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<br />10/07/1999 17:43
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<br />A T[I Z ALUr',UliUf'..l
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<br />f"'Aic,E D2
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<br />CONDITluN::; 01" PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned ~nder~tand5 that thi~ pe~mit M~Y be subject to "deed restrictions" which
<br />may be more restrictive than City rCCju:'a ti'.:>ns, Th':! und.,.r:~i gm~d a~l!Iumel!l responsibility for
<br />compliance with any applicable deed restLictions.
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner hao hired a contractor or ,~ontr~ctor~ t6 undertake worK, they may be required
<br />to b@ licensed in accord~nce with state and local regulations. If the contractor is not
<br />licensed as required by law, both the oWner and contractor may be cited for a misdemeanor
<br />violation under state law. If the owner or intend@d contractor are uncertain as to what
<br />licensin9 requirements may apply for the intended work, they are advised to contact the
<br />City of Zephyrhilll!l Building Department, 813-788-6611.
<br />Furth@rmore, if the owner has hir@d a contractor or. contractors, he is advised to have the
<br />contractor(s) sign portions of th"" "Contractor Sections" of this application for which they
<br />will be respons.i.ble. If you, as the owner signs as the contractor, you are indicating that
<br />you, r~ther than the contractor, are re~pollgible for th@ work. If the contractor wishes
<br />you to sign as Contractor that m3Y be an indication that he is not properly licensed and is
<br />not entitled to permitting privileges in the City of Zephyrhills.
<br />C. TRANSPORTATION IMPACT FEES AND UTILITf CONNECTION FEES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTF.S, AS AMENDED)
<br />I certify that I, the applicant, have been provided with a copy ot ~Florida's Construction
<br />lien Law - Homeowner's Protection Guide" prepared by the Florida D@partm@nt of Agriculture
<br />and Consumer A.ffairs. If the applicant is someone other that the "owner", I cerify that I
<br />have obtained a copy of the above descr.ibed document and promise in good faith to deliver
<br />it to the "owner" prior to cotnInencement.
<br />E. CONTAACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all th@ information in this application is aCCUrate and that all work will
<br />be done in compliance with all applicable laws regulatin9 construction, zoning, and land
<br />development.
<br />A.pplication is hereby made to obtain a permit to do work and installation as indicated. I
<br />certify that no work or installation has Gorrnnenced prior to issuance of a permit and that
<br />all work will be performed to n\~@t stand~Ldg of all laws regulating construction, City
<br />codes, zoning r~gulatlon5, and land development regulations in the jurisdiction. I also
<br />certify that I understand that the regtJ.latlons of othe.t. government~l l!lgencies may apply to
<br />the intended work, and that it is my respon~ibillty to identify what actions I must take to
<br />be in compliance. Such agencies include but are not limited to: *Department of
<br />Environmental Regulation-Cypress Bayheads, Wetland Axp-as and Environmentally Sensitive
<br />Lands, Water/Wastewater Treatment
<br />"'Southwest Florida WateL Management D.i.stt:ict-Wells, Cypress Bayheads, wetland Areas,
<br />Altering Watercourses
<br />"'Army Corps of Engineers-Seawalls, DOCks, Navigabl@ Waterways
<br />*Oepartmellt of' Health & Rehabilitative SeJ;'v:Lc@8, Environmental Health Unit-WellB,
<br />Wastewater Treatment., Septic TanKa
<br />*U.S. EnVironmental Protection Agency-Asbes~o~ abatement
<br />I alao certify that, if fill material is to be u$ed in Flcod Zone -AH or -A, etc.", it is
<br />und~- Fes.5i!~g 3. "c:;r,'p~nsating volume" will be aubmitted which
<br />~:s 0 ~ n4 ~ r.~~ :t:egiste,'ed in the State of Florida prior to permit
<br />
<br />A p ..A'-'" LD J ~o be a license to proceed with the work and not as
<br />aut C J tkil. ~ If'-'' I' or set a$ide any provisions of the technical codes,
<br />nor ~~ ent the 3uildinq Official from thereafter requiring a
<br />
<br />~;: ~~~' '1/b. ~ i~~~o~~~~, a~~h~~~~:~i~~SS~~ha:~r~:e1S ~~~~n~:~~th1n
<br />
<br />sili - o>>J nI .authorized by the permi t is suspended or abandoned for a
<br />peL ~D uD the work is ~ommen~ed. One 90 day exteneion of time
<br />ma::t "1 V.- _~J ~~ f@echargeof$15.00.Theextensionahallberequested
<br />in ~ ~/ ~~ta ~l approved inspection must be logged during each Bix
<br />mor U,,-7 ~(\P'J"'.e considered abandoned.
<br />WAJ -y ~ RECORD A NOTICE OF CO?1MENCeMENT MAY RESULT IN YOUR
<br />PA~ )VP PROPERTY IF YOU !NTEND TO OBTAIN FINANCING, CONSULT
<br />WI") GOOD PROMOTION._.c.r BEFORE F(~COP-DtNG YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
<br />$2. MAKES A WORLn.G'F NEED TO RECOHD ANI) POST A "NOTICE OF COMMENCEMENT".
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<br />l /11 Q A<Y'2,~/ e c24~_
<br />SIGNATURE: OWNER OR AGENT
<br />
<br />SIGNATURE: CONTRACTOR
<br />
<br />acknowledged
<br />1:L-
<br />
<br />STA.TE OF FLORIDA
<br />COUNTY OF
<br />The for@going instrument was
<br />8efore me this -----Pay of
<br />by
<br />
<br />STA.TE OF FLORIDA.
<br />COUNTY OF
<br />The foregoing instrument was
<br />Before me this _ day of
<br />by
<br />
<br />acknowledged
<br />19
<br />
<br />(name of per$on ~cknowledged)
<br />Owho i~ per~onally known to me, or
<br />
<br />(name of person aOknowledged)
<br />C1ho is personally known to me, or
<br />
<br />Owho has produced
<br />itype
<br />and whoO did 0 did not:
<br />
<br />o who has produced
<br />(typ@ of identification)
<br />and '",ho rJdLd DUd not take an oath
<br />
<br />of identification)
<br />tak@ an oath.
<br />
<br />Signature of p@rson taking ack~owledgement
<br />
<br />Signature of person taking acknowledqment
<br />
<br />NOi.me typed, prlnt:ed or :!;tamped
<br />
<br />Name typed, printed or stamped
<br />
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