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<br />CDNI) 1 , 1 UN["; UF PEnH IT ()FF I LVV) I T
<br />(). I~QI.I.~_~_QE.._J)RsJLm~:_!:lIF.I_tt;JJJJ.I\IX; ,
<br />Thp nndersigned understands that this per.it lay be ~ubject to "deed rest~ictions' whi[h lay be .ore restrictive than City
<br />regulations. Thp undersigned assules responsibility f~r c~~plian(e "ith any appli[ablp deed restri[tions.
<br />
<br />Fe. P!"L I_CENS~D CQN.I['i~~.LQ!3!::L}lIJQul;J)NTf~D_~rLJJ1_RE::f,3F:9H~uUUJ,::IIJJ~.P-.
<br />If the owner has hired a [ontractor or conti actors to underta~e WOI~, they m~y be required to be licensed in accordance with
<br />state and local regulations. If the contra[tor is not li[ensed as required by law, both the owner and contractor .ay be
<br />cited for a .isde.eanor violation under state law. If the owner or intended [ontra[tor are un[ertain as to "hat licensing
<br />require.ents lay apply for the intended work, thpy are advised to conta[t the City of Zephyrhills Building Departlent, 18131
<br />71111-bb 11.
<br />
<br />Further~ore, if the o"ner has hired a contra[tor Dr contra[t~rs, he is advised to have the contractorlsl sign portions of thp
<br />'Contractor Sections" of this application for which they "ill bp responsible. If you, as the owner sign as the contractor,
<br />you are indi[ating that you, rather than the contr~ctor, are responsible for the work. If the contractor wishes you to sign
<br />as contra[tor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
<br />City of Zephyrhills.
<br />
<br />I: . IT\AN!:;)P aRT A T ISllLI t'1f t4~_LI:::J~_t;:_~__{)IJQ__IJLtb1.LC C!JHtH~J:~T!JJJj_XEE.p-.
<br />
<br />n . ~lJl'~~IRUGT.lQ!LJ",JJ;:LL!-FM (I:I ,riP I ER '7 J :=1 ~ nun 1 J)() SlAT UTES ~ AS (WIENDED:I
<br />I certify that I, the appli[ant, have been provided with a copy of "Florida's Constru[tion Lien La" - Ho.eo"ner's Prote[tion
<br />Guidp' prepared by the Florida Depart.ent of Agriculture and Consu.er Affairs. If the applicant is so.eone other than the
<br />"oMnpr", I [ertify that I have obtainpd a copy of thp above de5clibed docu~ent and promise in good faith to deliver it to thp
<br />"owner" prior to cOllen[etent.
<br />
<br />F. CjJt!1T,()CTOR' SLm'Jt:!J~J3-'-.!?___eEEJ.l.HlYJI.
<br />I certify that all the inforlation in this application is accurate and that. all work will be done in cOlplian[e with all
<br />appli[able laws regulating construction, loning, and land develop.ent.
<br />
<br />Applir.ation is hereby aade to obtain a perait to do work and installation as indicated. I certify that no work or
<br />installation has coatenced prior to issuance of a per.it and that all work "ill be perforled to leet standards of all la"s
<br />rpgulating construction, Cih cod~s, liming reguli1tions, i'lnd land devl'lop~l'nt regulations in the jurisdiction. I also
<br />cprtify that I understand that the regulations of othpr govprn,ental agencies lay apply to the intended work, and that it is
<br />lilY rl'sponsibility to identify what actions I IIIUSt take to be in cOlpliance. Such agencies include but are not lilited to:
<br />, Departll'nt of Environ.ental RI'Qulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
<br />Water/Wastewatpr Treatlllent
<br />, Southwest Florida Watl'r ManaQl'lent District - Wells, Cypress Payheads, Wetland Areas, Altering Watercourses
<br />, Ar.v Corps of EnQinel'rs - Seawalls, Docls, Navigable Waterways
<br />, ~~partlent of Health L Rehabilitativl' Servi[es, Environlental Health Unit - Neils, Wastewater Treat.ent. Septic Tanks
<br />, US Environ.l'ntal Protl'ction AQency - Asbestos abatelllent
<br />I also certify that. if fill laterial is to be used in Flood lone "A" or "A,etc,', it is understood that a drainage plan
<br />addressing ~ "[olllpensating volu.e" "ill be subMitted which is prepared by a professional engineer registered in thl' State of
<br />Florida prior to per.it issuance.
<br />
<br />A per.it issued shall be construed to be a license to pro[eed with the work and not as authority to violate, cancel alter, 01
<br />set aside any provisions of the technical codes, nor shall issuance of a perlllit prevent the Building Official frol thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beco.e invalid
<br />unless the work authorized by such p~r.it is cOllltenced within six 1II0nths of issuanc~, or if work authorized by the perlllit is
<br />suspendpd or abandoned for a period of six .onths after the tiae the work is cOllllenced. One 90 day extension of tillie, lay bp
<br />allowed for the perlit with fee charge of tI5.00. The extension shall be requested in writing to the Puilding Offi[ial. An
<br />approved inspection lust be logged during each six lonth period, or the proje[t "ill be [onsidered abandoned.
<br />NARNING TO ONNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
<br />PRUPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT NITII YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
<br />COMMEN[E"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT",
<br />
<br />- -~~--
<br />SIGNATURE: CONTRACTOR
<br />
<br />SIGNATURE: OUNER OR AGENT
<br />
<br />"las acknDI'lledged
<br />, 19_ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The for ego i ng ills tn.lment
<br />befDre me this
<br />
<br />STATE OF FLORIDA
<br />COIJNTY OF
<br />rile fDf'egoing instrument
<br />before me this
<br />
<br />was acknDwledged
<br />, 19_ by
<br />
<br />-
<br />1(111[0 is personall y .,nolr/ll tc. me 01- NhD has
<br />pl-oduced
<br />as identification and who did/did not
<br />ta!::e an oath,
<br />
<br />whD is persDnally known to me Dr who has
<br />pl-oduced
<br />as identification and l'lho did/did nc.\;
<br />take an oath.
<br />
<br />(SignatLwe)
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed Dr Stamped)
<br />[101 ARY PUBL I C
<br />
<br />(Name Typed, Printed or Stamped)
<br />t.lQl AR'LE!!BL I C
<br />
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