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<br />CONDIT7~NS O~ PC~~IT AFFIDAVIT
<br />
<br />A. NOTICE OF DEED RESTR ICT::.O!\iEi.
<br />The ~ndersig~ed understands that this permit .~v bp subject to "deed restrictions" which lay be more restrictive than City
<br />regulations. The undersigned assules respon5ib~lity for compliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contractor or contractors to undert~ke -;ork;~ey may-be~Q-uired ~b;.~icensed in accordance with
<br />state and local regulations. If the contractor i,. not licensed as required by law, both the owner and contractor lay be
<br />cited for a lisdeleanor violation under state iaw" If the owner or intended contractor are uncertain as to what licensing
<br />requirelents lay apply for the intended "ork, they are advised to contact the City of Zephyrhills Building Departlent, (8131
<br />788-6611.
<br />
<br />Furtherlore, if the owner has hired a contractor or contractors, he is advised t'o have the contractor(sl sign portions of the
<br />'Contractor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
<br />as contractor that lay be an indication that he is not properlY licensed and is not entitled to perlitting privileges in the
<br />City of Zephyrhills.
<br />
<br />C.
<br />
<br />I
<br />TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEE~
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, have been provided with a copy of 'Florida's Construction Lien Law - Ho.eowner's Protection
<br />Guide. prepared by the Florida Department of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
<br />'owner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the
<br />.owner' prior to co..ence.ent.
<br />
<br />E. CONTRACTOR'S/qWNER'S AFFIDAVII
<br />I certify that all the information in this application is accurate and that all work will be done in cOlpliance with all
<br />applicable laws regulating construction, zoning, and laDd develop.ent.
<br />
<br />Application is hereby made to ~btain a perlit to do work and installation as indicated. I certify that no work Dr
<br />installation has commenced prior to issuance 0' a permit and that all work will be perforled to seet standards of all la~s
<br />regulating construction, City codes, zoning r2Q~lations, and land developlent regulations in the jurisdiction. I also
<br />certify that I understand that the regulation~ of other governmental agencies lay apply' to the intended Mork, and that it is
<br />IY responsibility to identify what actions I lust take to he ill cOlpliance. Such agencies include but are not lilited to:
<br />f Depart.ent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,
<br />Water/Wastewater Treat.ent
<br />f Southwest Florida Water ManaQement District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />f Army Corps of EnQineers - Seawalls, DOCKS, Navigable Waterways
<br />I Department of Health ~ Rehabilitative Services, Environ.ental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
<br />f US Environ.ental Protection AQency - Asbestos abate.ent
<br />I also certify that, if fill .aterial is to be used in Flood Zone 'A' or "A,etc,", it,is understood that a drainage plan
<br />addressing a 'colpensating volule' will be submitted which is prepared by a professional engineer r~gistered in the State of
<br />Florida prior to perait issuance.
<br />
<br />A perlit issued shall be construed to be a license to proceed with the Mork and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical code~l nor s~:all issuance of a pertit prevent the Building Ufficial frot thereafter
<br />requiring a correction of errors in plans, constructior; or violations of any code. Every perlit issued shall becole invalid
<br />unless the work authorized by such perlit is co.tenced within ~ix lonths of issuance, or if work authorized by the permit is
<br />suspended or abandoned for a period of six months after th~ t:!e the work is comeenced. One 90 day extension of ti~e, lay be
<br />allowed for the perlit with fee charge of $15.00. The extension shall be requested in ,writing to the Building Official, An
<br />approved inspection lust be logged during each six lonth period, or the project will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING THICE FOR IMPROVEMENTS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
<br />COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
<br />
<br />SI6NATURE: CONTRACTOR
<br />
<br />SI6NATURE: OWNER OR AGENT
<br />
<br />~J .~~
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument was acknowledged
<br />'.J',=fcq-e il1e;h"s 1'7'_ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing i~strument was
<br />before me t~i5 19
<br />
<br />ackrv:'!.l edged
<br />
<br />who is personally known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an oath.
<br />
<br />who is personally known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an oath.
<br />
<br />(S i gna tLll-e)
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed Dr Stamped)
<br />NOTARY PUBLIC
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
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