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A. NOTICE OF CONDITIONS OF file undersigned underst::: ~STRICTIONS PERMIT AFFIDAVIT_ regulations. fbe d' t thIS peRit aay be sub'ect ' un erslgned assuaes responsibility t J to. deed restrictions" which Ia b B. UNLICENSED CONT or COIphance with any applicable deJ r~:f~tf::~iCtive than City If the owner has hired. a RACTORS AND CONTRACT state and local regulat' contractor or contractors to undertal ~R RESPONSIBILITIES ~~~r:: aisdeaeanor I:::iat::n :d:~~:~:o:a:s 0:: license: :rr~~::d I:: ~ rt~~:o be licensed in accordance with 788-6611 s aly apply for the intended work the' the, owner or intended contr~ctor are OIfDer ~d contractor lay be . , y are adVIsed to contact the City of zepbvr:fftaI~ a~ to wbat licensing z' I S BuIldIng Departlent (813) ~urtheraore, if the owner has hired ' Contractor Sections' of thi ' a ~ontractor or contractors, he is adv' you are indicating that you, sr::~:c~tion~or which they will be responSib::~ :; ;:e the contractor!s) sign portions of the as contractor that Jay be an ' d' ,an e contractor, are responsible for th ' as the O1f1ler SIgn as the contractor City of Zepbyrhills. .lJ] lcatJon that be is not Properly licensed and is en:d\.:r the contr~ct~r wis~es yoU to Si~ en 1 ed to peRl ttlJlg prIVileges in the C. TRANSPORTATION IMPACT FEES AND ' UTILITY CONNECTION FEES D. CONSTRUCTION LIEN LAW I certify that I, the applicant have be (CHA~TER 713, FLORIDA STATUTES AS :uide" prepared by the Florida DepartJen~o:r;::::l~:: :o;opy of 'Florid~'s Construction Lien L~ - H'::~~~~ction "owner", I. certify that I have obtained a copy of the above /ons~ :ffalls. If the ~ppl~cant is soaeone other than the owner" pnor to CoalenCl!lent. escCI ocuaent and prOll1se In good faith to deliver it to the E. CONTRACTOR' S/OWNER' S AFFIDAVIT I certify that all the infocJation in this application is accurate and that all work Ifill be done in cOlpliance with all applicable laws regulatinq construction, Joning, and land developaent. Application is hereby lade to obtain a peIlit to do work and installation as indicated. I certify that no work or installation bas cOllenced prior to issuance of a peIlit and that all work will be perfoIJed to Jeet standards of all laws regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also certify that I understand that the regulations of other goveIllJel1tal agencies JaY apply to the intended work, and that it is IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lillited to: t DepartJent of Environaental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands, Water/Wastewater TreatJent t Southwest Florida Water Hanagelent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses t ArIJ Corps of Engineers - Seawalls, Docks, Navigable Waterways t DepartJent of Health & Rehabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater !reatJent, Septic ranks t US Environaental Protection Agency - Asbestos abatelent 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 addressing a 'clltpensating volllle" Ifill be subJitted which is prepared by a professional engineer registered in the State of Florida prior to perlit issuance. A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or set aside any provisions of the technical codes, nor shall issuance of a peIlit prevent the Building Official frllt thereafter requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beCClle invalid unless the work authorized by such peIlit is COllllJlced within six IODthS of issuance, or if work authorized by the peIlit is suspended or abandoned for a period of sil IODtbs after the tile the work is c-.mced. One 90 day extension of tille, lilY be allowed for the peIlit with fee charge of $15.00. !be extension shall be requested in writing to the Building Official. An approved inspection lUSt be logged during each sil IODth period, or the project will be considered abandoned. IIARNING TO omR: YOUR FAILURE TO RECORD A NO'I'ICE OF COHMDCBMD'I' HAY RESULT IN YOUR PAYING DICE FOR IMPROVBIIBlft'S TO YOUR PROPEJlt'Y. IF YOO IMI'BND TO OBTAID FINANCING, CONSULT WITH YOUR LENDER OR AN AftORMBY BEFORE RECORDING YOUR NO'I'ICB OF COHMENCEHBMI'. JOBS UNDER $2,500 IN VALUE 00 NO't NEED TO RECORD AND POST A "NO'I'ICE OF COHMENCEMENI'" ~ P rf'!if, p~~~ SIGlAIUBI: llIIIIII OIl AGIIII! ~ STATE OF FLORIDA S!ATE OF FLORIDA .D COONI'Y OF COUNI'Y OF Las C \J The foregOing instrument was acknowle~ged The foregoing inst~ent was aCkn~ledged before me this , 19_ by before me this S'ep.. g , 19 q by C "\.)jr d)cevJ S'". who is personally own t9 me or w 0 has produced' '\s ~ J'--'C. as identification and who 4ittt' 0 1- ~~oIJ~ "" . at~ ' 0 ~'\ C'e V\ L . k.t-J <) Ii) , (Name Typed, Printed or Stamped) NOTARY PUBLIC who is personally known to me or who has produced as identification and who did/did not take an oath. (Signature) (Nam~ Typed, Printed or Stamped) NOTARY PUBLIC ..~."~ DOREEN l. WOOD f~r;&''f~ MY COMMISSION' CC 191575 EXPIRES 'i."'....A~$ April 29. 1996 --1,1';;; 'f".'<!-~ IIONllED llfRU TlIOV fAIN INSURANCE. INC. ""lUll