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<br />CIJND 1 'J (INS ure-. PFnr.v T (\F F I D{W IT
<br />() . NQLH;:_~_QL...pg~!L.BsSTR I CT I UNE,
<br />The lIJ1der!iigned under!ihnd!i that thi~'p;;~-it--;;yh-b~~lIbjed to "d"ed r!'!itrirt.ion!i" Nhich lay be lore r!'!itridiv!' than Ci~y
<br />regulations. The undersigned a!iSUles responsibility fllr rll~pliilnce Nith any applicable deed restrictions.
<br />
<br />Fe. UN1::Lc,:EN$.E-.P_t::QHIf-y'~1;IJJ.B!:J.,OIJl)""I':UI'ITHDCIOF\, RESFUI'ISI B IL IT I ES
<br />If the ONner has hired ~ contractor or Cl'ntr actors hi under til~P ~~r~,'th~y ",ayb~~~Q~'i-~~'dt~-b'~-ii(l!nsed in ilw.rdance Nith
<br />state and local regulations. If the contractor is not lic!'nsed as required by Iii", both the o"ner and contractor lay be
<br />cited for iI lisdeleanor violation under stilte IaN. If the ONner or intended contractor are uncertain as to "hat licensing
<br />require.ents lay apply for the intended "ork, they are adyised to contact the City of Zephyrhills Building Depart.ent, 18131
<br />788-bbll.
<br />
<br />Further.ore, if the o"ner has hired a contractor or contractors, he is advised to have the contractor Is) sign portions of the
<br />"Contractor Sections" of this application for "hich they Nill be responsible. If you, as the o"ner sign as the contractor,
<br />you are indicating that you, rather thiln the contractor, are responsible for the "ork. If the contractor "ishes you to sign
<br />a!i contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
<br />City of tephyrhills.
<br />
<br />C .IBANE?F' aRT AT UJJLJ "jP r\I;_LEI;_J;:_~__llttl)h,___lJJJ.'=-tD::_..l,:;m~NgJ;~.lJ Qlt..F EE.!2.
<br />
<br />D. (:;JJN~JRUC:;TtQN_.I""LE:::!'L.!--_"H (CH(\PTER '7:l ~=t ~ FLun J J)() STATurES ~ r\s (WIEI\IDED:I
<br />I c"rtify that I, the applicant, have been provided Nilh a copy of "Florida's Construction Lien La" - Ho.eo"ner's Protection
<br />Guide" prepared by the Florida Depilrt,ent of Agriculture and Con~u.er Affairs. If the applicant is so~eone other than the
<br />"oNner", I certify that I have obtained a copy of the above described doc~~ent and pro.ise in good faith to deliver it to the
<br />"oNner" prior to cO'lencelent.
<br />
<br />F. cm':!IFnCTQR ~m'J..N~B~_~:LBIJ:::J..RA.YJ,I
<br />I certify that all the infor.ation in this application is accurate and that all work "ill be done in co.pliance "ith all
<br />applicable laws regulating con~truction, loning, and land developlent.
<br />
<br />Application is hereby .ade to obtain a per.it to do "ork and installation as indicated. I certify that no work Dr
<br />installation has co..enced prior to issuance of a perlit and that all "ork "ill be perforled to leet standards of all la"s
<br />rpgulating construction, City codes, loning regulations, and land develop.ent regulations in the jurisdiction. I al!io
<br />certify that I understand that the regulations of other govern,ental agencies lay apply to the intended work, and that it is
<br />.y re~ponsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not li.ited to:
<br />, Depart.ent of Environ.ental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
<br />Water/Wastewater Treat~ent
<br />, Southwest Florida Water nanaqelent District - Wells, Cypress Fayheids, Wetland Areas, Altering Watercourses
<br />, ~r.v Corps of Enqineers - Sea"alls, Docks, Navigable Waterways
<br />, Qeparteent of Ilealth I. Rehabilitative Services, Environ.ental Health U,nit - Wells, lIaste"ater Treat.ent, Septic Tanks
<br />, US Environlental Protection Aqenry - Asbestos abate.ent
<br />I also certify that, if fill laterial is to be used in Flood ZDne "n" Dr "A,etc,", it is understood that a drainage plan
<br />addressing a "co.pensating volu.e" "ill be subtitted "hich i!i prf.pared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance,
<br />
<br />n perlit issued shall be construed to be a license to proceed with the "ork and not as authority to violate, rancel alter, or
<br />set a!iide any provisions of the technical codes, nor shall issuance of a per.it prevent the Building Offirial fro. thereafter
<br />requiring a correction of errors in plans, construction, Dr violations of any code. Every periit issued shall bero.e invalid
<br />unless the "Drk authorized by such per.it is co.tented "ithin si~ lonths of issuanre, or if work authorized by the perlit is
<br />suspended or abandoned for a period of six .onths after the ti.e the work i!i cOltenced. One 90 day extension of tile, lay be
<br />allo"ed 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 .onth period, or the project will be considered abandoned.
<br />WARNING TO OIlNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT nAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBIAIN 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 />----
<br />
<br />SIGNA lURE: OWNER OR AGENT
<br />
<br />SIGNATURE: CONTRACTOR
<br />
<br />SlATE OF FLORIDA
<br />COIJN TV OF
<br />The for'egoing instrument
<br />befor-e me th is
<br />
<br />I-Ias acknNlIedged
<br />, 19_ by
<br />
<br />STAlE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument
<br />before me this
<br />
<br />I-Ias ac kncll-II edged
<br />~ 19_ by
<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 />\l'lho is pel-sona 11 y knol'm to me c,r I..,hc, has
<br />pn;duced
<br />as identification and who did/did not
<br />take an oath.
<br />
<br />(SignCltLu-e)
<br />
<br />(Signahn-p)
<br />
<br />(Name Typed~ Printed or Stamped)
<br />t.1Q,IAR'CfJJJ3LIC
<br />
<br />(Name Typed~ Printed or Stamped)
<br />NOIARY PUBLIC
<br />
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