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<br />CONDITIONSO~ PERMIT AF~IDAVIT
<br />A.. NOTICE O~ DE~p RESTRICTIONS
<br />The undersigned understands that this per~it .2Y be subject to 'deed restrictions' ~hich may be more restrictive than City
<br />regulations. The undersigned assu~es responsibility for compliance with any applicable deed restrictions.
<br />
<br />B. UNL I CENSED CONTRACTORS I'~NJ:) CONTRACTOR F::ESC:J2H!2) ~U..._LT I E~L
<br />If the OMner has hired a contractor or contractors to undertate nork, they may be required to be licensed in accordance with
<br />state and local regulations. If the contractor is not licensed as required by law, both the onner and contractor ~ay be
<br />cited for a eisde~eanDr violation under state law. If the owner or intended contractor are uncertain as to what licensing
<br />requireaents Day apply for the intended worl:, they are advised to contact the City of Zephyrhills Building Department, (813)
<br />788-6611.
<br />
<br />Furtheraore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
<br />'Contractor Sections' of this application for which they will be responsible. If your 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 aay be an indication that he is not properly licensed and is not entitled to per~itting privileges in the
<br />City of Zephyrhills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONi'-IECTION FEE,2
<br />
<br />I
<br />D. CONSTRUCTION LIEN LA~ (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 - Homeowner's Protection
<br />Guide' prepared by the Florida Depart~ent of Agriculture and Consumer Affairs. if the applicant is someone other than the
<br />'oNner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the
<br />'oNner' prior to commencement.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVI~
<br />I certify that all the information in this application is accurate and that all work will be done in compliance with all
<br />applicable laws regulating construction, zoning, and land development.
<br />
<br />Application is hereby made to obtain a permit to do work and installation as indicated.' I certify that no work or
<br />installation has conenced prior to issuance of a penit and that all Hork 11111 be performed to ,1eet standards of all laws
<br />regulating construction, City codes, zoning regulations! and land develop~ent regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other governmental agencies may apply to the intended work, and that it is
<br />.y r'sponsibility to identify what aetic.ns I must take to be in compliance. Such agencies include but are not liDited tCI:
<br />f Department of EnvironDentaI ReQulation - Cypress Dayheadsr Wetland Areas and Environmentally Sensitive Lands,
<br />Hater/Wastewater Treatment
<br />f Southwest Florida Water ManaQement District - Wells, Cypress Bayheads, Hetland Areas, Altering ~atercourses
<br />f Arty Corps of Enoineers - Seawalls, DOCKS, Navigable Waterways ,
<br />f Department of Health L Rehabilitative Services, Environmental Health Unit - Wellsr Wastewater Treataent, Septic Tanks
<br />f US Environmental Protection AQencv - Asbestos abatement
<br />I also certify that, if fill material is to be used in Flood Zone 'A" or "A,etc.', it is understood that a drainage plan
<br />addressing a 'compensating volume' will be submitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to permit issuance. "
<br />
<br />A permit issued shall be construed to be a license to proceed with the Hork 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 code, Every per~it issued shall become invalid
<br />unless the work authorized by such permit is commenced ~Iithin six months of issuance, or if work authorized by the permit is
<br />suspended or abandoned for a period of six ~onths after the time the Nork is com~enced~ .One 90 day extension of ti&e, ~ay be
<br />allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official, An
<br />approved inspection must be logged during each six month period, or the project will be considered abandoned.
<br />IlflRNIN6 TO OIHlER: YOUR FAILURE TO RECORD A NOTICE OF COlmENCEHENT~tAY RESULT IN YOUR PIWlN6 THICE FOR HIPROVEMErHS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCII16 , CONSULT HITH YOUR lENDER OR AN ~TTORNEY BEFORE RECORDING YOUR !lOTICE OF
<br />CO",E;;"ENT. JODS "NOER l~; ~O NOT NEED TO RECORD MID POST A 'N~T1~~ O~!O""E~. . r
<br />
<br />
<br />d~P'r~ ( t {~ ?!it~
<br />SIGIIATURE: OWNER OR AGENT 8M URE: COlHRACTOR
<br />t'f\ \~-~'l1..'S.'-~\C ~- \C-I-<\~
<br />
<br />STATE OF FLORIDA rJ'>
<br />COUIlTY OF TG:.&. c...::;
<br />The. fc.regoi ng i 17r-ument I-Jas acknowledged
<br />before me thisJ~() , 19~by
<br />
<br />f/tk~- e- ,,~
<br />
<br />who is personally ~nown to me Dr who has
<br />produced
<br />as identification and who did/did not
<br />take;jn/oath. /1 J
<br />fMadltrr ~
<br />(SignatLll-e)
<br />
<br />STATE OF FLORIDA
<br />COUIITY OF ~~c..()
<br />The foregoing instrument was acknowledged
<br />befc,,-e me this ld...... (')0\1., 19~ by
<br />
<br />~cJ
<br />
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />\
<br />,
<br />
<br />~HARU:Jm MIl UIlllM
<br />No.,,... 11 . II....
<br />My ComI' I... r........IUN ..-
<br />OQMM.A1I1IITI
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