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CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this peIlit lay be subject to -deed restrictions" which lay be lOre restrictive than City regulations. !he undersigned assUles responsibility for. cOlpliance with any applicable deed restrictions. B. UNLICENSEP CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner bas bired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be cited for a lisdeleanor violation under state law. If the owner or inteoded contractor are uncertain as to wbat licensing requirl!lents lay apply for the intended work, they are adrised to contact the City of Zepbyrbills Building DepartJent, (813) 788-6611. Furtherlore, if the owner bas hired a contractor or contractors, he is advised to have the contractor(s} sign portions of the -Contractor Sectionsu of this application for wbich they Ifill be responsible. If you, as the owner sign as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that lay be an indication that be is not properly licensed and is not entitled to perlitting privileges in the City of Zephyrbills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of uFlorida's Construction Lien Law _ Hoaeowner's Protection Guide" p{epared by the Florida DepartJent of Agriculture and ConsUler Affairs. If the applicant is sOleone other than the uowner", I certify that I have obtained a copy of the above desCribed docUlent and prOlise in good faith to deliver it to the "owner" prior to coaencelent. E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all applicable laws regulating construction, zoning, and land developlent. Application is hereby lade to obtain a per.it to do work and installation as indicated. I certify that no work or installation bas COIIenced prior to issuance of a perlit and that all work will be perf oIled to .eet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other ~oveInlental agencieR lay apply to tbe intended work, and that it is .y responsibility to identify wbat actions I lUSt take to be in cOlpliance. Sucb agencies include but are not li.ited to: t DepartJent of Environmental Regulation - Cypress Raybeads, Wetland Areas and Environmentally Sensitive Lands, Water/Wastewater !reatJent t Southwest Florida Water Hanagelent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses t ArIY Corps of Engineers - Seawalls, Docks, Navigable Waterways t DepartJent of Health & Rehabilitative Services, tnvirODlen.tal Health Unit - Wells, Wastewater YreatJent, Septic 'lanks t US EnvirODlental Protection Agency - Asbestos abat8lent I also certify that, if filllaterial is to be used in Flood Zone "AD or "A,etc.", it is understood that a drainage plan addressing a .cOlpensating voluae" will be sublitted wbich is prepared by a professional engineer registered in the State of Florida prior to perlit issuance. STATE OF FLORIDA COUNTY OF The foregoing ~i1/~ent was acknowledged before me this . , 19~ by ~~~ who is personally known to me or who has produced as identification and who did did not take an oat ~ p~ STATE OF FLORIDA ~ COUNTY OF ~ The foregoing in~.n ant wae acknouledged before me this ~ ' 19z:L by ~~~~ who is personally known to me or who has produced . as identification and who did[did nQt take an o~~ ~I'~ ~ ~_ (Signature) ~ (Name Typed, P ~#.ted or Stamped) NOTARY PUB ~~ BOBBlE J BURKE * * My CommInion 00543871 Expires Mar. 31. 2000 (Namt! Typed, Printed or Stamped). . NOTARY PUBLIC:\",,'1 ""#.1 .... 6 ~ BOBBlE J eURKE *.* MyComrnlnion OC543871 Expires Mar. 31, 2000 ~ ,,>" ..,,.,, OF f~O"~