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<br />CONDITIONS OF PEI~IT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />lb. under.igned undo"I.... Ib'l thl. per.11 oa, 10 .ubJecl lo 'deed r..lricli.... wblth oa, be SOr. restrlcli.. tIon Clly
<br />regulations. fhe undersigned assues responsibility Cor co.pUance Ifith any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRAC'l'Ons AND CON'j'UAC'l'On RESPONSIBILITIES
<br />If 110 ....r has bired · contr'clor or coolr.clor. 10 und.rl... ..r'. lbor oa, be r.guired to 10 II,ooood la .....daooe 0111
<br />.I.le .nd local regul.li..., If lb. tootr.clor i. nol licen.ed as r.,.ired b, 1'0, bolb lIo ...., and COOlIactor ..y 10
<br />'Iled for · oi8<leooanor viol.Uoo under .1.1. I.., If II" """er or lnlooded conlra'lor or. ..,erlain .. to 811at 1I_lng
<br />rogalr....I. oay .ppl, for lb. Inl..d.d ..r'. lb., .re .dd"" lo coolact llIe CIt, nf Z.plJyrblll. Bulldlll!J~, (813)
<br />788-66U.
<br />
<br />FDrlberso". If lb. osnor I~. !ired · ,onlra'lor or oonlra,Io", lie i. add.ed tn '.ave Uoe contraclor,.) .i!lll portlou of lIo
<br />'Coolraclor SocU....' of lbis .ppJicaU... for obith lb., oill be respon.ibI.. If roo, as lIo """er 81!111 as Il8 coatractor,
<br />roo .re Indicating lIIal yo.. ralllOr lIIan lI1e COlIlra,lor. .re r"pon.ibl. for lI1e IOd. If lIo contractor oiJlJoa roo 10 'Igo
<br />as contraclor 1101 oay 10 '" Ind;calion 1101 b. i. nol prop.rl, licoo.ed .nd I. nol enlllled to Plflilllng prl,lltgOI la 1Io
<br />City of Zephyrhills.
<br />
<br />C. 'l'RANSPOR'l'A'l'ION IMPACT FEES AND U'j'ILl'l'Y CONNECTION FEES
<br />
<br />"
<br />{
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<br />D. CONSTRUC'rION LIEN i:IlW (CIIAP'rER '/13, FLOIIIDA STATUTES, AS AMEilDEDJ
<br />I "rlify thaI I, lIo .ppllcanl. 10.. Io.n provided ollb . ,op, of 'Florida', Construclion Lien Lao _ Boooooaor'. Protocti..
<br />Guld.' pr.pared by lb. Florid. DepartsOUI nf Agrienllnr. .nd C......r Aff.i", ff lb. 'ppli,,"t I. ....... otIor Ii.. 1Io
<br />.....r.. I cortif, Ib.1 f love obl.ined · cop, of lb. .bove d'.crlbed doc....I .nd prooi.. I. good 1.llb to dell... II to 110
<br />"olfner" prior lo co..encelenl,
<br />
<br />E. CONTRACTOn 'S/OWNER'S AFFIDAVl'l'
<br />I "rllf, lIIal .11 lb. inforoalion in Ibi. .ppllcaliwl I. "enr'l. .nd lIIal .11 vor' of II be dun. In CUlpIIanco olli all
<br />applicable laws regulating construction, loning, and land developlent.
<br />I
<br />
<br />Application is hereby lade to obtain a per.it to do Ifork and instailation as indicated. I certify that DO worl or
<br />Inslallalinn bas COIIOnced prlnr I. I....." of . perllt and lbal all .... oill 10 perfOOlOd to lilt llaadardo of all Iaoo
<br />regul.llng ","tru,li.., CII, codes. sonlng regul.lion.. and land de..I",""1 regulall... 10 tho jurlollctl... I .1..
<br />'.rllfy li'l I und.r.land lbol tho regul.lion. of 'lIor 90.......101 agen,;.. oa, apply 10 110 laloudol ...., and 1101 II I.
<br />.y responSibility to identify Ifhat actions I lusl take to be in co.pliance. Sucb agencies include but are not lillted to:
<br />· Deiortoout of B.'ir.....I.1 Regul.llon . C,pr... Ba,b.ads, B.tland Ar". and Bn'ir.....laIly SOOIitivo Iando.
