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<br />CONDITIONS OF PERMIT ArFIDAVIT
<br />A . N.QI,!J,:J~_OF ___DEEDJ~SJR U;;T I Ot:Ji:l.
<br />The undersigned understands that this per.it .ay be subject to "deed restrictions" which .ay be .ore restrictive than City
<br />regulations. The undersigned assu.es responsibility for co~pliance with any applicable deed restrictions.
<br />
<br />B. UNL I CENSED CONTRACTORS ~t!.r.L_G_QtnBfl~TQR J.::;:"'~p_E9NS.I.~_1 LIT !ES
<br />If the owner has hired a contractor or contractors to under take work, the.r fIlay be required .to-b;-i-icensed in accordance wi th
<br />state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor .ay be
<br />cited for a .isde.eanor violation under state la". If the owner or intended contractor are uncertain as to "hat licensing
<br />require.ents .ay apply for the intended work, they are advised to contact the City of lephyrhills Building Depart.ent, 10131
<br />700-MIl.
<br />
<br />FurtherMore, if the owner has hired a contractor or contractors, he is advised to have the contractor!sl sign portions of the
<br />"Contractor Sections" of this application for which they will be responsible. If you, as the owner 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 .ay be an indication that he is not properly licensed and is not entitled to per.itting privileges in the
<br />City of lephyrhills.
<br />
<br />(' IBANSPORTATION H1PACT FEES {-)ND UTI1-ITYJ~_QNNECTl.QN FEE.9..
<br />
<br />D. CONSTRUCTION L".IEtL!-AW. (CHAPTER 713, FLORID() STATUTES~ ()S m'1ENDED)
<br />I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien La" - Ho.eowner's Protection
<br />Guide" prepared by the Florida Depart.ent of Agriculture and Consu.er Affairs. If the applicant is so.eone other than the
<br />"o"ner" , I certify that I have obtained a copy of the above described docu~ent and prOMise in good faith to deliver it to the
<br />"owner" prior to co..ence.ent.
<br />
<br />E. CONTRnCTOR'S/pHNER'S AFFIDflVII
<br />I certify that all the inforlation in this application is accurate and that all work "ill be done in co'pliance with all
<br />applicable laws regulating construction, loning, and land develop.ent.
<br />
<br />Application is hereby lade to obtain a per.it to do work and installation as indicated. I certify that no work or
<br />installation has co..enced prior to issuance of a perlit and that all work "ill be perfor.ed to .eet standards of all laws
<br />regulating construction, City codes, zoning regulations, and land develop.ent regulations in the jurisdiction. I also
<br />certify that I 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 co.pliance. Such agencies include but are not li.ited to:
<br />. Depart,ent of Environ,ental ReQulation - Cypress Bayheads, Wetland Areas and Environ.entally Sensitive Lands,
<br />Water/Wastewater Treat.ent
<br />. Southwest Florida Water "anaQe,e"t District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />f Ar.v Corps of EnQineers - Seawalls, Docks, Navigable Waterways
<br />. Depart.ent of Health ~ Rehabilitative Services, Environ.ental Health Unit - Wells, Wastewater Treat.ent, Septic Tanks
<br />* US Environ.ental Protection Aqency - Asbestos abatetent
<br />I also 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 volute" Mill be subtitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to per.it issuance.
<br />
<br />A pertit issued shall be construed to be a license to proceed 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 per.it prevent the Building Official fro. thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Every per.it issued shall beco.e invalid
<br />unless the work authorized by such per.it is co..enced within six .onths of issuance, Dr if Mork authorized by the pertit is
<br />suspended or abandoned for a period of six tonths after the ti.e the work is co..enced. One 90 day extension of tile, lay be
<br />allowed 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 sir. tonth period, Dr the project will be considered abandoned.
<br />WARNING TO OWNER: 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 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 />1\ ~ ~l
<br />SIGNATURE: OWNER OR AGENT ~
<br />
<br />1'> \ fA.,( ~
<br />SIGNATURE: CONTRACTOR
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF ~ \f'-eJ,\,t.,j
<br />The foregoing instrument was acknowledged
<br />before me this' l.{-th l\faJ,4 19~ by
<br />
<br />R... e.. ~ ~o V060--
<br />who is personally known to me or who has
<br />produced lL Oft.... (.tec~
<br />as identification and who di Idid .iiDf'
<br />.~ake an oath. V V
<br />
<br />(Signature) ,~ /).
<br />f'C. ~V I ^ K.f/&.~~ _
<br />. .~T'.Iih:"1t or tamped}
<br />DT ARq;";P~~~.g~:l!~L
<br />(1V'""''''!}V "91 ;73t..:C f.:,'Y'ATE ':.:)P FL?RIDA
<br />~,,)l.-v- - .. NO_ CCl97050
<br />\ Y::S9:;0::l?1~9"J ~:.AP~J-51996J
<br />
<br />STATE OF fLORIDAr\
<br />COUNTY OF r\ ^e1 t... I'
<br />The foregoing instrument1was acknowledged
<br />befc,re me this ftm.,I'1K , 19.ft- by
<br />
<br />(C..,c ~o VOC-tL
<br />who is personally known to me or who has
<br />pl-oduced h._OJ\. l..i t:!. ~
<br />as identification and who di {did not )
<br />take an oath. ~ ~~ -
<br />
<br />(Signature) I .J ..J__
<br />f<:);; l> .^ ~S1O:..
<br />(Name Typed, Printed or Stamped)
<br />
<br />t.~ ,~/i'"}.-r:'r';-S\C---l
<br />KE.i/;N .r.I~.L;}.',.;'
<br />NCfrn<y FU;',UC :;-;1".1E C-F FLORIDA
<br />C~.:::;/;<' ;S:~.iCl'.:I\jO. CCJ97050
<br />L'f.v"'..'."P'Y")~" "T) 'P" ~"1996
<br />;.;/..1,,;,.,':;;:;.L:"'~l'i .~~:::;.~~ ~" (.:..1\,.'_" I"~ . ;:"h L.u..
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