|
<br />'VE":'!llIII',,[...., ""._"...., ". "6"",__,,,_..,_. '"" t:Il
<br />
<br />I~
<br />
<br />....
<br />
<br />..
<br />
<br />CONDITIONS OF PEqMIT AFFID~VIT
<br />L~2:r:l q~J!~PEED RESTR I CT I ONf';
<br />he unc~r5lgned understands that this perlit .ay be subject ~, "deed restrictions" which lay be lore restrictive than City
<br />f!(julat c,r'i, The undersigned assules responsibility for co.piiance with any applicable deed restrictions.
<br />
<br />!t~!=-I q::NSED CONTRACTORS A.I;!D CONTRACTOR RESPONS.I B I LIT I ES
<br />: the )wner has hired a contractor or contract~r5 t~ ur.d~.take work, they lay be required to be licensed in accordance with
<br />tate aid local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be
<br />, lted rJr d lisdele2!lOr violation under state law. If the ollner or intended contractor are uncertain as to what licensing
<br />~quir[>'ents lay apply for the intended work, they are ~dvised to contact the City of Zephyrhills Building Deparhent, (813)
<br />. '38-66: 1.
<br />
<br />: ~Tther'ore, if the owner has hired a contractor or contractors, he is advised to have the contractorlsJ sign portions of the
<br />Contrdctor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor,
<br />'ou are indicatIng that you, rather than the contractor, are res,onsibIe for the work. If the contractor wishes you to sign
<br />s contractor that Day be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
<br />.ity tf Zephyrhllls.
<br />
<br />rF;AN~F'ORTATION IMPACT FEES AND UTILITY CONNECTION FEES.
<br />
<br />CONS1RUCTION LIEN LAW (CHAPTER 713. FLORIDA STATUTES. AS AMENDED)
<br />r certIfy that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law - HOleowner's Protection
<br />3uide" prepared by the Florida Departlent 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 doculent and promise in good faith to deliver it to the
<br />'owner' pr ior to COlllenCElent.
<br />
<br />.. CONTr:<ACTOF:' S/O\.oJNER I S AFFIDAVIT
<br />I certIfy that all the inforlation in this applic~tion is accurate and that all work will be done in coapliance with all
<br />appli dbl~ laws regulating construction, zoning, and land developlent.
<br />
<br />Application is herEby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
<br />Installation hds cOllenced prior to issuance of a perlit and that all work will be perfor.ed to leet standards of all laws
<br />regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
<br />certify that ( understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
<br />~y responsibilIty to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
<br />. ~aTt.ent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
<br />W~ter/Waste~ater Treat.ent
<br />. Southwest Florida Water HanaQelent District - Wells, Cypress Bayheads, Wetland Ar~as, Altering Watercourses
<br />. Art! Corps C<f EnQineers - Seawalls, Dods, Navigable Waterways
<br />. Departlent ~f Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
<br />. US Environlental Protection AQency - Asbestos abatement
<br />I al~G certify that, if fill laterial 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 sublitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance. ..
<br />
<br />A per~,it issued shall be construed to be a license to proce~d 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 perlit prevent the Building Official frol thereafter
<br />requlring a correction of errors in plans, cQ~5truction, or violations of any code. Every perlit issued shall becole invalid
<br />unless the work authorized by such perlit is COllenced within six lonths of issuance, or if work authorized by the perlit is
<br />suspended or abandoned for a period of six lonths after the tile the work is cOlienced. One 90 day extension of tile, lay be
<br />allowed:for the perlit with fee charge of $15"O~. The extension shall be requested in writing to the Building Official. An
<br />apprDved inspection lust be lo~ged durinq each siy, acnth period, or the project will be considered abandoned.
<br />WARNI~G TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCEHENT HAY RESULT IN YOUR PAYING TWICE FOR IHPROVEMENTS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
<br />',""E~) JO'S UHOER ".500 IH 'OlUE ~O NOT NEED TO RE'ORO AHO pOST A "HOT ICE OF ',"KEH'EKEHT".
<br />
<br />
<br />., .~ ~.c<~
<br />
<br />SIG URE: OIlNER OR AGENT I6NATURE: CONTRACTOR
<br />
<br />STATE OF FLORIDA ()
<br />COUtnv OF I~ Q J:i:' f)
<br />The foregoing ins~mr[lt was 7'f.\j)lc;wled~ '?d
<br />befclre me thIS )D . L!:lJq, 1'7~::'1
<br />
<br />STATE OF FLORID~
<br />COUNTY OF / ()~JL)
<br />The foregoing instrum
<br />befron:? me this 10m
<br />
<br />
<br />was aC~jledged
<br />. 19....' bv
<br />,- .
<br />
<br />
<br />(Y)t-Lv/IJ ~wRCIe ;:JR-
<br />
<br />
<br />who is personally me Dr who has
<br />pl-c,duce ...
<br />as 'd:~~fication and who did/did not
<br />
<br />take ~.;~hQ hf bull k oN
<br />
<br />(Sign~ure) \ r Q /. ^..J.-L
<br />UP)} I , rL: UUR.~~
<br />(Name Typed. Printed or Stamped)
<br />NOTARY PUBL i c ".'-;,~'ii~'r~~;-... GAIL W. BURKETT
<br />i.r'h ';.r:1 MY COMMISSION' AA 694972 EXPIRES
<br />~$;'~.ii: August 31, 1993
<br />"":r,f.Hr.::~~'" BONDED TIlRU TROY FAIN INSURANCE,INC.
<br />
<br />who is ersonally or who has
<br />produced
<br />as identification and who did/did not
<br />take pp_ oath. . (11. ,u ~
<br />.~1 Q ~ ~J1!LlP~
<br />(Sig~atLlr.e) ! () ",/. Jj,
<br />(.!2 A / L Yl QUtf!:(" ~ ]T~
<br />(Name Typed, Pr~~\~p or Stamped)
<br />lo\....l:~.,.... GAIL W BURKETT
<br />NOTARY PUBL I C {~:".6"1~ MY COMMISSION i AA 694972 EXPIRES
<br />'1.i-&\f;,.l Aullust 31, 1993
<br />. ..I/f"f,I..' QQNIltiO lllFlU TROY FAIN INSUIlANCE. 1He.
<br />
|