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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The under.lgned under.lands thai Ibl. per.11 say be .ubjecl 10 'deed r..lrlcll.... >bleb .., be lOr. r..trlcll.. lhas til,
<br />regulations. fhe undersigned assOIes responsibility for cOlpliance with any applicable deed restrictions.
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<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If lb. ...er has hired · conlr,clor or contr'clor. 10 ..dertale NOrl. ther.., be required 10 be II....ed in accordaoce 0111
<br />.1.le and local regul.II.... If lhe contr.clor I. 001 llceo.ed as required by I... boll 1Io ..... and contractor say he
<br />cited for · .Iad.....or ,lol.lion under .tale 1'0. If the ...er or Inlended conlraclor are uncertain as 10 'hal 1100DsI0g
<br />regulr....ts .., .pply for the inlended NOrl. they .re .d'lsed 10 cootacl the Clly 01 Zophrrblll. Building Oeparts,gt. (113)
<br />788-66Il.
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<br />FUrtbersnr.. II lhe DOner h.. hired a conlraclor or conlr.clor.. he i. ad'i.ed 10 ha,. Ihe conlractor(.) .ign poctl... of 1Io
<br />'Contraclor Secll.... of Ibi. 'pplic.tlon for which lIey 'ill be respon.lble. II fOU. as 1Io ..... sign as tb8 contractor.
<br />you are indic.llog thai YOU. r'lber lban the CODlractor. are r"PODSible for the 1Or1. If the contr.ctor 'iales ,.. to sign
<br />.. CODlr'clor thai ..y be an Indicallon thai he I. ..I properly licensed .od I. DOl enlllled to perlilliog prl,llogeo In lIo
<br />City of Zephyrbills.
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<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
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<br />D. CONSTRUCTION LIEN L1\W (CllllPTER 713. FLOllIDlI STATUTES~ AS AMENDED)
<br />I cerllfy lb.1 I. 1Io .ppllcanl. ba,e beeo provided ollb . copy of 'Florld.'. COnstrucllon Lien Las _ ........... Frntoctl..
<br />Guide" prepared by the Florida DepartJent of Agriculture and ConsOler Affairs. If the applicant is SOleOOe other than the
<br />....er.. I cerlify thai I ha,e obl.ioed · copy of the above described dncnsenl .nd Prosl.e io good faith to deliver II to 1Io
<br />"owner" prior to COllenCelent.
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<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforlation in this application is accurate and that all wort will be done in COIpliance with all
<br />applicable laws regulating construction, loning, and land deveJoplent.
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<br />Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify tbat no wort or
<br />Install.lion has CDIOODCed prior to I....... of. persit and thai .11 NOrl .111 be perf..... to...1 .tsoIsrds of all lasI
<br />regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of otber govern.ental agencies asy apply to the intended wort, and that it is
<br />IY responsibility to identify what actions I lUst tate to be in co.pliance. Sucb agencies include but are not lilited to:
<br />* Departlent of EnviroRlental Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
<br />. Water/Wastewater freatlent
<br />* Southwest Florida Water Hanagelent District - Wells, Cypress Hayheads, Wetland Areas, Altering Watercourses
<br />* Ar., Corps of Engineers - Seawalls, Docks, Havigable Waterways
<br />* De rtlent of Health & Rehabilitative Services BnvirODJental Health Unit - Wells, Wastewater rreatJent, Septic ranks
<br />* US BnviroRlental Protection Agency - Asbestos abateJent
<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 "colpensating volOle" will be sublitted whicb is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit. issuance.
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<br />" A per.11 I..ued sIoll be cou.lrued 10 be . license 10 Proceed 'Ith lie ..rl ..d 001 as aulborlly to .Iolats. cancel aller. or
<br />sel ..ide ..y provl.l... of Ibe lecbnlcol codes. ..r .b.11 i.,u,"" of a per.11 pr....1 1Io Building Offlclol fros lIoresfter
<br />requirIng a correclion of error. In pi.... conslrncll... or ,Iolall.., of ..y oede. Ivery IOIOit IIOUed shall bocioe lora1id
<br />unl... Ibe ...1 aulborl.ed by .ucb per.11 I. OOI8Oocol ,Ilblo .1, IDDlb. of i........ or If ...1 BUtIorieed b, 1Io pooslt Is
<br />8D8pl!I1ded or abandoned for · perlnd of .i1 IDDlbo .fter the tlse the ..rl is _ced. !Me 90 day "lenslCSI of lIse. say Ie
<br />allnved for lbe per.11 .Ith fee charge of 115.00. The "Iensl.. shall bs r",,,1oI 10 srltlog to !be BnIidlng Official. 10
<br />approved inspection lust be logged during each six IOnth period, or' the project will be considered abillldoned.
<br />-DIG 10 lNIIR: YOIJII FIlLIlRIIO RICOIIO A AllTICI OF ~ IIAY ilISO/., II YOIJII PAnG IliCl FOIII-.ats 10 IOlII
<br />PROPERrY. IF YOU IHrBHD TO OBrAIH FINAHCIHG, COHsun WIrH YOUR LEHDER OR AI AfTORIBY BBFORB RECORDIHG YOUR HorICK OF
<br />COHMEHCBHENT. JOBS UNDER $2,500 IH VALUE DO HOT HEED TO RECORD AHD POST A "HOrICE OF COHIIBHCBHBIIt'".
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<br />SIGHA~: ~ OR AGE ~ '.
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<br />~~ C?-/~
<br />IGHAfUR: COHfRACTOR
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<br />STAfB OF FLORIDA
<br />COUHrr OF
<br />The foregOing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19_ by
<br />
<br />STATK OF FLORIDA
<br />CooHTY OF
<br />The foregOing instrument was acknowledged
<br />before me this , 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
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