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<br />CONDIflONS OF PERMIT AFFIDAVIT
<br />A. ~OI.I!,:E OF _.PEED........f:~STR IJ~J IONS.
<br />The undersigned understands that this per_it lay be subject to "deed restrictions" Nhich lay be _ore restrictive than City
<br />regulations. The undersigned assules responsibility for cOlpliance Mith any applicable deed restrictions.
<br />
<br />B . ~!!'lL I CENSED CONTRACTOR9-_..Bn!Lj';Qt.tTRI1C_T.QR J3g?ElJN~.I.!U ~I.I1EJ2.
<br />If the owner has hired a contractor or contractors to undertake Mork, they may be required to be licensed in accordance with
<br />state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be
<br />cited for a lisdeleanor violation under state IaN. If the owner or intended contractor are uncertain as to what licensing
<br />require.ents lay apply for the intended work, they are advised to contact the City of lephyrhills Building Departlent, (9131
<br />798-6611.
<br />
<br />Further.ore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) 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 lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in t.he
<br />City of lephyrhills.
<br />
<br />c. TRAN!?rORT A T ION I "trACT FEEE.L.fl!'..!P__I::!.I.I.I:::1..TLJ::~.gN~_ECI_li:11LFEE.$..
<br />
<br />D. ~ONSTRUCTION LIEN LA~ (CHAPTER 713~ FLORIDA STATUTES~ AS AMENDED)
<br />I certify that I, the applicant, have been provided with a CDPY of "Florida's Construction Lien Law - HOleo"ner's ProtectiDn
<br />6uide" prepared by the Florida Departtent of Agriculture and Constller Affairs. If the applicant is so.eone other than the
<br />'oNner", I certify that I have obtained a copy of the above described document and prolise in good faith to deliver it to the
<br />"owner" prior to cottence.ent.
<br />
<br />E. CONTRACTOR' S/OHNER 1 S AFE.!..D?l~l.T.
<br />I certify that all the infortation in this application is accurate and that all work "ill be done in co'pliance with all
<br />applicable laws regulating construction, zoning, and land develop_ent.
<br />
<br />Application is hereby tade to obtain a pertit to do work and installation as indicated. I certify that no work or
<br />installation has cOI_enced prior to issuance of a pertit and that all work "ill be perforted to teet standards of all laNs
<br />regulating construction, City codes, zoning regulations, and land developaent regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other govern_ental agencies lay apply to the intended Hork, and that it is
<br />.y responsibility to identify Nhat actions I .ust take to be in coepliance. Such agencies include but are not li.ited to:
<br />I Departtent of Environ.ental RequlatiDn - Cypress Bayheads, Wetland Areas and Environtentally Sensitive Lands,
<br />Water/Wastewater Treat.ent
<br />, Southwest Florida Water Manaqelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />f Ar.y Corps of Enqineers - Seawalls, Docks, Navigable Waterways
<br />, Depart.ent Df Health & Rehabilitative Services. Environ_ental Health Unit - Wells, Wastewater Treat_ent, Septic Tanks
<br />I 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 plan
<br />addressing a 'colpensating volu.e' Hill be subtitted which is prepared by a professional engineer registered in the state of
<br />Florida prior to per.it issuance.
<br />
<br />A per.it 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, Dr violations of any code. Every perlit issued shall beco.e invalid
<br />unless the work authorized by such per.it is cOI.enced within six .onths of issuance, or if Nork authorized by the perlit is
<br />suspended or abandoned for a period of six tonths after the tile the work is cO'lenced. One 90 day extension of tile, .ay be
<br />allowed for the pertit with fee charge of tI5.00. The extension shall be requested in writing to the Building Official. An
<br />approved inspection tust be logged during each six .onth period, or the project Nill 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 FINANCIN6, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
<br />COM"ENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCE"ENT'.
<br />
<br />\G- '
<br />, .0., \".i"'h~~-
<br />
<br />~ -
<br />SIGNATURE: OWNER OR AGENT
<br />
<br />"Ias acknowledged
<br />19_ by
<br />
<br />STATE OF FLORIDA ~
<br />COUNTY OF f\ SO;:)
<br />The foregoing instrument1wCls acknowledged
<br />befc,re me th i s~~ ~~ t 19~ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument
<br />before me this
<br />
<br />c.J\~
<br />who is to me or who has
<br />pl-[,duced ~
<br />as identification and who did id not'
<br />take an oath. 0L'. -
<br />
<br />(Signature) ,~. i .-l. .---
<br />t.<=-eu. ..... ~Se.
<br />(Name Typed, Printed or Stamped)
<br />NOT ARY PUBL I C OFFICIAL NOTARY SEAL
<br />",,?-~Y PUe KEVIN KRUSE
<br />~~IE.fl{~ COMMISSION NUMBER
<br />tJ, '!~;*, ~ CC548891
<br />7", !~aa' d? MY COMMISSION F.XPIRES
<br />f' OF f\..:-)' t\PR.::>'8 ~l'lOf,)
<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 />(SignatLll-e)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
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