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<br />
<br />
<br />P,. tiOT I Cs~l}.s:sIL,B~,r.T\_IG]:J;'-~'\:5c;.
<br />The undersigned understands that this permi t il\i:Y hr.' subject tr. 'dr.i'd rp.~tri::Lc'i':"'" \;:Ii[h roo'! bi.' 0orr. restrictive than Ci ty
<br />regulations. The undersigned assu~es r~spnnsibilily f~T COlp!iancp. Hith ~ny ~rplirahlp. deed restrirtions,
<br />
<br />B. \}t:JL I CEESE].) CQL'J..TRB..~I.QI3.f'-..f:~t:L9. CQNTB.~==-IJl[~_J::,r~,flLI~li:if.,-IP.llc..]_L1F~~=~
<br />If the OMner has hired a contractDr or cnntrac\crs to \Inderta~e "ork, they m~y br required to br licensed in iccDrd;1nCp. Hith
<br />state and local regulations. If the contractor is not licensed ~5 required by law, both the ouner and contractor ~ay be
<br />cited for a misdeeeanor violation under state laM, If the owner or intended contractor are uncertain as to "hat licensing
<br />requireeents nay apply for the intended Kork, they are advised to contact the City of Zcphyrhills Duilding Dcpart~ent, (813)
<br />788,6611.
<br />
<br />Furthermore, if the owner has hire~ a contractor or contractors, he is advised to have the contractor(s) sign portions of the
<br />"Contractor SectiDns" of this application for "hich they "ill be responsible. If you, as the ONner sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the uork. 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 2ephyrhills.
<br />
<br />C . T F: A N S F' 0 R T (~) T ION H1 PAC T FEE S A I'm U T IL. I..I::LJ;::.c~~~ji:li~J=LL~ilJuJ:=:J:';tC3
<br />
<br />D. CONSTRUCTION LIEN LA~ (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I iertify that I, the applicant, have been provided with a copy,of 'Florida's C0nstruc~ion Lien La" - Ho~oowner's Protection
<br />Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. if the, applicant is so~eone other than tho
<br />"oMner', I cortify that I have obtained a copy of the above described document and promise in good faith to deliver it to the
<br />"owner' prior to com~encement.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVII
<br />I certify that all the information in this application is accurate and that all work will be done in cOlpliance with all
<br />applicable laws regulating construction, zoning, and land development.
<br />
<br />Application is hereby made to obtain a perait to do work and installation as indicated. I certify that no work or
<br />installation has co~menced prior to issuance of a permit and that all work will be perfor~ed to leet standards of all laws
<br />regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction, I also
<br />certify that I understand that the regulations of other governmental agencies may apply tD the intended "ork, and that it is
<br />my r'sponsibility to identify \"ihat actions I must take to be in co~pliance. Such agencies include but are nDt lir.ited to:
<br />t Department of Envirc,ne.:enti:l Requlation ' Cypress Bayheads, Hetland Plreas iJnd Eivliic,n;,enlid 1/ Sensi tive Lands,
<br />Hater/Wastewater Treatment
<br />t South"est Florida Hater Manaqement District - Hells, Cypress Bayheads, Hetland Areas, Alteiing Watercourses
<br />f Ar~y Corps of Enqineers - SeaMalls, Docks, Navigable Waterways '
<br />f Department of Health 1, Rehabilitative Services, Environment;lI Health U_nit - \')e'11s, ;.iasteliatei Treat~ent, Septic Tanks
<br />t US Environ~ental Protection Aqenct - Asbestos abatement
<br />also certify that, if fill material is to be used in Flood Zone "n" Dr "n,ete,', it is understood that a drainage plan
<br />addressing a 'compensating volume' Mill be sub~itted which is prepared bv a professional engineer registered in the State of
<br />Florida prior to per~it issuance.
<br />
<br />A perait issued shall be construed to be a license to proceed with the "ork and not 25 authority to violate, cancel alter, Dr
<br />set aside any provisions of the technical codes, nor shall issuance of a permit provent the Building Official fro~ thereafter
<br />requiring a correction of erfors in plans, construction, or violations of any code, Eveiy perlit issued shall bocole invalid
<br />unless the Mork authorized by such perait is com~enced within six months of issuance, Dr if uark authorized by the permit is
<br />suspended or abandoned for a peiiod of six lonths after the time the work is cO~5enced. One 90 day ExtensiDn of tile, aay be
<br />allowed for the perlit ~ith fee charge of $15.00. The extension shall be reqUEsted in "riling to the Building Official, An
<br />approved inspection pust be logged during each six ~onth period, Dr the project Hill he conSIdered abandoned.
<br />HARNING TO OHNER: YOUR FAILURE TO RECORD n NOTICE OF COMMENCEMENT MAV RESULT III YOUR PAVING T~ICE FOR IMPROVEMENTS TO VOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT HITH YOUR LENDER OR AN ATTORNEY DEFORE RECORDING YOUR NOTICE OF
<br />COMMENCEMENT. JODS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST n 'NOI1CE OF COMMENCEMENT'.
<br />
<br />_,~ ,.n6,,'B>~
<br />
<br />SIGNATURE: OWNER OR AGENT
<br />
<br />SIGNATURE: CONTRACTOR
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF Pasco
<br />The foregoing instrument was acknowledged
<br />befono> me this , 19_ by,
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF P as co '
<br />The foregoing instrument was acknowledged
<br />befc,,'e me: thisFebruary 25" lq~ by
<br />
<br />Russell M. Brown
<br />
<br />viho i 5 p['r'C::',:,,-,,~d 1 y knc".-m tc, me ~XXXJj{"(!X:ii)X\kX
<br />~~~~~~~~XXXXXXXXXXXXXXXXXXXXXXXXXXXXXXX~X
<br />'x<XX1<iXQ{l)OOO():DO~XX~Xi Cj,-,c1 \i!-; 0 Jl!X,o / did no t
<br />. t a'l.#-t- n.l 0 L." a at t h h - -./ ---Ad, ;1
<br />~~~#~-~
<br />( S i 9 Jl a t u ,- e )
<br />Brenda L. Buchana~~
<br />. - _1"- .~~~~.. r.'
<br />\ f,j a m e I y P to? [:, r-',- ..Jf'~'c:CJ ""<'\ '" t c\l(!)f1fK)1AL SEAL
<br />
<br />rJQJllgypl'ynJc:. f .~. I ~~E~oD:;i'S~~;~:~~::
<br />....~l Nov. 13,1996
<br />"~:~OFfl.~...'" Comm. No. CC 240110
<br />......
<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 />(Signatun?)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOT AF:Y F'UBLI C
<br />
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