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<br />CUI'liJIIICif'-,:,::; Ul- f Lhh,[ t Hi i- J U" ,I. I
<br />A. NOTICE OF DEED RESTRICTIONS
<br />, The undersigned understands that this perait.ay be subject to -deed restridions" which flay be /lore restrictive than City
<br />regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance Nith
<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 lisde.eanor violation under state IaN. If the ONner or intended contractor are uncertain as to what licensing
<br />requirelents lay apply for the intended work, they are advised to contact the City of iephyrhills Building Departlent, 18131
<br />788-6611.
<br />
<br />Furtherlore, if the ONner has hired a contractor or contractors, he is advised to have the contractorlsl sign portions of the
<br />"Contractor Sections" of this application for which they will be responsible. If you, as the ONner 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 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 "Florida's Construction lien law - HOleowner's Protection
<br />Guide- prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
<br />"owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
<br />.0Nner- prior to cOllencelent. '
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforlation in this application is accurate and that all work "ill be done in compliance with all
<br />applicable laNS regulating construction, zoning, and land developlent.
<br />
<br />Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work Dr
<br />installation has COllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
<br />regulating construction, City codes, zoning regulations. and land developlent regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other governlental agencies lay apply to the intended work, and that it is
<br />IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
<br />I Departlent of Environlental ReQuIation - Cypress Baybeads, Wetland Areas and Environlentally Sensitive lands,
<br />, Water/Wastewater Treat.ent
<br />I Southwest Florida Water "anaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />I Ar.v Corps of Enqineers - Seawalls, Docks, Navigable Waterways
<br />I Depart.ent of Health l Rehabilitative Services. Environ.ental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
<br />I US Environlental Protection Aqency - Asbestos abate.ent
<br />I also certify that, if fill laterial is to be used in Flood Zone "A- Dr .A,ete,", it ,is understood that a drainage plan
<br />addressing a -co.pensating volule- will be sublitted which is prepared by a professional'engineer registered in the State of
<br />Florida prior to perlit issuance.
<br />
<br />A per.it issued shall be cons~rued to be a license to proceed with tbe work and not as authority to violate, cancel alter, Dr
<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 becOle invalid
<br />unless the work authorized by such perlit is cOI.enced within six lonths of issuance, or if work authorized by the per.it is
<br />suspended Dr abandoned for a period of six lonths after the ti.e the work is cO.lenced. One 90 day extension of tile, lay be
<br />allowed for the perlit'Hith fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
<br />approved inspection lUSt be logged during each six lonth period, or the project will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CO""ENCE"ENT KAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
<br />PROPERTY. IF YOU INTEND:TO OBTAIN FINANCING, CONSULT NITH YOUR lENDER OR AN ATTORNEY BEFORE RECORDINS YOUR NOTICE OF
<br />Co""KeElEOT lOBS UOO,' '2,500 I 'NeU' on OoT ",'0 TO "CO.O .00 POST~'N~O'NC'" ·
<br />
<br />
<br />
<br />CONTRACTOR
<br />
<br />
<br />SIGN
<br />
<br />was acknowledged
<br />, 19~ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF Polk
<br />. The foregc. i ng instrument
<br />before me this June 1?
<br />
<br />STATE OF flORIDA lk
<br />COUNTY OF . Po
<br />Th~,foregoing ins~rument
<br />before me th is June 12
<br />
<br />"Ias acknc,wledged
<br />, 19--9:1- by
<br />
<br />Herbert W. Key
<br />who is personally
<br />produced
<br />as identification
<br />an oa~
<br />
<br />known to me or who has
<br />
<br />Herbert W. Key
<br />who is personally known to me or who has
<br />produced
<br />as identification and who did/did not
<br />~e an o~~f;' /] )
<br />~;~~~:u::;<' /V. ,f;:J(p6>~> ~"-
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />did/did not
<br />"
<br />j
<br />-> '-'-
<br />
<br />
<br />t
<br />
<br />(Name Typed, Printed or stamped)
<br />NOTARY PUBLIC
<br />
<br />
<br />A JANET G. RAYBORN
<br />Notary Public. Slate of Aoroa
<br />My Conm. Expires Jan, a. 2000
<br />No. CC 523228
<br />Bonded Thill .flltlal Kollf' Ifnritf
<br />1-(800) 72:3-0121
<br />
<br />JANfffG:-RAYBORN
<br />Nalary Public, Slate of Rorida
<br />My Coiml. Expires Jan. a. 2OX)
<br />No. CC 523228
<br />Bonded Thill filtlal .lIf, .,..,.
<br />1-(800) 723-0121
<br />
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