _ _ S``�. " , �r� , �:'�.,�*,
4 , , � !` :�gs,' ._ z, ;�; i��� %i ;;
x �Y'i�y� `"�' �' .r�">.'�^A� ' �- `s, -
� � an��4. i a;�� 7,�� • �t..._ -� ` . �
� i_ } � r ��.# � .�",1�.�F 9� R�`��A'�"�+7'+�,.a ' . :Li_ �, � t '
, t ' �rt '. i� ,Se:� ��"""° � � =f. 4 ► '�1,c'�
� t� t` i .E T� �s ,�°{ ,t� .r r d;,� ..7 t,?"�T
, t'�' } 's }±�l 1% { '�t�� ?����f �'� �z ��s; i�'t . i � "�#'' r�.._ t..i,�:"' �S
; . . ! ���� � .,�.:
� � � . + �'� } '�.�. .���w w---w•� ,,;,—l . '�",,�,`_.
� t . „', ' . � � �� �'.{�1?' ��t"P.� .�'. . 2a ..
•r . , _ '. r r..`� *`�.+ .,i , t.
LLY.�. t'`S � M `, T�" .L �' � '� P h ;
� `t � ;. f :�, 4 * ' ���.}_ %
if,'�r ,�, .1 i. t � �;i�l y
P �1�� .t ` � '? S .1'. .. � - � .
' ;'Y.w�i '�� `{��ir� t•''i,,���,_� � �, ,..�,yN;''�•' -
' { �{ F a..�•4 w� + '' �.',,° ! ��.°'�
��.:� '�{� k.. �i' �r��,� ..,,�t;;° .t �� �A- r , .. . ,
{ � ,�` 7a�r ` t ';'�, t �.
{ �'�'4 �4� '" l �;� . �„�� '
� �,! �g i s ji
� =.�' "y_ z k.��f:2.� e��� �t� � �y.'�'2
` � ' �..��:?'' '�' �� ._ ry�
'` ;a, !�` t�� �, �' .wr`�.��.�t1, -� � :
,`F�� #•�}�i Y � ..i�s� .t
� . ��i:�i'•#, _°;,'�"
.�Y�,�t,a* i f , �i`��.�t�� n"a:Ioy�f�p' � - ,. ,
'4�, t,� .r��.,� I
+ � � � '�.%��'.;�'.
. f, f f �
� ��� �.
f �..
�*1 t '�,i�. ..q;- _.�, » _ ' � �T.r �ti
`ae:�', ' ,1
€�+� "� �;'��'�,.,�.�;r.��r� . i4
� �-" � .�`t
�4, :���=° r r
� � � ���{i� . ' 3,i-����' , v . . ._ �_�•>wf j ., 1.
� � � � '` �`�ia� k y E ' l�'�Y
� � �#�;.�- ,'!�;',` �
.�.'.
� ,� i � ,� f ,� •_. ,.-� i
'P���„ �i�,��~ ,�.
;R � i , �'7w�+e�'� ]V
, ��!' '�t'� ��t. P`+.�,
t�+ i I ♦
.. . �f �Y�� `;, E � �' •` �'
. '� �+l¢,�,�� .� �� '� j� ��,�
it: i t� t _ ht�. �.f `Z
' ° 3� . , ... j.k,
• =�i ���r' �,�'K +� :
="`sw°.`�►� . � � �. -
�� n.;�`,�`,� ' ,.� � �� ��r
' ;;Y�S+ ? '�i �
� ,� �
, ''�' ";;'y p £'a
� , rs.�x'��`'�t�rytf. ' k � F�'
. .,* ��.�`, ���� '"�,�
. �`',;�
�,-_.
< ., • �r :�'�`_
,�.:`,gj��:` 1'��
„ :�. :. �
�
f �' .� + _
:�;F�- �C�.
. ' • _,` � ',��
�
.:e . . 7• r��
'1't. ' (
. ° f
� .R r h
� "j�df wr`� � .��
f���T p��,t .
�d �
tt
.`' '�+�. _ k
� P^ „ 'i.f�,-�t '
•%''t.�7 � .a .. _ �x":.p°�" r,- .. �,
� PERMIT APPLICATION
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
See. A'1-�ac�lr¢c� C�!!'ow'�
AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing
information is accurate and that all work will comply with all applicable codes. I understand these rndes shall take precedence over all
approved construction documents,and issuance of this permit is verification that I will notify the property owner of Fbrida Lien Law
req., F.S. 713.
The issuance of this permit dces not ensure compliance with deed restrictions and I understand that additional deed
restrictions may apply to this property.
All work shall comply with the current Florida Building Code, Public Works Design Manual and FDOT Design
Standards(if applicable). (Public Works Design Manual online link:www.ci.zephyrhiils.fl.us/public works.asp)
APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT
TECHNICIAN OR NOTARY PUBLIC.
NOTE: The City of Zephyrhilis is not responsible for maintenance or repairs of driveways. Driveways shall not alter/
�^��ere With existin9 stormwater treatmerit and/or conveyance.
