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<br />AP~-:-2,1 -94 THU 9; ~;)~ GEt-lERAL H':;Jt"E DEVE'-9,PMENT P - (.'12
<br />CO. i!JITI0NS OF PERI'1.I"r AFFID(WIT I
<br />A. ~9T ~ CE OF DEED Re;5T~i:~CI I ONij" ., ,
<br />Thl under.lgnrd understands that this p~r.ll "~y bt sub).,t to "dead rr$trlction." which liY bl lor. rastrictlv. than Caty
<br />ru~ulatlons. Theundrrslgned 'S5U.C~ rosponsibility for cD.pliant. ~ith ~ny Ippliclhlt deed restrictions,
<br />
<br />B. UNL I CE'NSED CONTRAcrC1nS AND CpNTRACrOR REs.e.QN~tLlii.I l: I T I E~
<br />If thl OMnor has hired a contractor or tuntractor, to undertako .ork, they .ay b~ required to bl llt~n~~d In accordanc. MI\h
<br />st~tl ind local re9ul~tlons. If the ,tontr~ctor I~ not licQns~d as required by Jaw, both the owner Ind contractor lay be
<br />cit~d for I Ilsdeaeanor vlolation u~drr ~tate law, If t~u owner or intend~d contractor are uncertain as to what lictnslnq
<br />requirelents lay apply for the intended uork, they ar. advis~d to contact the Ci~y of Zephyrhills Building Depart,ent, (8131
<br />78B-6611. .
<br />
<br />Further.ori, 11 thl owntr hiS hirvd I co~tractor or c~ntractorsl hv is jdvised to h~ve th! contractor(s) sign portlons of the
<br />'Contrjctor Sections" of this application for which they Mill be respo~5iblv. If you, is the owner siVn as the contractor,
<br />you er. indiCilting that you, r.ther th~n the contractor, irt responsible for the Mork. 1f th, contrattor II1shn you to sign
<br />, as contrlctor thilt liY be an indication that he is not pr~perly licensed and 15 not entitled to perlitting privll'OtS In. the
<br />City of Zephyrhills.
<br />
<br />c. TRANSPORTATION IMPACT FE~S AN
<br />
<br />
<br />s
<br />
<br />D. CONSTRUCTION LIEN LA~ (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />J certify that It the applicant, hive b~cn provided Mith a copy of 'Florida's Construction Lien La~ - H~leoMner'l Protection
<br />Guide" prepared by the Florida Depart.ent of Agriculture and Consuler Affairs. If the,applicant is SOleone other than the
<br />'ollner", I certify that 1 have obtained a copy of the above described doculvnt ind prolise in vood fiith to deliver it to the
<br />'oMner' prlolN!o COllrncelent.
<br />
<br />IE. CONTRACTOR · 51 p~JNEa:.F._AF'F I OAV J T
<br />J certify that all the inforlation in this ipptication is accurate Ind thjt all work "ill be don~ in cOlplianc' ~it~ all
<br />applicable laws re9ulating cDnstruction, ~oning, Ind land deveJop.ent.
<br />
<br />Application is hereby .~de to obtain a perlit to do work and installation as indicated. t certify that no Mork or
<br />ln~t~llatlon has co..~nced prior to issuante of I p~rli\ and that ill Mork Mill bt perfor.ed to levt standards of all JawS
<br />regulitin9 cDnstructlon, City cod~s, lonln9 rvgula\ions, and land develop.ent re9ul~tions In the jurisdiction. 1 1150
<br />certify that 1 understand that the r~gulations of other govern,ental agencies lay apply to the intended work, and that It Is
<br />IY responsibility to identify ~ha\ adi~111 1 lust hke to be in cOlpliante. Such ~gencies include but are not ti.lted to:
<br />. OPDartlent of Environ,ental R~Qul~ti~n R Cypr~ss Bayheads, WetJand Areas and Environ.entally S~nsitlve Lands,
<br />. "ater/Wastewater Treat.tnt
<br />t Southwest Florid. w~ter "anaQ~.cnt Dls~ . Wells, Cypress B~yhcads, Wetland Areas, Altering Watercourses
<br />t ArlY Corps of EnQinnrs ... SUHalh, Dt".\I, Hilvi9abh Watm.ays .
<br />. Depart,ent of Health , R~habilitatlYe ~~rvite~, Environlental Health Unj~. Wells, Ma5t!~ater Trcat.~nt, Scplic T.nks
<br />t VS Environ.ental Protec\ion Aacncy - A~bestos ab.telrnt
<br />1 1110 certify t~at, if fill latQrial is to be used in Flood Zone 'A" or 'A,vtc.', it is understood that a drainage plan
<br />addressing I 'colpensatinq volulc' ~ill be sublitted which is prepared by a professional engineer registered in the state of
<br />Florida prior to perait issuin~'.
<br />
<br />A perlit issued shall be construed to be a license to proteed Mith the Hork and not as authority to violate, cln~el .lter, or
<br />set i5ide any provisions of the technical cod~s, nor shall issuante of a perlit prevent the B~llding Official frol there.fter
<br />requiring ....correc:tion of errors in plan.., construction, or viohtions of Iny codt. Every perlH issued shalt beeo.. invalid
<br />unltss the work luthori~ed by such permit is co.tenced Hithi.n six lonths of issuance,' Dr if Hork authorized by thl per.it i5
<br />suspended or abandoned for a period of Sl~ eonths after the tile the work is COIQcnced. ' One 90 day extension of ti.e, liY be
<br />allowed for thl perllt Kith fee charqc or 115.00. The extension shall be requested in Hritioq to the Building Official. An
<br />approv~d inspection lust be logged dud',,) each si~ lonth period, or thl! projvtt Mill be considered ..b~ndoned,
<br />WARNING TO OYNER: YOUR FAILURE TO RECORll A NOTICE OF COHKENCEHENT MAY RESULT IN YOUR PAYING TWICE FOR lKPROVErtEHTS TO YOUR
<br />PROPERTY. IF YOU INTEND TO 08TAIN F IHAHI:lllGt COllSUL T W lTH YOUR LENDER OR AN ATTORNEY BEfORE RECORDING YOUR IlOnCE OF
<br />COKKEHCE~EHT, JOBS UNDER $2,500 IN V~lU,: 00 tlOT HEED TO RECORD flUD POST A 'WOT ICE OF COI1t1ENCEIIEHT" ,
<br />I
<br />
<br />.
<br />SIGNATURE, OWNER OR AGENT
<br />~ :}S-2- 3"30 - S-,y. 2 C;,s--O
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The fQregoin; instrument
<br />before me th~5
<br />
<br />- . -'
<br />SiGNATURE, COHT~ACTOR- ~
<br />L ,-~2- - lr3 4 oS &- L cr .$- - ~
<br />I
<br />
<br />was acknowledged
<br />, 11'_ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF ,
<br />The fDre9~in9 instrument
<br />befe.nt me this
<br />
<br />was acknowledQed
<br />, 19_ by
<br />
<br />who is personally ~nown to me or who h~&
<br />produced
<br />as identification and who did/did not
<br />tal,. an ooath.
<br />
<br />~ho is porsonally known to me or who has
<br />produced
<br />aa identification and who did/did not
<br />ta"e an oath.
<br />
<br />(Signature)
<br />
<br />(Signatul-e)
<br />
<br />. (Name Typed, Pr inted 0\- StClmped)
<br />NOTARY PUBLIC
<br />
<br />(Name Typed, Pri~ted or Stamped)
<br />NOTARY PUBLIC'
<br />
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