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<br />CONDI'rIONS OF PEUMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />rb. ~rslgned uDd.,.taeds thet tbi. persit lOy be .ubj.ct to 'deed ,..t,iclio..' whieb lOy be .... restriclive lhon Clt,
<br />regulatlons. The undersigned assDles responsibility for co.pliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the ..... has hi'ed · conl,aclo, or contr'clo,. to uoderlale "'I, lb., 10, be '"Iui'ed 10 he Ilc,",", io accordi0c8 with
<br />.1.1. and loc.1 regul.li.... If lhe conl'acto, I, 001 IIc....d as regui'ed by law, both the ..... aod controctor IO, he
<br />cIted lor · .i&deoe.oo, viol.lion usd., .1.1. ION. II the ...., 0' lnl"ded cont'aclo, .,. uscertal. .. 10 MIot Iiceooi.g
<br />'""i'....I. IO, .pply fo, the int..ded ..'I, Ib.y .,. advi.ed 10 cootact the Cil, 01 Z.phyrbiII. BoIIdlDg Deparllent. (BIl)
<br />788-6611.
<br />
<br />Fu'the,..,.. If the OInor b.. hired · cont"clor ., conl,act.,s, be i. .dvised t. ba,. the cont,actor(.) sign portl... of the
<br />'Cont,.ctor Sectl.... .f thi. .pplicatlon f., whicb they will be ,espuooibl.. II roo, as the ..... .ign as the contractor.
<br />roo ". iDdicatiog th.t you, ,.tb., tban lb. cont,.cto" ar. '''pon.lbl. fo, the "'I. If the contracto, wiobes ,.. to .Ign
<br />.. contr.ct., that IO, he '0 i.dic.tion that b. i. oot P'.pe,I, licen'ed .Dd I. oot entitled 10 peroittiDg prl,111gOI in the
<br />City of Zephyrhills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND U'l'ILI'rY CONNECTION FEES
<br />
<br />"
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<br />
<br />D. CONSTRUCTION LIEN Lftw (CIIAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I c.,tif, that I. the .pplicant. h.,. been p,.'ided with. copy 01 'FI.rld.', COOItroctloo Li.. Law _ Booeowoer'. Protectioo
<br />~uIde' prepa'ed by tb. FI.,ida DeP"lIent .f 8g,Icultu,. aod Cons..., Iff.irs. If the .pplicast i. ....... otIor than the
<br />....or.., I ce,tify that I bate obl.lned · copy .f lh. .bo" described doc....t .Dd P'..Is. 10 good f.ith 10 dell..r It to the
<br />"owner" prior to co..ence.ent.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVI'l'
<br />I c.,tify that .11 the 10fo'lOtioo i. this .ppllc.tioo is .ceu,.t. .nd tb.t .11 ..rl will he done i. CDlpllaoce with all
<br />applicable laws regUlating construction, loning, and land develop.ent.
<br />I
<br />
<br />Application is hereby .ade to obtain a per.it to do wort and instailation as indicated. I certify that DO worl or
<br />leotall.tius has C08IeOoed prio, to i..uaoc. of . pe,.it ..d that .11 ",I will he perf,",", to lOOt 'looIordo of all I...
<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 govern.ental agencies .ay apply to the intended vork, and that it is
<br />.y responsibility to identify what actions I .ust take to be in co.pliance. Such agencies include but are not Iiaited to: ,_.
<br />· Deparllent of BnviroDlental Regulation - Cypress Bayheads, Wetland Areas and Bnvironaentally Sensitive Lands,
<br />Water/Wastewater Treat.ent
<br />· Southwest Florida Water Hanage.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />· Ar.y Corps of Engineers - Seawalls, Docks, Navigable Waterways
<br />· De arLaent of Health & Rehabilitative Services Envirou.ental Health Unit - Wells, Wastewater Treat.ent, Septic lan.s
<br />· US Envirou.ental Protection Agency - Asbestos abate.ent
<br />I also certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc.., it is understood tbat a drainage plan
<br />addressing a "Co.pensating volu.e" will be sub.itted which is prepared by a professional engineer registered in the State of
<br />Florida prior to per.it. issuance.
<br />
<br />. I pe,.it I.sued .hall be DOOOt,ued to 10 . lice... to p'oceed lith the "'I and eot as .uthorit, to 'ioloto, caocel a1ler. or
<br />..t ..ide .n, p,o,l.i... of the t.chnlClI cod", eor .hall i.,","," of 0 penlll prevent the Bulldiog Offlclll f... lIoreofler
<br />requirlog · eo,rectios of .rro,. In pi.... con.tructiDO, 0' ,iol.tl... of '0' cod.. S"" PIIIIt Iooued ~I becooo IeoaIld
<br />onl... tb. ..'I ..thorlled by ouch polIlt i. ......coi Iltbln .11 ""tho of i......., 0' If "'I autboriled by the PIIIIt I.
<br />suspended or abandoned for a period of six IOnths after the tile the wor. is cOIIenced. One 90 day eatension of tiae, 181 he
<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 IOnth period, or the project will he considered abandoned.
<br />WARNING TO ONNER: YOlIR FAILURE TO RECORD A NOTICB OF COHHBNCBHBNT HAY RBSULT IN YOUR PAYIftG TWICE FOR IHPHOVKHDrS TO YOUR
<br />PHOPBRfY'. IF YOlI UTEND TO OBTAIN FIIfANCING, CONSULT WUH YOUR LBNDBR OR All ArrORlKY BEFORB RBCORDIHG YOlIR NOIICE OF
<br />COHHEHCIHENT. JOBS UNDER $2,500 IN VALUE 00 NOT NBED TO RECORD AND POST A "NOTlCB OF COtIHBHCIHIiN1'-.
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<br />~~~~.i ~ tE~~----
<br />SIGHATURB: ONNER OR AGENT (/
<br />
<br />STATE OF FLORIDA ~
<br />COUny OF ~
<br />The foregOing instrument
<br />before me this ~A_~~O
<br />
<br />was acknowledged
<br />, 19~ by
<br />
<br />
<br />-SIGNATURE: CONTRACTOR
<br />
<br />STATB 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 />(Signature)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
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