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<br />~YTY~ UF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned understands that this perlit lay be subject to "deed restrictions" which lay be .ure restrictive than City
<br />regulations. The undersigned aSSlmes responsibility (or cOlpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRAC'l'OH RESPONSIBILI'l'IES
<br />If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
<br />state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor aay be
<br />cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
<br />requiruents lay apply for the intended work, they are advised to contact the City of Zephyrbills Building Departlent, (813)
<br />788-6611. .
<br />
<br />Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor(8) 8ign portions of the
<br />.Contractor Sections" of this application for which they will be responsible. If you, as the owner sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the wort. If the contractor wisbes you to sign
<br />as contractor that lay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
<br />City of Zephyrhills.
<br />
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<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES ~.
<br />
<br />D. CONSTRUC'l'ION LIEN L1\W (CHAPTER 713, FLOlHDA STA'l'UTES, AS AMENDED)
<br />I certify that I, the applicant, have been provided with a copy of .Florida's Construction Lien Law - HOIeowner's Protection
<br />Guid~" prepared by the Florida DepartJent of Agriculture and Conslmer Affairs. If the applicant is sOleone otber than the
<br />.owner", I certify that I have obtained a copy of the above described doculent and prolise in good faith to deliver it to the
<br />"owner" prior to co-.encuent.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
<br />applicable laws regulating construction, laning, and land developlent.
<br />I
<br />
<br />Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that no wort or
<br />installation has cOllenced prior to issuance of a perlit and that all work will be perforJed to Jeet standards of all laws
<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 other govern8ental agencies lay apply to the intended wort, 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 />· DepartJent of Envirofilental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
<br />. Water/Wastewater Treatlent
<br />· Southwest Florida Water "anaguent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />· ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
<br />· Departlent of Health & Rehabilitative Services, EnviroDlental Health Unit - Wells, Wastewater Treallent, Septic Tanks
<br />· US EnviroDlental Protection Agency - Asbestos abate.ent
<br />I also certify that, if fill laterial is to be used in Flood Zone "Aft or "A,etc.", it is understood that a drainage plan
<br />addressing a "colpensating volOle" will be sublitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit. issuance.
<br />
<br />. A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
<br />Bet aside any provisions of the technical codes, nor shall is~u~nce of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Bvery perlit issued sball beCOle invalid
<br />unless the work authorized by such perlit is cOllenced within sil IOnths of iSSUance, or if work authorized by the perlit is
<br />suspended or abandoned for a period of six IOnths after the tile the work is cOllenced. One 90 day eatension of tile, JaY 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 lust be logged during each sil IOnth period, or the project will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCBHBNT HAY RESULT IN YOUR PAYING DICE FOR IHPROVEIIHIIS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORIBY BBFORE RECORDING YOUR NOTICE OF
<br />COHHENCRHENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COHHKNCKHKNT".
<br />
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<br />SIGNATURE: OWNER OR AGENT
<br />
<br />SIGNATURE: CONTRACTOR
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19_ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY 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 wbo bas
<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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