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<br />CONDITIONS OF PERMIT AFFIDAVIT <br />A. NOTICE OF DEED RESTRICTIONS <br />lb. und.rslgn.d und.rstands that this ..rslt oay be suhj.ct to 'd..d r.stricti...' which oay he IDr. restrlcti.. than City <br />regulations. rhe undersigned assUles responsibility for co.pliance with any applicable deed restrictions. <br /> <br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES <br />If th. ow... b.. blred a cootractor or cootractors to und.rlale worl. they oay he r.goired to he Ilceosed in accordan.. wilb <br />stale and local regulati.... If lb. contractor is oot lic.nSed .. reguired by I... both th. ..... and conlIactor soy he <br />cited for a sl.deoeaoor violation und.r .tat. I... If lb. ....r or iotended contractor are oocertain as to .Iot licensing <br />r.guires..ts oay apply for th. Int'nded worl, they are advis.d tn contact tie City of Z.phyr.llls Bulldlog Oeparlsent. (81l1 <br />788-6611 . <br /> <br />Furtherwor.. if the ....r ha. hired a contractor or contractors. h. Is advised to ha,. th. contractorls) .110 portions of tie <br />'Contractor Section.' of thi. application for wbleb lIey will be responslhl.. If YOU. .. the "'er alga .. tbe CODtrector, <br />you are Indicating that YOU. rath.r than th. contractor, are responsibl. for tie worl. If the contractor .1.... rou to slga <br />a. contractor that lay be an indication that b. i. not properly licensed and Is ..t entitled to perajtti.g prl,lleges i. tie <br />City of Zephyrhills. <br /> <br />C. TRANSPORTATION IMPACT FEES AND U'l'ILI'fY CONNECTION FEES " " <br /> <br />D. CONSTRUCTION LIEN LfIW (CIIAPTER '113, FLORIDA STATUTES.. AS AMENDED) <br />I ..rtlfy that I, the applicant, have be.. provided with a c.py .f 'Ylorida's Constroction Lien La. _ Booeosoer's Protection <br />Guid.' p..pared by tie YI.rida Departs"t .f Agricultur. and C......r Affair.. If lbu applicant ia ....... .ther than tbe <br />.....r., I certify that I have obtained a copy .f th. above described docuoeut and prowls. i. good faith to dell... It to tbe <br />"owner" prior to co-enCl!llent. <br /> <br />E. CONTRACTOR' S/OWNER' S AFFIDAVI'f <br />I c.rtify that all th. inforsatlon in this appllcati.. is accurat. and tbat all worl .ill be done i. 00Bpi1.... .ith all <br />applicable laws regulating construction, loning, and land developlent. <br />I <br /> <br />Application is hereby .ade to obtain a per.it to do wort and instailation as indicated. I certify that no worl or <br />I.stallatino b.. CDBOenced pri.r t. i..uance .f a persit and lhet all worl .111 he perf.rsed to ...t 'looIards of all I... <br />regulating C...truction, CIty cod". .nolng regulatl.n.. and land devel.,...t regulatl... i. tbe jorloilctl... I aIlD <br />..rtlfy that I und.r.land that tbe regulation. .f .tber go.......tal agencies lay apply to tbe Iolended sorl, and tbat it I. <br />.y responsibility to identify what actions I .ust take to be in co.pliance. Such agencies include but are not lilited to: <br />· Del"rbrent of in'ir.....tal Regulation - Cypre.. 8ayheads. Metland Ar... ..d 8nvir.....laIly 8eoalti.. ionds, <br />Water/Wastewater Treablent <br />t Southwest Florida Water Hanage.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses <br />t Ar.y Corps of Engineers - Seawalls, Docks, Havigable Waterways <br />· De arlseot of Health' Hehabllitati,e Services Io'ir.....tal Health Unit - Wells. Mloleoater rrealseot. SeptIc 1anI. <br />t US EnviroDlental Protection Agenct - Asbestos abatl!llent <br />I al.. certify lhet, If fill sat.rial i. to be u.ed in Ylood .... 'A' or 'o,.tc.', it Is uod.r.looI that a drainage pi.. <br />addr...ing a 'CDS,..sating vol.... will he suboitted which Is prepared by a professional engin,er registered in tbo Stale of <br />Florida prior to per.it. issuance. <br /> <br />. I petSlt I..uod shall be constru'd to b. a licens, to procoed wilb 1Io worl and not as authority to violate. caoceI aller, or <br />.et aside any provision. of 1Io t'eboical cod,s, nor shall i....... of a per.lt pr....t the 801ldlog Officlol froo tboroafter <br />roqulrlog a corr,ctlno of error. in pi.... "nstrocti... or violations of ..y cod,. Bverr persJt i88Ded 8hal1 becooo Iotalld <br />Onl,.. the wort authorlled by .uel per.lt i. ......cod .itbin si, IDOtho of i.....ce. or if sorl aotborlsed by 1Io polIit i. <br />suSpended or abandoned for a P'rind of siz sooths after the tise the worl is _Ced. Ilns gO day estensl.. of 1WI, soy be <br />allowed for tho peralt lilb fee cbarge of 115.00. lb. est"sion shall be requested I. wrill.g to the Holldlog Official. .. <br />approved inspection .ust be logged during each six .onth period, or the project will be considered abandoned. <br />IIARlflG ro OIIIEII: I'OOR "fLDHH ro RKCOlID 0 IIClrIOlOF COIIIIIIICIlIIm lilY _r III _ PIYfIlG mOl flIR IlIPiIlfIIIms ro fOUII <br />PIIOPERrY. IF roo IRZI/IO ro DIlrm f1It1J1CIRG. CDROOLr Rnu I'OOR I.HIDI1fII 01111I Anomy HH1OlUlIIICII/uJIIIG I'OOR lIOrlCR OF <br />COHHEHCEHHHT. JOBS UHDER ALOE DO HOT HEED TO RECORD AND POST A "HOTICE OF CO HCEHEIfIIl . <br />.... <br /> <br /> <br /> <br />, I <br /> <br />OR AGH~T <br />;) rqt. f+ <br /> <br />srATE OF FWRIDA [) <br />COUHTY OF ~~ <br />The foregOing instrument was acJmowledgedbefore me this MJu. J ~ , 199.:7- by <br /> <br />(;.ec r~~ It-. /IJ~~ko fh J"12-, <br />who is per onally known to ~or who bas <br />produce~ ,/ <br />as identi ation and W did/. not <br />ta a h. <br /> <br />STArK OF FLORID~ <br />COUNrY OF ~ <) <br />The foregOing instrument was acknowledged <br />before me this ) /- !l L; , 19L.L. by <br />~~, ~AO:' .A 0 <br />who is personally known to me or who has <br />produced )f b Ys-- ')kd- Yt- ~""'J..o - 0 <br />as identification and who didldid not <br />take an oa~ a. m '7'4- <br /> <br />(SignatureJ/f:::8 .4. 11"01 - <br />(Name Typed, Printed' or Stamped) 7 <br />NOTARY PUBLIC <br /> <br /> <br />$~lf\~'~ Nqy A. Moody <br />€*:~:*S MY COI.MssIoN , CCS34806 EXPIRES <br />~. . ~ Fe!IruIIy 21, 2000 <br />'~Rf..l'iI IIllQo lIIlU 'IIIlV I'NN 1NSUIWIcf. INC, <br />