|
<br />cm'l!) I T I 01\15 OF PER1'1I T (~FF I D{~'v' IT,
<br />'':L NOitCC:OF bEEt) '~ESTFUCTldNS? .
<br />The undell!i1gnedundeishnds thit this perlit 'uay be sublect to "deed restrictions" l/hich Eay be lore restrictive than City
<br />regulations. The undersigned i5SUleS rCiponsibilityfor cDlpliancll HUh any applicable deed restrictions,
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If t~, owner hiS hired i contrictor or c;ntractors to undertake work, they may b~ required to be licensed in lccordancl with
<br />state and local regulations. If the ''ront'rktor i!i not i icensed as required by hH, both the 9wner and contractor uy be
<br />cited for a alsdeaeancr violation under state law. If t~e owner or intended contractor are uncertain as to what licensing
<br />requirelents lay apply for the intended :Iork, they are advised to contact the Ci~y of Zephyrhills Building Depart.ent, (813)
<br />788-6611.
<br />
<br />Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the.contractorlsl sign portions of the
<br />"Contractor Sections" tf'this application for which they will be respohsible. If you, as the owner sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the Hort. If the contractor Hishes you to sign
<br />. as contractor that aay be an indication that he is not pr~perly licensed and is not entitled to perlitting privileges in. the
<br />City of Zephyrhills.
<br />
<br />C. TRANSPOR1ATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />r certify that I, the applicant, have been provided with a copy of 'Florida's Construction Lien Law - HOleoKner's Protection
<br />Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOleone other than the
<br />'owner", r certify that I have obtained a copy of the above described docuDent and pro~ise' in good faith to deliver it to the
<br />"owner" prior to cOllencelent.
<br />
<br />E. CONTRACTPR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforlation in this application is accurate and that all Hork Hill be done in coapliance with all
<br />applicable laNS regulating construction, zoning, and land developlent.
<br />
<br />Application is hereby lade to obtain a pllraitto do work and 'installation as indicated. I certify that no work Dr
<br />installation has cOllenced prior to issuance of i perlit and that all work Nill be perforled to leet standards of all laws
<br />regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. r also
<br />certify that I understand that the reguiations of other governaental 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 />. Departlent of Environ.ental ReQulati~n - Cypress Bayheads, Wetland Areas and EnvironJentally Sensitive Lands,
<br />Yater/Wastewater Treataent
<br />'Southwest Florida Yater ManaQeaent District - Wells, Cypress Bayheads, Uetland Areas, Altering Hatercourses
<br />. ArlY Corps of EnQineers - Seawalls, D~cts, Navigable Waterways .
<br />t Deparhent of Health r. Rehabilitative Services. Environlenhl Health Unit - lIells. UasteHater. Treahent, Septic Tanks
<br />t US Environ.ental Protection AQency - A:bestos abatelent
<br />I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc,", it is understood that a drainage plan
<br />addressing a "coepensating volule" Hill be subaitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to per.it issuance. .
<br />
<br />A perlit issued shall be construed to be a license to proceed with the Hork and not as authority to violate, cancel alter, or
<br />set aside any provi$ions of the technical codes, nor shall issuance of a .perlit prevent the Building Official frol thereafter
<br />requiring a correction of errors in plan;, construction, or violations of any code, Every per1it issued shall becole invalid
<br />unless the work authorized by such pertit is 'coleenced within six Donths of issuance,' or if Hork authorized by the per.it is
<br />suspended or abandoned for a period of s~x lonths after the'tiee the Hork is coaDenced. . One 90 day extension of tile, lay be
<br />alloNed for the ~erlit Hith fee charge of ~15.00. The extension shall be requested in writing to the Bui1din. Official. An
<br />approved inspection _ust be logged durin~ each six lonth period, or the project will be considered abandoned.
<br />I/ARHING TO Ol/NER: YOUR FAILURE TO RECORII A NOTICE OF COHIIEIICEHEIlT HAY RESULT \II YOUR PI\YIHS TUICE FOR IHPROVEtlENTS TO YOUR
<br />PROPERTY. IF YOU IIlTEND TO OBTAIN FIIlAIl~IlI6, CollSUL T WITH YOUR LEllDER DR All ATTORNEY BEFORE ,RECORDING YOUR HOTICE OF
<br />COXMENCEKENT. JOBS UNDER ~2,500 IN VALUl: DO HOT HEED TO RECORD AItD POST A "HOTlCE OF COf1I1ElICEIIENT".
<br />
<br />
<br />~ ~'
<br />~~ ....._.. G,u.;t K~O
<br />SIGN E: Ol/HER OR AGENT SIGIl RE: COHTRACTO'R
<br />
<br />J~. ..)
<br />
<br />STATE OF FLPRIDft B' STATE OF FLORIDA 0",..$ c........_
<br />COUIHY OF ._ as c...o COUNTY OF L ~ 'V
<br />The foregoing instrument wa~ .cknowledged The foregoing instrument was acknowledged
<br />before me this Ntlu b , llJfl- by befc.re me this ~.~ , 19.:l.:J- by
<br />
<br />J 6:: 1'\tQ. 1- K. 'l3 LCL.'-k We. L L J a. rtL.f- 1< 8> ilL'-- k. We..L.'-
<br />who is personally known to me Dr who haa ~ho is personally known to me or ~ho has
<br />produced '.> , produced
<br />as identification and who dill/t:lid not. as. identificaticlll and who did/did hot
<br />I .
<br />take an ~?:.tnM--' {1. ~____ take an ~~~ . 0. ()~
<br />
<br />(Signatu e~ . ./1_ . < (Signat l-e) .
<br />fja.-f;~ rr.. A /11// e.rn... ~ ~-
<br />,<Name Typed, Pr i nted or Stamped) . (Name Typed, Pd nted ~-/ st'a P~~~I~C~ ~i ".: ";i)~';d" i
<br />NOTARY PUBLIC,. ..._,__,_,_-""- NOTARY 'PUBLIC \';!,,';;;:::'7.,,' :~(j8 J
<br />\ :. 8~R8ARA A. t.' '. ,,'"'' . . :'__1....___
<br />. '.~,..~f,";,l.' <Hie \ . P'Jt,liC ,t ',; IIOlldd ~
<br />. ~ Notary .' ,- - ;.-
<br />My Ccmrn. L ~
<br />1 l~__;.mm. No- ~.
<br />~ (~, \ w~-________..-_.__....'
<br />
<br />
|