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A. NOTICE OF DEED RESTRICTIONS The und~rsigned understa~s that this perlit lay be subject to .deed restrictions. which lay be lore restrictive than Ciiy regulatIons. The underSIgned assUles responsibility for cOlpliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor Dr contractors to undertake work, they lay be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be cite~ for a lisdeleanor violati~n under state law. If the owner Dr intended contractor are uncertain as to what licensing requlrelents lay apply for the Intended work, they are advised to contact the City of 2ephyrhills Building Departlent 18131 788-6611. ' Furth.rlOre, if the owner has hired a contractor Dr contractors, he is advised to have the contractorlsl sign portions of the .CoDtractor Sections. of this application for which they will be responsible. If you, as the owner sign as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction lien law - HOleowner's Protection &aide. prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is so.eone other than the .owner., I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the .o.ner. prior to COUlnce.At. E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the inforlation iA this application is accurate and that all work will be done in cOlpliance with all applicabl. la., regulating cODstruction, zoning, and land developlent. Application is hereby lade to obtain a perlit to do ..rk aDd installation as indicated. [certify that no work Dr installation has coatenced prior to issuance of a perlit and that all work will be perforled to leet 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 governlental agencies lay apply to the intended work, and that it is ay responsibility to identify what actions I lUst take to be in cOlpliance. Such agencies include but are not lilited to: f Departlent of Environaental Reaulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive lands, Water/Wastewater Treataent f Southwest Florida Water "anaaelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways f Depart.ent of Health l Rehabilitative Services. Environlental Health Unit - Wells, Waste.ater Treatlent, Septic Tanks f US Environaental Protection Auency - Asbestos abatellnt I also certify that, if fill laterial is to be used in Flood Zone "A" Dr .Atetc.", it is understood that a drainage plan addressing a .coapensating volule. .ill be sublitted which is prepared by a professional engineer registered in the State of Florida prior to perait issuance. STATE OF FLORIDA COUNTY Of 1>-<1 S L .:> The foregoing instrument was acknowledged before me this L() JIJ)'\E> , 19...lL by ~ (\ \M 'L LfVt \-6 Y\. who IS personally known to me or who has produced as identification and who did/did not take, ~hses.,e. ~ (Signature) STATE OF flORIDA COUIITY OF _"'Pit~Lo The foregoing instrument was acknowledged before me th i s ? U \..\0'\1'1 1 ~ by \Ia \V II Lnll~1) V1 who is personally known to me or who ha~ produced as identification and who did/did not take~~~ ~ (Signature) (Name Typed, Printed or Stamped) NOTARY PUBLIC DAVID R. ABLA . Notary Public, State of Florida My Comm. Expires Aug. 23, 1998 Comm. No. CC 402501 (Name Typed, Printed or Stamped) NOTARY PUBLI C :)A VIO R. ABU Notary Publ!c, Stato of Florida My Comm. Expires Aug. 23, 199B (",amm. No. CC 402501