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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />110 under.ig..d uod.,.tando I!.t thi. pe,.ll say be 'u!ject to 'deed '..lricli...' ohio! oar be .... reslrictl.. tbao C1t,
<br />regolallon,. 110 und.r.lgned ....... "'P008lhlllly 10' COIplianc. with any appllcabl. deed r..trlcti....
<br />
<br />II. UNLICENSED CONTRACi'ORS AND COnTRACTOR REsponSIBILITIES
<br />If the ..... !.. !I'ed a conl',clo, 0' conlracto,. to undertale ..'I, th., ..V be regoired 10 he II....ed in aCCDrdan.. with
<br />.tat. and lOCal 'egolatl.... If th. cont'.ctor I. .ot licen.ed .. reguired by law, both 1Io ..... and coolroctor .., he
<br />cited fo, a .iod.....or ,Iolatioo undo, .t.t. lao. If the DO..' 0' I.tended coot,ICIo, are uncorlain as to what II....iog
<br />regui'....t. '" appl, fo, th. intend.d ..rl, lhey a,. ad,ised 10 conlact t!. Clt, of Z.phyrbill. Bolldlog Oeparlleot, (Bill
<br />788-6611.
<br />
<br />Fu,lheroo,., if the "oer !.. hired a contractor 0' cootr.cto,., b. i. advl.ed to ha,. the cootrOClor(.) .igs porti... of 1Io
<br />'Ooot,actor Sectl...' of thi. applic.tioo fo, wbieb th., will be reopoo.I!I.. If ron, as 1Io _er sign as 1Io cooltactor,
<br />roo ore iodlcatlog tbot roo, ,atbe, Iban the coot,octo" ar. '''PDROlhl. for the ..'I. If the costraclor '1aIoo roo 10 .Ign
<br />a. contractor that .., he as i.dicatlon that be i. .ot proper I, lic....d aod I. not eotltled 10 petoJtllDg prl,llegoo io 1Io
<br />City of Zephyrhills.
<br />
<br />C. TRANSPDRTATION IMPACT FEES AND UTILITY COnnECTION FEES "
<br />
<br />D. CONSTRUCnON LIEN Lftw (CIIAPTER '113. FLORIDA STATUTES, AS AMENDED)
<br />I cerllf, that I, 1Io applicant, ha,. be" P'OVlded with a copy of 'Flo,id.'. COootructlon Lien Lao _ Dooeoouer'. Protecti..
<br />~uld.' prepared by the Flo'ida D.pa'lIeot of Bg,icultn,. and C......r Iffai,.. ff lIo applicant I. ....... oth.r lIoa lIo
<br />'....,', I c.rtlfy that I have n!tained a copy of t!. abo,. d..c,ibed doculOOt and P'''i.. 10 good faith to dell,er II to tho
<br />.owner" prior to Co-.ence.ent.
<br />
<br />E. ~ONTRACTOR' S/OWNER' S AFFIDAVI1'
<br />I certify that all lIo loforoatioo in this appllcatloo I. .ceu,.t. .nd th.t all ..rl will be done i. COIpliaoce with afl
<br />applicable laws regUlating construction, loning, and land develop.ent.
<br />I
<br />
<br />Applicatl.. I. berehr ..d. to obtai. a pe"it to do ..'I and I..tailatloo a. iodicated. I certif, lAat no vorl or
<br />loolallation has COIIeoced prlo, to i..uaoc. of a pe'.it and that all ..rl will he perf,""", 10 lOOt 'laodooio of all I...
<br />regul.tlng conotructioo, City cod", loning 'egulation., and land d.,.IDpoeot 'egulati... 10 lIo jurlldlctioo. I ai..
<br />cerllf1 that I .nder.taod thaI the "golat!o08 of otbe, "","""tal agencl.. sa, Ippl, to tho ioteoded ...1, and IIot it I.
<br />If ,,,po08ibilll, to id..llf, what .ctiooo I .u.t tale 10 be I. COIpllaoc.. Sue! 8geoc1.. laclude hut ore oot 1Ioited 10: "
<br />· OeIo'bJeot of Eo'i'.....tal Regulatloo - Cypr... 8o,head., wetland I,.as and RO'i......taJl' Seo.lti" Laodo,
<br />Water/Wastewater Treat.ent
<br />· Soulloeot Flo,ida Rat., Kao.....ot Di.t'ict - Rell., CIP,... Barbe.d., wetland Ar.a., Alt.,I.g later.......
<br />· Ar.y Corps of Engineers - Seawalls, Docks, lavigable Waterways
<br />· De artiest of Dealtb , Rebabllltatl,e Serrlc.. Eo'i......tal Health Uoit - iOIl., Raot...ter rrealleot, Septic raolo
<br />· US Bnviron.ental Protection AgencI - Asbestos abatelent
<br />I al" ..'tlfy that, if fill ..terial is to he used in Flood .... 'I' 0' 'I,.tc.', it I. und"'lood that a draiDage plan
<br />add,...ing a 'COIpenoating ..I...' 0111 he .uboitted which i. p'.pa'ed hy a p'of...looa/ engln.er regi.tered is 110 State of
<br />Florida prior to per.it. issuance. ,
<br />
<br />. A po'.it IOOUed shall he C008t,ued to h. a lice... to proceed oith the ..rl and ..t as aUlho,lt, 10 ,10Iale, caocoI alter, or
<br />set asld. any P'ovi.I... of tb. lecImlcal cod.., .or shall i....... of a per.it p,....t 1Io Building Official froo tIoreaftor
<br />'",,1'1"1 a CDiTectl.. of "ro,. I. pi..., ....tructl.., or ,ioiatl... of any cole. Irory petoJt 1"001 01011 Iocooe Inralld
<br />unl... the ..'I aUlho,iled by .uch potlit i. C.....coi wlthlo .i, IDDth. of i......., Dr If ..rl 'Ulhorised by tho potllt I.
<br />.UIpOOded 0' ahaodooed for a period of .i, ..nllo aft.r th. ti.. the ..,I i. COIIeocoi. Doe 9B day eoleooloo of tioo, .., he
<br />all..ed fo, the per.it with fee charg. of 115.00. rh. eolenol.. shall he regueotea I. writing 10 the Building Offlciaf. 10
<br />app'oted iDOpeclloo lUSt he logg.d do,lng each .i, IDDth period, 0' lIo project 'III be considerol ahaodooed.
<br />-IIIG YO WIlE8: YOOR FIILIIRB YO R8COIIO I .orlCl OF ClIlIlIICIIlIIr lIAr RlSDLr III _ PIY/IC "'ICI FOIlIIIPIIDVIiIIlII8 YO rfIIIIl
<br />PRllPIRI'f. IF 100 IlIfm YO llII1'811 FlmcllC, CDllSULr Rfm 1001I LBIIDIR DR .!II IffIIIm _ ~IIG YOOR IIIlfICI OF
<br />COHHIICEHIN'l. JOBS UIDBR $2,500 IN VALUI DO lOT IEID TO RECORD AND POST A "NOTICB OF COHHIICBHlIff".
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<br />Zf2
<br />SIGNATURE: COlfRACTOR
<br />
<br />
<br />~.l
<br />
<br />STATR OF FLORIDA
<br />COUlfff OF
<br />The foregOing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19_ by
<br />
<br />STATI OF FLORIDA
<br />COUNTY OF
<br />The foregOing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19 by
<br />-
<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 />~~rsonally 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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