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<br />CUND I f J UNS UF FEnN I T (IFF I IHW I T
<br />(). I\IIJIl~_~-PE_._pg~.!LBI;:J::;JlLlJ;JHJJJ~3 _ .
<br />Ih~ "nrl~rsigned underst~nds that this p~r.it May be ~"bj~ct to "d~~d r~stricti~ns' "hich ,ay be lor~ restrictiv~ than City
<br />rp.gul~tions. The undersigned assu.ps responsibility for co~rlian(e "ith any applicable deed restrictions.
<br />
<br />fl. UNLLCENSE!>__~QN.IRO!:;IJJB~..OIJI). LJJNTfY\L,:.ILJfl..Rr:::?F:(JtmI~_I..t",ILt~f.J.
<br />If the owner has hired a contractor or c~ntractors to unrlerta~p "ork, ther may be rPQuir~d to b~ licensed in accordance with
<br />state and local reguhtioRs. . If the coll.!!:.a.E.torl.u.ot li~ensed as required by la", both the owner and contractor lay be
<br />__~ '._ _.............h._
<br />ci ted for a .isde'eanor vio I~tion_~.'!d~~_~!ate~~!,.~ If the o"ner or Intended .C.ootf-actor are uncer lain as to "hat licensing
<br />r-equJ"reiiirits"la-Y--apply for the intended "ork~.they are advised to conlart the City [If Zephyrhills Building Depart.ent, 18131
<br />788-6611.
<br />
<br />Further~ore, if th~ owner has hired a contractor or contractors, he is advised to have the cDntractorls) sign portions of the
<br />'Contractor Sections. of this application for which they "ill be responsible. If you, as the owner sign as th~ contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the "ork. If the contr~ctor wishes you to sign
<br />as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
<br />City of lephyrhills.
<br />
<br />C. IB.Bf\J!:?PORT A T I QILI t~lf'fCjI2Ll:....E;~~_HH.I2_lJLt'=-l.LY_....I;!JHlt~~ILQ.t,:L FEE.!:?.
<br />
<br />n . c,;.Ql"!.~IBU~T JJJH.J",J.I:;:!L1.J\H ( [~I fnpn:.R "7 j ~=J. FL.UR J Dr) SHHUTES ~ ns ()NEI...DED)
<br />I certify that I, the applicant, have been provided "ith a copy of 'Florida's Construction Lien Law - Ho~eo"ner's Protection
<br />Guide" prepar~d by the Florida Depart.ent of Agriculture and Con~u'er Affairs. If the applicant is sOleone other than the
<br />"o"oer", I certify that I h~ve obtained a copy of the ~bove described docp~ent and pro~ise in good faith to deliver it to the
<br />"o"ner" prior to cO"encelent.
<br />
<br />F. GPtf!FnCTQR I s[.m'J~~IC___$__J}fE!.Rl:\\lJI.
<br />I certify that all the infor.ation in this application is accurate and that all work "ill be done in co.pliance with all
<br />applicable la"s regulating construction, zoning, and land develop.ent.
<br />
<br />Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that no work or
<br />installation has cOI,enced prior to issuance of a perlit and that all work "ill be perfor.ed to leet standards of all la"s
<br />rpgulatin~ construction, City codes, zoning re~ulations, and land developlent regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other governlental agencies .ay 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 li.ited to:
<br />· Depart.ent'of Environ.ental Requlation - Cypress Bayheads, Wetland Areas and Environ.entally Sensitive Lands,
<br />Water/Wastewater Treatlent ,
<br />· Southwest r10rida Hater Manaqelent District - Wells, Cypress Bayheads, . land Areas, Altering Watercourses
<br />. ~rlY Corps vf Enqineers - Sea"alls, Docks, Navigable Waterways .
<br />· D.~~.ent of Health L Rehabilitative Services._~~ironlenlal "~~~l! - Wells, Haste"ater Treatlent, Septic Tanks
<br />, US Environ.ental Protection Aqency - Asbestos abate.ent .
<br />I also certify that, if fill .aterial is to be used in flood Zone "A" or "A,etc.', it is understood that a drainage plarr.
<br />addressing ~ .co.pensating volule" Kill he subMitted which is prepared by a professional engineer registered in the State of
<br />rlorida prior to perait issuance.
<br />
<br />A per.it issued shall be construed to be a license to proceed Kith the work and not as authority to violate, cance) alter, or
<br />set aside any provisions of Jhe technical codes, nor shall issuance of a per.it prevent the Buildin~ Official fro. thereafter
<br />requiring a correction of eiiors in plans, construction, or violations of any code. Every perlit issued shall becole invalid
<br />IInless the work authorized by such perait is co..enced within six .onths of issuance, or if work authorized by the per.it is
<br />suspended or abandoned for a period of six .onths after the tile the work is co..enced. One 90 day extension of tile, lay be
<br />allowed for the per.it with fee charge of '15.00. The extension shall be requested in writing to the Building Official. An
<br />~pproved inspection lust be logged during each six lonth period, or the project will be considered abandbned.
<br />HARNING TO OWNER: 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 HITII YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
<br />COMMENCEMENT. JOBS UNDER .2,500 IN VALUE DO Nor NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
<br />
<br />
<br />,~ ~ .. ..~ v.' /(
<br />C' ,..- /~ ~~ . ( .... . /i~' .
<br />SIGNAT E: OHNER OR A ENT SIGNATURE: . TRACTOR
<br />
<br />\'lho i 5 per~.:111 y knDl'II1;?t
<br />produced '-..A~~"-<
<br />as identific.:1tion and wh did/did
<br />
<br />.~:J:~~t;~~1 ;;Ii&~<lL
<br />
<br />(SignCltLwe) ,f
<br />
<br />
<br />STATE OF FLORIDA ///)
<br />COUNTY OF '--- ;l ~-e)
<br />The foregc.ing in trum~nt ",as aC97'ledged
<br />before me this I ,I ~ 19 . by
<br />
<br />/)L-t~/. )~U2~'/
<br />\o',ho is pe,-s 11.:111 Y knol'~ to m
<br />p,-oduced-i..a.r--dt. /-~ Z~
<br />.:1S identification and ho did/did
<br />take . ..arl;;'" i~h ;' '. /J / p7 ... /n
<br />/ Jl'ct--f2 ,;;r /.5-<<-4 ~
<br />~
<br />(Si gnature) (
<br />
<br />
<br />(Name Typed~ Printed Dr Stamped)
<br />NOJARY PUBLIC
<br />
<br />............... OFFICIAL SEAL
<br />l~~~\ GLADYS L. BUSH
<br />: 1 My Commission ExpIres
<br />~ . : Oct. 7. 1996
<br />"':><r~ ~l Comm. No. CC 234022
<br />..tr..~!.""''''
<br />
<br />(Name Typed, Printed or Stamped)
<br />t.:LQ.I AR'LEJlf3L I C
<br />
<br />....?..~ OFFICIAL SEAL
<br />'!i'~\ GLADYS L. BUSH
<br />f 1 My Commission Expires
<br />~.. ; Oct. 7, 1996
<br />"'''~eOFf~~.' Comm. No. CC 234022
<br />......-.....
<br />
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