<br />Vater/Vastewater Yreatlent
<br />I SouthNest Florida Vater HanageJent District - VeIls, Cypress Bayheads, Vetland Areas, Altering Natercourses
<br />I ArlY Corps of Engineers - Seawalls, Docks, Navigable Vaterways
<br />· Do .rlooul of He.lth , R"abililali,. Services Bn,irOOl..lal R..lth Unil - Bell.. B..I...ler 'r"loool, Septi, r....
<br />I US EnviroDlental Protection Agencl - Asbestos abateaent
<br />f also certlf, 1i.1. if fill ...,,1.1 is 10 b. ,... iu Flood "'.. 'A' or ....Ic.., It i. uod"l_ 1101 . dralaago pi..
<br />addr...l" · 'CUIpOnoatlog ..I.... oill b. .uh8llled obl,b I. pr.pared by . prof...loo.1 ongluoor regi.tered II 1Io Stale of
<br />Florida prior to per.it. issuance.
<br />
<br />
<br />. A P.roll ilsued sholl be co..lr"", 10 be · 11'.... 10 prO'eed olth 1Io vor' and nol a. "lIorllr to 'loIata, 0ID081 .ller, or
<br />.e. ..ide '"' pro,i.l... of Ih. ledbol,al cod", nor .ball i"",",, of I p.rlil pr....1 tho Ballding Offl,ial froo tIaroofler
<br />r.quirlog a corr.,tI.. of orror. in pi.... COOllr"li.., or ,iol..i... of au, cod.. 8torr PIIIi. I..... ahoJl bocooa 1avaI1d
<br />unl... lb. NOrl "Iborlled by ."b porli. I. COOIOO,oI within .11 IOOlb. of i......., or If ...1 ..thoriled b, 1Io PIIIi. i.
<br />"'POudod or ahaodunol for a poriotl of .Ix 800110 .flor lb. 1100 tho .... I. -.cod. 011o gO day 0....1.. of lioo, .y 10
<br />.I10l10d for th oro. Ilb foo cllarge of $15.00. rile 01...1... 811a1l 10 reguoaled in orltlng to tho BaIldlog Official. 10
<br />approve sp 1 st e Jogged during each six IOnth period, or the project will be considered abilDdooed.
<br />TO 011 R: YOU II LURE fO CE OF'COIIIIENCKHENT MY RESULT IN YOUR PAYlIC flUCE FOR IMPROVIIIDl'S 10 YOUR
<br />. IF U INTEND OBfA FIlfAlfCING, CO SULT VlrB YOUR LENDER OR AN AnORIIIY BEFORE RECOHOIIC YOUR IOIICI OF
<br />NT. SUNDER, 50 IN VALUE DO NOT NEED TO RECORD AlfD POST A "NOTICE OF COHHBNCKIIUI". '
<br />
<br />---~ ~oan.-t--
<br />~Afui OlfrRACYOR
<br />
<br />LOR
<br />COUNTY OF / tt..A (~
<br />The foregoing irtrument.was acknowledged
<br />before me ti,l. ~u) 19 a by
<br />
<br />./i.{~ 6..~,Jl.
<br />who is p rSO~llY known to me or who has
<br />produced I ~
<br />as identificat.on and who did/did not
<br />take an 0 A.. /'5 ()
<br />
<br />) /Yl ~';{ ,6 e7-.LVJ ()
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC~_,
<br />
<br />~'~~~';; ~;:5;[~~ \
<br />. ,~) Comm. ~175 li
<br />...."." --~............
<br />",~~~_~<11"___ -
<br />
<br />
<br />
<br />SfAfE OF FLORIDA OAr
<br />COUNTY OF { '.>( 0
<br />The foregoing instrument was acknowledged
<br />before me this ~ 19 q7 by
<br />
<br />JA ~ c.. ~rnLJ.)N .
<br />who is person By known 0 me or who bas
<br />produced ev
<br />as identificat on and who id/did not
<br />take all oatb.g~A J~\lli. ''''~
<br />
<br />(Signature) C:; . J fI ^ B
<br />"- (l Y\G\Vo... IVI. aLter
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />
<br />l0
<br />
<br />-l
<br />SANDRA M. BAUER
<br />Notary Public, State of Florida
<br />My Comm, E~pires July 23, 1999
<br />No, CC471 074 Uh
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