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<br />r"'!".i1" 0' -- T 0['19 C~- PEHI,ol I T (',FF I Dr:; 'v I T
<br />A. NOTICE OF D~~U k~bIRl~llUN8
<br />The undersigned understands that this permit ~ay be subject to "deed restrictions' Hhich ~~y be roore restrictive than C:_ -
<br />regulations. The undersigned assumes responsibility for compliance with any applicable de!d restrictio.s,
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<br />B. UNL I CENSED CONTRACTORS e,ND CQ/'oITRACTQR ,..f:Em~:.iJl'.:!S..L[~li~..LU E;,;::;
<br />If the owner has hired a contractClr ot cClntractors to undertake "Clrk, they Illay be required tel b~- i-i-censed in accordance with
<br />state and local regulations. If the contractor is not Ii .ensed as required by law, both the Clwner and contractor may be
<br />cited for a misdeleanor violatjCln under state law. If the owner or intended contractor are uncertain as to what licensino
<br />requirelents lay apply for the intended work, they are advised to contact the City Clf Zephyrhills Building Depart~ent, (813)
<br />788-6611.
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<br />Furthermore, if the owner has hired a contractor or contr..ctors, he 1S advised to have the contractor(s) sign portions of the
<br />'Contractor SectiClns" of this application for which they ~ill be responsible. If you, as the {.wner 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 may be an indication that he is not properly licensed and is not entitled to per~itting privileges in the
<br />City of Zephyrhills.
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<br />C. TRANSF'ORT A T I ON Il'1PACT FEES AND UT I L I TY CONI\IECT I OJ:::!.. FEEfi.
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<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 - HOf.e~wner's Protection
<br />Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. if the applicant is ~o~eoneother than the
<br />"owner', I certify that I have obtained a copy of the above described docuroent and promise in good faith to deliver it to the
<br />"owner' prior to cO~IDencement,
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<br />E. CONTRACTOR'S/DWNER'S AFFIDAVIT
<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 lalls regulating construction, loning, and land Jevelopment.
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<br />Application is hereby made to obtain a perlit to do work and installation as indicated, I certify that no work Dr
<br />installation has commenced prior to issuance of a permit and that all work will be perfor~ed to ~eet standards of all laws
<br />regulating construction, City codes, loning regulations, ~nd land development regulatiuns 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 />IY responsibility to identify what actions I must take to be in cocpliance. Such agencies include but are not limited to:
<br />f Deoarttent of Environmental ReQulation - Cypress Bayheac;, Wetland Areas and Environ~ental]y Sensitive Lands,
<br />Water/Wastewater Treatment
<br />f Southwest FIClridi Water Manaoement District - Wells, Cyp~es5 Bayheads, Wetland Areas, Altering Waterco~rses
<br />f Aray Corps of Enoineers - Seawalls, Docks, Navigable Wat~rways
<br />f Deoartment of Health ~ Rehabilitative Services. Environmental Health Unit - Wells, Wastewater Treat~ent, Septic Tanks
<br />f US Environlental Protection AQencv - Asbestos abatement
<br />I also certify that, if fill laterial is to be used in FloLJ Lone "A' or "A,etc,', it is understood that a drainage plan
<br />addressing a 'compensating voIJ!e" will be submitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance.
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<br />A perlit issued shall be construed to be a license to procred with the Hork and not as authority to violate, cancel alter, Dr
<br />set aside any provisions of the technical codes, nor shall issuance of a per~it prevent the 8uilding Official frolli thereafter
<br />requiring a correction of errors in plans, construction, Dr violations of any code, Every per~it .issued shall becote invalid
<br />unless the work authorized by such permit is com~enced Hithin six months of issuance~ or if ~ork authorized by the permit is
<br />suspended or abandoned for a period of six Donths after the time the work is cOffiffienced. One '90 day e~ten5ion of ti~e! lay be
<br />allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the 8uilding Official. An
<br />approved inspection must be logged during each six month period, Dr the project will be considered abandoned.
<br />HARNING TO OHNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR . OR BE ORE - 0 ~OTICE OF
<br />COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND p' A 'NOTI" OF
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<br />,NATURE: CONTRACTOR ~~"tl
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<br />/ r-..-
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<br />STATE OF FLORI!)~ .
<br />COUNTY OF !!_ll..5 t?-O
<br />The foregoing instrument was acknowledqed
<br />before me th is fill Ii-, /'1 , 193..3. by -
<br />
<br />The forege.ing inst;-ument 1'125 ackn:'I'Jledged
<br />befctj-e me this "I--f'1f!11-. 1<1 , 19 43 bv
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF jJ II ,.S (! 0
<br />.
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<br />7< A y A '7?ILbl,~ ~- .-, o'
<br />vJho i ~Ee)C5c<nal ~)l.:nOI.m tOI~.V[tj- loihc. has
<br />pl-oduced .- -
<br />as identification and who did/did not
<br />take ~oath. . ~.. -1f). _
<br />~fL-<'. l, ~4/-v( hr..__
<br />(Signatu,-e) t<A". _c7:S,u...:J: 13 Rt'vJ AI
<br />
<br />vER IZY' P !-1I1A/1:S
<br />I"ho is.....~personcSry_t~Tio\'m who has
<br />pl-oducea--- -
<br />as identification and who did/did not
<br />take an o:;,~ - I~ 1
<br />- ~t..1,,~.J (.A/~
<br />(SignatLll-e') '/(lH1f~EI{ J: 'J3RtI~JJ
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<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTAF:Y PUBL I C
<br />
<br />(Name Typed, Printed or Stamped)
<br />UQT AR'(J...1~f3L L~
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<br />.~
<br />
<br />KATHL&EN J. BRI)WN
<br />Slate of Flori,]:!
<br />.., Comm. ExD. April 2, 1995
<br />Comm.' ec 095617
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<br />~
<br />
<br />KATHLEEN J. BROWN
<br />State of F! 'J r r]a
<br />Mreomm. Exp. April 2,1995
<br />eomm. , CC 095617
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