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s�aaao-oozo � City of Zephyrhills Permit Application Fax-813-780-0021
<br /> NOTICE OF DEED RESTRICTIONS: The undersigne�`{'��'8$��a�efl�at this permit may be subject to"deed" restrictions" �
<br /> which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
<br /> appliGable deed restrictions.
<br /> UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
<br /> contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the
<br /> contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
<br /> under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
<br /> intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
<br /> 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
<br /> portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
<br /> contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
<br /> County.
<br /> TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
<br /> that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
<br /> use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
<br /> 90-07, as amended. The undersigned�also understands, that such fees, as may be due, will be identified at the time of
<br /> permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
<br /> receiving a "certificate of occupancy" or final power release If the project does not involve a certificate of occupancy or
<br /> final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
<br /> fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
<br /> CONSTRUCTION LIEN LA11V (Chapter 713, Florida Statutes, as amended): If valuation of work is$2,500.00 or more, I
<br /> certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
<br /> Protection Guide" prepared by the Florida Department of Agriculture and Consumer, Affairs. If the applicant is someone
<br /> other than the"owne�', I certify that I have obtained a copy of the above described document and promise in good faith to
<br /> , deliver it to the"owner" prior to commencement.
<br /> , CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work
<br /> will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
<br /> hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
<br /> commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
<br /> construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
<br /> certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
<br /> my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
<br /> - Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
<br /> Lands, Water/Wastewater Treatment.
<br /> - Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
<br /> Watercourses. �
<br /> - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
<br /> - Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
<br /> Septic Tanks.
<br /> - US Environmental Protection Agency-Asbestos abatement.
<br /> - Federal Aviation Authority-Runways.
<br /> I understand that the following restrictions apply to the use of fill:
<br /> - Use of fill is not allowed in Flood Zone"V" unless expressly permitted. �
<br /> - If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
<br /> "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
<br /> licensed by the State of Florida.
<br /> - If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
<br /> construction, I certify that fill will be used only to fill the area within the stem wall.
<br /> - If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
<br /> properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
<br /> the conditions of the building permit issued under the attached permit application, for lots less than one (1)
<br /> acre which are elevated by fill, an engineered drainage plan is required.
<br /> If I am the AGEMT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
<br /> this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
<br /> plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A
<br /> permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
<br /> set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
<br /> requiring a correction of errors in plans,.construction or violations of any codes. Every permit issued shall become invalid
<br /> unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
<br /> the permit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
<br /> may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
<br /> justifiable cause for the extension. If work ceases for ninety(90) consecutive days, the job is considered abandoned.
<br /> WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
<br /> PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERfI(. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
<br /> WITH YOUR LENDER OR AN ATTORNEY BEFOR� RECORDING YOUR NOTICE OF COMMENCEMENT.
<br /> FLORIDA JURAT(F.S.117.03) , ' � ' ,
<br /> OWNER OR AGENT������!y�OrY�c2yt�C-�-� �CONTRACTOR '�'.�l� �
<br /> Su¢scri ed and swom to(or affirmed)b fore me this. _ , _ Subscribed a swor (or affirmed)before me this
<br /> J�/S r bY��F,-f�t�—h�a rna��,�in, s'//S�/7 _ S.q-c�� L�� c!�c,–J, a c�
<br /> Who is/are personally icnown to me or has/have produced Who is/are personally known to me or has/have produced
<br /> as identification. as identification.
<br /> - �-' � �• � otary Public � ' � otary Public '
<br /> Commission No. �0 /G'0�-� , � Commission No._ FF`l/(0 4 ��'}'
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<br /> Name of Notary typed,printed or stamped ^ Name of Notary typed,printed or stamped
<br /> ;��:�`�'�; LINDAANId KRUMHCLTZ :�"° LtNDAANM KRUMHOLTZ #
<br /> :+;��: MY CONMISSION#�F976028 �� �' �
<br /> " MY CQMMISSION#FF916028 i
<br /> '.2,,,���" EXPIRES Septembar 07.2019 "'2a;,y��� EXPIRES September 07,2019 �
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