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<br />-.........
<br />
<br />- CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RES'rRICTIONS
<br />lb. undor.igool und...laod. lhal Ihi. perall lOy he .ubjocl to 'd.oI ['.I[iclioo.' whieb lOy be IO[. restricli.. than Cily
<br />regulations. rhe undersigned assUles responsibility for co.pliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CON'l'RAC'l'OH RESPONSIBILITIES
<br />if the ....r has hlrol · contr.ctor or conlr'clor. to underlak. ..rl, Ih.y lOy he required to be ii....ed io 'ccordaoca wilb
<br />.1.1. and iocal regul.lion.. If Ih. conlr.clo[ i. nol lic.n..d as [eQoi[ed by I.w, bolb tbe ..... and contractor .., be
<br />clled for · .i.d.....or ,iul.lion und.r .1.1. I.w. If Ih. own.r or inlended conlr,clor .r. uncerlalo as 10 wbal Ilc...tng
<br />r.goir....tv "y .pply for lhe inl.nd.d oorl, Ib.y .r. .d.i..d to conlacl th. Cily of &epbyrbill. Boildlog Departo,ol, (813]
<br />788-6611.
<br />
<br />Forlh....r., ii Ih. ....r has bired · conlr'ctor or conlr'Clor., be I. .d.i.ed 10 ha.. the contractor(.) .igo porlioos of lbe
<br />'Cootraclor Socii....' of Ibi. .pplicallon for whieb lhey will he res/lotlSibl.. If 1'00, as lbe "'or olIO as the oootractor,
<br />you are indicaliog 1101 roo, r.ther lion the conlr.clor, .r. r"/lotlSibl. ior th. ..rl. If the contractor wiahes roo 10 .i9O
<br />.. contr.clorlbal ..y he .n iodic'lion 1101 h. i. .01 Properly licensed and i. nol ..Iilied 10 PlIJdtliog pri'ii.... i. lb.
<br />City of Zephyrhills.
<br />
<br />C. 'rRANSPORTATION IMPAC'r FEES AND U1'ILITY CONNECTION FEES ""
<br />
<br />D. CONSTRUCTION LIEN LAW (CIIAPTER 713, FLORIDA STATUTES. AS AMENDED)
<br />I cerlify thaI I, lb. .ppiicanl, ba.. beeo provided with. copy .f 'Florid.'s Coo.lrocli.. Li.. Law _ 80000w0er'. Proteclion
<br />Goid.' prepared by the Fiorid. Deparloenl of Agricullu[. .nd Coo..... Iff.i... If lbe .ppiicant i. ....... olber than lbo
<br />....or', I cerlify 1101 I ba.. obl.i.oI · copy of the .bo" described doco,,"1 .nd P[OlIi.. I. good f.1th to dell", it 10 th.
<br />"owner" prior to COalenceaent.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I c.[llfy 1101 .Ii lb. info[..lloo in Ibi. .pplic'llon i. .ccor.t. and lhal .il ..[1 will be done is coopll.... wilb all
<br />applicable laws regulating construction, zoning, and land develop.ent.
<br />I
<br />
<br />Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that no worl or
<br />i..I.II.li.. bas ....enced prior 10 i.....c. of . ",.it and that .11 ..rl will be perforooi 10 ...t .looIaoIs of all I...
<br />regulating construction, City codes, zoning regulations, and land develop.ent regulations in the jurisdiction. I also
<br />corllfy tb'l I nod.r.t.od lhal the r.,ol'lio.. of olbor got......I.1 ....ci.. lOr 8pplr to the lolended ...1, sod that it is
<br />.y responSibility to identify what actions I .ust take to be in co.pliance. Such agencies include but are not li.ited to:
<br />t DepartJent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and BnviroDlentally Sensitive Lands,
<br />Water/Wastewater rreatlent
<br />t Southwest Florida Water HanageJent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />t Ar., Corps of Bngineers - Seawalls, Docks, Havigable Waterways
<br />t DepartJent of Health & Rehabilitative Services, BnviroDlental Health Unit - Wells, Wastewater freatJent, Septic fanks
<br />t US InviroDlental Protection Agency - Asbestos abate.ent
<br />1.180 c.rllfy th.l, If fill ..I.rl.1 is 10 be 0Bed io Flood Zon. '1' or '1,.lc.', il i. ooIerslood!lol. dr.iooge pi..
<br />odd....i.g · 'CUlpOOBaliog ..I.... will be .obollled .bieb I. pr.pared by . prof...I...1 englo"" regi.tered in 1Io Slate of
<br />Florida prior to per.it. issuance.
<br />
<br />. I penlit issoed shall be conslroed 10 b. . liceos. 10 proceed wilb the ..rl and oot .. aullority to 'iol.te, canoel alter, .r
<br />..t ..id. .ny pr..I.i... .f !be tecboicai cod", nor .hall is,u,"" of . penlit pr....t the Building Official froo tIoreolter
<br />requiring · "'recti.. .f err.r. io plan., construcli.., or ,i.I.II... of any cole. Every peroit losoed &ball becooe invalid
<br />unl... the ..rl .othorl"" by such POlOil i. ......ced wilbin .i. ...Ib. .f issuance, .r if ..rl aotIori.ed by tie peroit I.
<br />.o&peoded .r .baodooed for · period of .1. ...tbs .ft.r !be tloe the ..rl i. """,,cod. Doe 90 day ..t...l.. of lioe, lOr be
<br />allowed for the per.it with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
<br />approved inspection .ust be logged during each six IOntb period, or the project will be considered abandoned.
<br />WARHIHG TO ONHIR: YOUR FAILURI TO RECORD A HOnCK OF COHHIHClHKHT HAY RISULT IH YOUR PAYIHG 'fIIICE FOR IMPROVIIIDrS TO YOUR
<br />PHOPIRn. IF YOU IH1'IHD ro OBTAIH FIHANCIHG, COHSULr WIrH YOUR LIHDBR OR AH ArTOMIY BIFOM RECORDING YOUR HarICE OF
<br />COHHIHCEHBHT. JOBS UNDIR $2,5001N VALUI DO HOr NIED TO RECORD AlfD POST A "HOTICI OF COHHIlfCIHlJf1'".
<br />
<br />SIGHArURI: OWNIR OR AGIHT
<br />
<br />. I
<br />
<br />SIGHATURE: COHrRACrOR
<br />
<br />STATI OF FLORIDA
<br />COUlt1'Y OF
<br />The foregOing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19_ by
<br />
<br />STATB OF FLORIDA
<br />COUHn OF
<br />The foregOing instrument
<br />before me this
<br />
<br />was aCknowledged
<br />, 19 by
<br />
<br />who is personallY.known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an oath.
<br />
<br />who is personally known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an Oath.
<br />
<br />(Signature)
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
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