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<br />A. I.:-'_QT :LeE OF DEE:~D r,E~:;Ti~: I CT I Clf\.j~;
<br />1he I1ndersignvd und~;5lil-~~j~'th,;i.this -p~~il-;;;;:-i~uldect to 'c..:~d t'estrict;("ns' I/hich lay be lore restric live thall Ci ty
<br />rel;ulill!ons. The ur.dersigned ar-sules responsibility for Coa~h;:IlL~ Nith allY applie.ble' deed restrictions,
<br />
<br />[;. ~Jf\IL I CENSED COI:Jn:-.:i:jCTQr{s......BJ:i.Q., CONTRACTOR F:f::-Sr:'()I\IE; I DI LIT I ES
<br />If the DlIller has hired a contractor or cOlllrilctcrs .0 undertake lIork, they ~-~y-b~-~~qui-~;dtc.b";}icl!nsed in acee.raance 'lii lh
<br />~tate and local regulations, If the'contrDc~or :s.~ot licensed as requir~d by law, bolh the ownl!r and contractor .ay be
<br />cited fQr OJ lisdeleanor violation under sti!~~ :illl. If the oWl1er or intended ceoli\rilctClr are uncertain as to what licenSIng
<br />require~ents lay apply for the intended work, ~hlY are advised to contact the Cily of 7ephyrhills Building Depart.ent, (813)
<br />78[j-6611 ,
<br />
<br />Furtherlore, if the owner has hired a contractor or contra(tor~, ~~ .s advised to have the contractor(s) sign pDrlions 0f the
<br />'Contractor Sections" of this application for which they ":11 Je I~S~OIl~ihlE. If you, as the owner sign as the contractor,
<br />you dre indicating that you, rather than the contractor, are respJnsible for the work. If the contractor wishes you to siqn
<br />as contractor that aay be an indication that he is nQt properly licensed and is not entitled to perlitting privileges in'the
<br />Ci~y of Zephyrhills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CON~ECTION FEE~
<br />
<br />D. COt.JSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, (,S AMENDED)
<br />I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - Homeowner's ProtectIon
<br />Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. if t~eapplicant is SOleone other than the
<br />'owner", I certify that I have tbtained a copy of the above described doculent and promise in good faith to deliver it to the
<br />'owner" prior to (Ollencelent,
<br />
<br />E. CONTRACTOR'S/DWNER'S AFFIDAVIT
<br />! fertify that all the inforlation in this application is accurate and that all Nor~ will be don? in coapliance with all
<br />arplicab)~ lalls regulating construction, zOlling, and land developaenL
<br />
<br />Aoplication is hereb~ ~ade to obtain a perlit to do Nork and installation 1S indicated. I certify that no wDrk or
<br />instal1ati~n has co..eneed prior to issuance of a perlit and that all work will be performed to leet standards of dll l~w~
<br />regulating construction, City codes, zoning regulations, and land developlent regulatiQns in the jurisdictiDn, I .150
<br />cprtif! that I understand that the regulations of other govern~ental agencies may ap~ly to the intended ~0rk, and that :t is
<br />E:'( rer,ponsibility to identify what actions I lust take to b, in cOipliance. Such agencies include but arf ne,\ liaded te,:
<br />I f)P..P..a!J~~~lVir~_~~~tion - Cypress Bayheads, lIelland Areas and Elwiror'loentally Sensitive Land<;,
<br />Water/llastewater Treat~ent
<br />I ?g_~~_~st Flprida Water ~anaqeaent District - Wells, Cypress Bayheads, lIetland Areas, Altering Watercourses
<br />{ r~X.J~1S of Enqineers - Sl'iltalls, De,ds, Navigable Watefll.':.'/s
<br />9_e.Q~:.t~ent of He,l1th !. Rehabilitative Services, Environllf!'~~_ ' Health Unit - ~)ells, Wastewater Treataent, Septic Tdnks
<br />I U~~r~Jc~Q~~~ntal PrQtecti~~ Aqency - Asbestos abatelent
<br />;;lsD cprtif)' that, if fiil material is to be used in Flood 7c,ne 'A" or 'A,etL', it is undershod tt:,;t a draInage plan
<br />addre5~ing a 'coLlpensating voluiIle" will be sublitted which i5 ill epared by a professic'nal engineer reglc"ttred III t111: State of
<br />Florida prior to perait issu~n(e.