PROPERTY OWNERS: By signing this application: I certify that I have read and understand the ownerybuilder disclosure
statement. 5-w' (please initial)
S� �it�i��i A�M.t !N� � �l����
Appl' Pri t Name Applicant Signature Date
. 6-�'���Z
Per i echni ' Signature (or)Notary Signature Date
Applicant is( )personally known to me or produced as identification.
(type of identification)
Page 2 of 3
PERMIT APPLICATION
OFFICE USE ONLY
PI�BLIC Wt�R�1�5�t�ly�1(
Concrete (min. 6'� Y N
Asphalt Base(min. 6'� Y N
/�
Asphalt(min. 1�/z'� Y N
Length (min. 19� Y N � Z
Width (10'min—20'max) Y N l 2�— "
Existing sidewalk. Y N
New sidewalk. Y N
ADA compliant. Y N ►� i}
Expansion material required. Y N /�T �o�' PqYENI E.o,P
Contiguous parking pad. Y N
Triangular flare(3'W x 7'L) Y N
Visibility triangle o.k.? N
Side set back(3'min. R.O.W.) N
Plan Review Fee
Addittonal descri on of work as defined Pwblk�INot�CS Dlrec6pr and or nee:
Permit application approved by: Date: � S�N l z
Page 3 of 3
$�a-�so-oozo City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received
Phone Contact for Permittin _
Owner's Name S�vC. �' S Owner Phone Number �(3 '— 3 l3—����
Owner's Address S���o � � 5 ��, Ow�er Phone Number � �
Fee Simple Titleholder Name Owner Phone Number C �
Fee Simple Titleholder Addresa
JOB ADDRESS 1 LOT# �
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED B NEW CONSTR 8 ADD/ALT � SIGN Q �] DEMOLISH
INSTALL REPAIR
PROPOSED USE Q SFR Q COMM Q OTHER [--
TYPE OF CONSTRUCTION Q BLOCK Q FRAME Q STEEI Q
DESCRIPTION OF WORK �Q��nC wq,.q �d �i d G✓4[K
BUILDING SIZE SQ FOOTAGE �X V � HEIGHT ��
QBUILDING $ VALUATION OF TOTAL CONSTRUCTIOIjR l Z�d
.� .�0
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
QGAS Q ROOFING Q SPECIALTY �] OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER C/���;��. __�Q COMPANY 'e4/� 12'P��L.
SIGNATURE ���w REGISTERED Y/ N FEE CURRE� Y/N
Address License# C �
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# �
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# � �
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# C
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Address License# C
RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construcGon,
Minimum ten(10)working days after submittal date. Required onsite,Constructlon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FadliUes�1 dumpster;Site Work Permit for subdivislo�s/large projects
COMMERCIAL Attach(3)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new conshuctlon.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary FaciNties 8�1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compiiance
SIGN PERMIT Attach(2)sets of Engineered Plans.
"""'PROPERTY SURVEY required for all NEW constructlon.
Directions:
Fill out applicatlon completely.
Owner&Contractor sign back of applicatlon,notarized
If over 52500,a Notice of Commencement ia requlred. (A/C upgrades over 57500)
"' Agent(for the contractor)or Power of Attomey(for the owner)would be someone with nota�ized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Servfce Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable�deed restrictions. '
UNLICENSED CONTRACtORS AND CONTRACTOR RESPONSIBILITIES: If the oWner has hired a contractor or
contractors to undertake work, they may be required to be licensed in accordance with.siate and bcal reguletions. If the
contractor is not licensed as required by law, both the owner and contractor may`be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resou�ce Recovery Fees must be paid prior to
receiving a ucertificate of occupancy" or final power release. If the project does not invoive a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Fu�thermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Fiorid� (:on�truction l:ien Law—Homeowner's
Protection Guide" prepared by the Florida Depa�tment of Agriculture and Consumer Affairs. if the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the°owner"prior to commencement.
CONTRACTOR'S/OWNER'S AFFIDAVIT: I ce�tify that all the information in this applicatipq.is•accurate and that ali work
will be done in compliance with all appiicable laws regulating construction, zoning and 1"ait�"development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
ce�tify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions 1 must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalis, Docks, Navigable Waterways.
- Department of Health 8 Rehabilitative Services/Environmental Health Unit-Welis, Wastewater Treatment,
Septic Tanks.
- US Environmentai Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
If the flil material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
If the fill materiai is to be used in Flood Zone "A" in connection with a permitted building using stem wail
construction, I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued unde� the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO �WNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LE DER O AN ATTORNEY B FORE RECORDING Y UR IC OF C E T.
FLORIDA JURAT(F.S. 117.03 G���i��"� � � /i/
vr
OWNER OR AGEN� . CONTRACTOR
Subscribed and swom to(or affirmed)before me thls Subscribed and swom to(or affirmed)before me this
by by
Who is/are personally known to me or has/have produced Who Islare personally known to me or hasa identlflcatioen
as Identlficatlon.
Notary Public
Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,p�inted or stamped