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<br />, CONDITIONS OF PERMIT AFFIDAVIT
<br />'A. .NOTICE OF DEED RESTRICTIONS
<br />!be undersigned understands that this perlit lilY be subject to -deed restrictions- wbieb lilY be lOre restrictive than City
<br />regulations. !be undersigned assUJeS responsibility for COIpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the OlDer bas bired a contractor or contractors to undertake work, they lilY 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 lilY be
<br />cited for a lisd_anor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
<br />requirl!ll!Dts laY apply for the intended work, they are advised to contact the City of Zephyrbills Building Departlent, (813)
<br />788-6611.
<br />
<br />FurtherlOre, if the OlDer bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
<br />-Contractor Sections- of this application for wbieb they will be responsible. If you, as the OlDer sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wisbes you to sign
<br />as contractor that laY be an indication that be is not properly licensed and is not entitled to perlitting privileges in the
<br />City of Zephyrhills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, have been provided with a copy of -Plorida's COnstruction Lien Law - H(IIl!(JIIJ1er's Protection
<br />Guide- prepared by the Plorida Departlent of Agriculture and ConsUll!f Affairs. If the applicant is sOleOlle other than the
<br />"OlDer", I certify that I have obtained a copy of the above described dOCUll!Dt and prOlise in good faith to deliver it to the
<br />"owner- prior to co.enCl!leJlt.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforlition in this application is accurate and that all IOrk will be done in cQIPliance with all
<br />applicable lillS regulating construction, loning, and land developleDt.
<br />
<br />Application is hereby Iilde to obtain a perlit to do work and installation as indicated. I certify that no work or
<br />installation bas ~ced prior to issuance of a perlit and that all work will be perfoI'led to leet standards of all laws
<br />regulating construction, City codes, loning regulations, and land developleDt regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other goverIlleDtal agencies lilY apply to the intended work, and that it is
<br />IY responsibility to identify what actions I lust take to be in cOlpliance. Sueb agencies include but are not lilited to:
<br />t Departlent of EnvirOlllelltal Regulation - Cypress Bayheads, Wetland Areas and Envirolllelltally Sensitive Lands,
<br />Water /Ifastewater 'I'reatlent
<br />t Southwest Florida Water Hanagl!ll!Dt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
<br />t Arty Corps of Engineers - Seawalls, Docks, Ifavigable Watenays
<br />t Departlent of Health' Rebabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater 'I'reatlent, Septic 'I'anks
<br />t US EnvirOllleDtal Protection Agency - Asbestos abatl!lleDt
<br />I also certify that, if fill Iilterial is to be used in Plood Zone -A- or "A, etc. ", it is understood that a drainage plan
<br />addressing a -COIpeDSating vol_- will be sublitted whieb is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance.
<br />
<br />A perlit issued shall be construed to be a license to proceed with the IOrk and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beccE invalid
<br />unless the work authoriled by sueb perlit is COIIeDced within sillODths of issuance, or if work authorized by the pmit is
<br />suspended or abandoned for a period of sillODths after the tile the work is co.enced' One 90 day extension of tile, lilY be
<br />allowed for the perlit with fee ebarge of $15.00. !be extension shall be requested in writing to the Building Official. An
<br />approved inspection lUst be logged during eaeb sillODth period, or the profect will be considered abandoned.
<br />WAlUlING '1'0 l*IfER: YOUR FAILURE '1'0 RECORD A IfOfICK OF C(JIMDCEHIIf'I' MAY RESUL! IIf YOUR PAYIIfG nICK FOR IMPROVEHEH'I'S '1'0 YOUR
<br />PROPER'I'Y. IF YOU IJI'I'BIfD '1'0 OB'I'JIIf PIWClIfG, COIfSUL'I' WI'I'B YOUR LBlfDIR OR AIf AnoRDY BEFORE RECORDllfG YOUR IfO'I'ICE OF
<br />aJOfElfCEMBJl'l'. JOBS ORDER $2,500 IN VALUE DO If Of IfUD '1'0 RECORD AIfD POS'I' A "MOfICE OF COMMEIfClMlJl'l'".
<br />
<br />JOt: EldatoFn, C.E.B-. Colleen Cuffe C-Fo John L. Wallace, Executive V.P./C.O.O.
<br />
<br />~d C'AtfI=e i2 RJ ' 0-1--- 2' UALYcu->-
<br />SIGJlArURE: l*IfER OR AGEJI'I' . . / SIGJIA'I'URE: COJI'I'RACfOR
<br />FLORIDA MEDICAL CLINIC 'INSON BUILDING CORPORATION
<br />
<br />SrA!E OF FLORIDA
<br />COUIfrY OF /Ja..u .-l)
<br />The foregoing instrument was acknowledged
<br />before me this i.L::...d '-J , 19 9"_ by
<br />
<br />S'I'A'fE OP FLORjfA
<br />COUJI'I'Y OP 'a..xJ CD
<br />The foregoing instrument was acknowledged
<br />before me this _LL - 07 S- ~ 19~ by
<br />
<br />Uho is personally known ~r who has
<br />produced
<br />as identification and who did/did not
<br />
<br />~':y'r~~
<br />ignature)
<br />[l/lI2)EEN /J. St-/pjJE;e~
<br />(Hame Typed, Printed or Stamped)
<br />HOT . PUBLIC
<br />CARLEEN A. STlPPERT
<br />NotIry Public. State of Rorida
<br />My Comm. Exp. Sept. 6, 1999
<br />Comia.",,"o. CC 493590
<br />
<br />(!lto is personally known to ~r who has
<br />produced
<br />as identification and who di~d n~
<br />~ an o~tb;/ ~ .
<br />b..Jz.b-~ ..A, - 1J"'y'-z-
<br />Signature) / /
<br />[l19~1 ee,1 .4. S f.1itl'"'f'+
<br />(Name Typed, Printe or Stamped)
<br />HOTARY PUBLIC
<br />
<br />
<br />
<br />CARLEEN A. STIPPERT
<br />Notary Public. State of Aoric18
<br />My Comm. Exp. Sept. 6. 1999
<br />Comm. llo. cc. 4935.90
<br />
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