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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />rhe und.ceigeed under.tood. that thi. POceit .., b. .ubject to 'd.ed c..tcicti.... >bieb .., be IOC. resleictive tboo Cit,
<br />regulations, The undersigned assUles responSibility for co.pliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If tb. ....c bas blced · cootc.ctoc oc contc.ctoc. to nndert... ..cl, th.,.., be cequIced to be Ilc...ed in accord.... .iti
<br />.t.t. and loeal cegal.tions. If the cootc.ct.c i. oot Ilc"'ed as cegaiced by I.., both !be ....c and contractor lOp be
<br />cited f.c · .iol......c oiol.tion ned.c .t.t. I... If tlo ....c oc int..ded cootcactoc .ce ,""Ctalo as to wIot li""'1ng
<br />c.qnlreoonts '" .ppl, foc lb. int.nd.d NOcl, tb., .c. adoi'ed t. cnet.ct tb. Cit, of r.ph,chill. Building Depacboeot, (BII)
<br />788-66U.
<br />
<br />Fnctheconc., if the ....c has hiced · contc.ctoc .c oo.tc.ct..., he i. .doi.ed to have the contractoc(.) .iga portions of tho
<br />'Cootc.ctoc S.ction.' of !hi. applic.tion loc >bich lb., .ill be ceoponsihl.. if fOU, as tho ..... .ige as tho contractor,
<br />you ace indic.tlng that you, c.thec tl.. the cootcactoc, .ce ceoponsihle foc lbe lOCI. If tbe contractor .Iob.. fOU to olga
<br />as contc.ctor that .., he .. lodic.tioe that he i. ..t pcopocl, li.....a and i. not entitled to IOCalttiog pci.ilegoo 10 lb.
<br />City of Zephyrhills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND U1'ILI'rY CONNECTION FEES ,.<
<br />
<br />D. ~ONSTRUCTION LIEN L1IW (CHAPTER "113, FLORIDA STATUTES, AS 1IMEllDED)
<br />I cectif, that I, tho appliea.t, h.ve heen pcovided .lth . c.py of 'Flocida'. Coesleuction Lien La. _ .........'. Protection
<br />GUide' prepaCed by the Flocld. Depactleet of Agcicuituce awl COneuoec Aff.ic.. If tho 'pplicant I. ....... oller lion tho
<br />....ec., I cectif, that I hao. oht.ioed · CDpJ of tbe .booe deoccihed dncu...t .nd pcnol.. io !ODd faith to deliver It to tho
<br />Rowner" prior to co"encelent.
<br />
<br />E. CONTRACTOR r S/OWNER r S AFFIDAVI'r
<br />I c.ctif, tb.t .il tbe iOfoc..tion io thi. application i. .ccuc.te .od tb.t .11 NOcl .ill he done io onopli.... .Ith .11
<br />applicable laws regUlating construction, loning, and land developlent.
<br />1
<br />
<br />Application i. berebr oode to obtaio . poc.it to de "cl and install.tion .. indicated. I certify liot no sorl or
<br />l..t.ll.tloo has cnooenoed pcloc to I....... of . poc.lt .nd that .11 "cl .ill he peef",", to ...t .tandooio of all I...
<br />cegulotlng coo.truetion, City cndos, .onlog cegui.tion., awl land de,elopoent Cegul.tion. 10 tbe !uclodlctlon. I alon
<br />cectif, that I oedec.t.od that the cogul.tion. of otber go'ecnoentol agenci.. '" appl, to tbe loteoled sorl, and that it i.
<br />., ce.pon.lhillty to identify .hat .ctions I .u.t tale to he io c..pliance. Sucb ageoci.. iocinde hot ace not Ilsdted to:
<br />· DejO<tleet of lo'ic.....t.1 Regul.tion - C,pces. Bnyheois, IOtland Aceas and RO'ironoeolall, Sensitive land.,
<br />Water/Wastewater Treatlent
<br />I Southwest Florida Water Hanagelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />I Arl' Corps of Engineers - Seawalls, Docks, Navigable Materways
<br />· De ortleot of Heallb , Relabilitative Sec,ices Ro.i......t.1 He.lth Unit - Weli., WOsb!sater ,...toent, Septic rants
<br />I US InviroDlental Protection Agency - Asbestos abate.ent
<br />I .i.. cortlf, that, if fill ..teci.1 i. to be used in Flood Zen. 'A' oc 'o,.tc.', it i. underolood that a drainago plan
<br />'ddcesoing · 'COOpen..tleg ..I.... will he 'oboltted wbiob i. pcepaced bY a pcofeselonal engineer ceglotered In tha State of
<br />Florida prior to per.it. issuance.
<br />
<br />. A POCOit I..ued .hall he coo.trued to be a lice..e to PCOCOed .Itb the woel and not as .ullocitr to .iolate, CIDOIl aiter, or
<br />oOt aside anI previ.i... of the technic.1 cod", nor .bali i.,u,"ce of . pocoit pcevent lbe Rullding Official /coo tbeceafter
<br />ceqo!ciog · corcection of ecroc. io pi..., con.truetion, oc ,iol.tl... of anI code. Bvecr pecoIt iasued 1ba11 hocooo In,a(ld
<br />onieo. the ..cl ..thnci'ed bY .uob poc.it i. caooenced wilbin .t. onnlb. of i......., or if woel ,ullor1sed IJ the pecoIt I.
<br />"'pendei oc ahanlloned foc · period of .ix ...ths .fter the !be the ..cll. __. 1m 90 dllf ..tensi", of !be, 0IIf he
<br />.llnoed foc the pocoit wilb fee cb.cge .f $15.90. rhe ext...ion shali be cequ"led in .citing to the BnIiding Official. An
<br />approved inspection lust be logged during each six IOnth period, or the project will be considered abandoned.
<br />_IRG 10 00RIl: - FAlWR1 10 IIRCWlD A /IOfICl or ClIlIlRJiCmJI, IIA' IIISUL' II '11III PAflRG TWICI PUIlIllPllOVlllilrs 10 _
<br />PROPERTY, IP YOU INTEND TO OBTAIN FINANCIHG, COHSULT WITH YOUR LEHDER OR AN ATTORBHY BEPORB RBCORDING YOUR BarIC! OP
<br />COHHEHCEHENT. JOBS UNDER $2,500 IH VALUE DO NOT NBID TO RECORD AND POST A "NOTICE OF COHHBNCBIIDI".
<br />
<br />SIGNATURB: OWHER OR AGENT
<br />
<br />. I
<br />
<br />SIGHATURE: COHTRACTOR
<br />
<br />srArE OF FLORIDA
<br />CooHfY OP
<br />The foregOing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19_ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument was aCknowledged
<br />before me this , 19_____ by
<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 />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 />(Signature)
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
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