<br />
<br />A perlit issued shall be con~trued to be a license to proceed with the Morl: and not as authority to violate, cancel ~ltec, DC
<br />set aside any provisions of the technical codes, nor shall issuance of a per~it prevent the Building Official fcoc thereafter
<br />requiring a correction of errors in plans, construction, or vi~]ations Qf any code, Every periit issued shall beC0k€ InvalId
<br />unless the work authorized by such perlit is CONlenced within six months of issuance, Dr if H0rk authocized bf t~2 perlll lS
<br />susp~nded Dr abandoned for a period of six lonths after the time the Mork is co~~enced.' One 90 day extension of Il~e, aav ~p
<br />allowrd for the perlit with fee charge of $15.00. The extension shall be requested in writing to the BUIlding Dffl[lal, An
<br />approved inspection must be logged during each six Ilnth period, Dr lhe proJPct ~ill be cOllsldeted abdudDllrd.
<br />WnRHI~G TO OWNER: lOUR FAILURE TO RECORD A NOTICE OF COHMEr~EMENT MAY RESULI IN YOUR rAYING THICE FOR I"PROY["lH1S 10 YUUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FIHANCINS, CONSULT WITH YOUR LENDER OR AN AII0RNEY BEFORE RECORDING YOUR ~QTIC[ OF
<br />CO~\t1ENCEt1EHT. JOBS UNDER 12,500 IN VALUE DO NOT NEED TO RECORD MD POST A 'NOTICE OF COI1I1EllCEtlnn'.
<br />
<br />~
<br />
<br />SIGNATURE: OWNER ~
<br />
<br />
<br />...-'-
<br />,/
<br />
<br />STATE OF FLORIDA
<br />coulm OF \-\ \ \ \ s \YO r 0 U.a h
<br />The foregoing instrument w~ acknowledged
<br />before me this Or-\-. ~ , 19~ by
<br />
<br />p~, \ \O'1e
<br />whe, lS iJers~I',c.lly kno\f:ll to me c,r whe, has
<br />prDG,..H:ed ~, \ ve ~ \ C e (\ e....
<br />as identification and who did did not
<br />
<br />takE_ a4!~ ...l r .
<br />(Sig"atu~)t\~. ~:;
<br />
<br />
<br />(Name fyped, Printed or Stamped)
<br />
<br />N.OTARY PUJ1LJI
<br />
<br />NOTARY PUBLIC, stAlE OF FLORIOA,
<br />MY COMMISSION EXPIRES: SL'I. ~8, 1993,
<br />SONDED THRU NOTARY PUB~IC Uru.....e:RWRITER..
<br />
<br />ST~TE OF FLORIOA
<br />COUNTY OF
<br />The forege, i. nlJ
<br />befc'j-e me this
<br />
<br />I Hillsborollc;h
<br />instn.llnent vl,,'.S ",cl,r'L,\.;l':~d(](~cj
<br />
<br />]0/8
<br />
<br />, 1 9_<1.:2__ by
<br />
<br />Mario Gonzalez
<br />
<br />~ho is personally
<br />pr-6dLlced
<br />as identiflcat10n
<br />take a
<br />
<br />I::nO\'ln
<br />
<br />tc, me
<br />
<br />()1- ~"Jh[l lidS
<br />
<br />af)d who dld/did
<br />
<br />nc, t
<br />
<br />N !..J )Y-i:, "-~'--'-1-
<br />(Signa Ire)
<br />\1
<br />Gerda C, Ne',berty______,____
<br />(Name Typed, Printed or Stamped)
<br />r~OTAR,( f:UW=-.II
<br />
<br />~
<br />
<br />(~
<br />
<br />.~1('
<br />: f9l"
<br />
<br /><..Olikl>A C. NJ!WlIliKRY
<br />No'.,y Public, 5'01e 01 Florida
<br />My Comm, hpifC' Feb 13..1996
<br />No, CC 11:106/0
<br />
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