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<br />contractor(s) sigu portions of the ~Contraetor 5ect~onsn o~ this .pp~1cation fo~ which they
<br />will be responsible. If you, as the owner 5i~ Da the contractor, you are indlcat~ng that
<br />you, rather than the contractor, ara r~sponsible for the work. If the contractOr wi.hcs
<br />you to sign a& contractor that may be an indication that he is not properly licensed and 1.
<br />not entitled to per.mitting privileg.. in the City of Zephyrhill..
<br />C. TRANSPORTATION IMPACT FBES .AND UTILITY CONNECTION B'EES
<br />,D. CONSTRIJC'l'UION LIEN LAlf (CHAPTBrt 713, FLORIDA STMUTES, AS AKtNDED)
<br />I certify that I, the applicant, have been provided with a copy of ~ilorlda's Construction
<br />lien Law - Homeowner'e Protection Guide" prepared by the Florida Department of Agriculture
<br />and Consumer Affairs. If the applicant 1s 80~one other that the ~ownern, I cerify that I
<br />h~ve obtained a copy of the above descr1bed document and promise in good faith to deliver
<br />it to th. ~ownern prior to commencement,
<br />E. CONTRACTOR'S/OWKER'S AFF!DA~T
<br />I certify that all the information in thie application is accurate and that all Work will
<br />be done in Compliance with .1l applicable laws regulating con$truction, zoning, and land
<br />development.
<br />Application 1s hereby made to obtaln a permit to do work and in.tallation as indicated. I
<br />cartify that no work or iDstallat10n has commenced prior to 1s.uance of a permit and that
<br />all work will be perfo~d to meet standards of all laws rogulating construction, City
<br />codes, zoning regulations, and land development regulation. in tbe jurisdiction. I also
<br />certify tnat'! understand that the regulation. of other governmental agena1e. may apply to
<br />the intended work, and that it i8 ~ responsibility to identify what actions I must take to
<br />be in compliance. Such ~ge.ncies include but are not lLmited to: *Departm.nt of
<br />Env1.ronmenta~ Regulation-Cypre.. Bayheaas, Wetland AJ:erll!l and EnVironmentally Sensitive
<br />L~n~, Water/Wastewater Treatment
<br />*soutbW.5t Florida Water Kanag..ent Di.trict-Wella, Cypress BaYheads, Wet1and Areas,
<br />Altering Watercourses
<br />*A.nn:v Corps of Engin"rll-S*awalls, Docks, NiIlvJ.gable Waterway.
<br />*Department of Health & Rehabilitative Services, Envi~onm.ntill Health Unit-Wella,
<br />Wastewater Treatment, 8eptic Tanka
<br />*U.5. Environmental Proteot1on Agency-Asbeatoa ab.t~nt
<br />I also certify that, if fill material is to be used in Flood Zone ~Ak or ~A,etc.w, it i~
<br />understood that a drainag. plan ~ddressing a ~oompens.ting volumeH Will be submitted which
<br />is prepared by a professional engineer registered in the State of Flo~1da prior to per.mit
<br />.1.sauilX1ce.
<br />A permit is~ued shall be construed to b. a license to proceed with' the work $nd not as
<br />authority to Violate, cancel, alter, or set aside any prOViSions o~ the technical oode.,
<br />nor shall issuance of . p.~t pxevent the Building Official from thereafter requiring a
<br />correction of errors in plans, construction, or violat1o~. of any oode. Kvery pecmit
<br />is~ued shall become invalid unless the work authorized by such permit is Commenced within
<br />six IllC1nths of issuance, or if work: aUthor12:ecl, by the p.~t i. sUlilPended or abandoned for a
<br />period of ~1x mcnth. after the t~e the work l. QOmmenced. One 90 day extension of 'time
<br />may be allowed ~or the permdt with t.. oharge ot ~15.00. The extension ahall be requosted
<br />in writing to the Building Off1c1al. An approved inspection must be 10gged during ..Qb 81x
<br />month perioq, o~ the proj.ct will be considered abandoned.
<br />WARNING TO OWER; YOUR FAILURE TO RECORO A NO'l'!CE OF Cmeu:NCEMEHT )Qy Ri:SVLT IN YOUR
<br />PAYINI; TWICE FOR IMPROVEMENTS TO YOUR PrtO'E!\TY. IF YOU INTEND TO OBTAIN FINNfCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY ~EroRI!: RECORDING YOUR NOTICE OF COMl4&tfCBKI:NT. JOBS UNPBrt
<br />
<br />
<br />:~:li:;: _O~ - .osc;:e~'.~
<br />
<br />.--,.~ --- -- ------...................--, ...- ....- --....--- ~_...4SIoVIi;;
<br />
<br />STATE OF n.ORI~~60
<br />COUNTY OF ~
<br />The foregoing i~~ument wa.A~OknOWled9~
<br />Befo~ m~ thisl? qay of ~nv ' 1
<br />~QLlla^ ~QC..c~L"" _
<br />(name or person. aCknowledged)
<br />who ie per1Sonally known to me, or
<br />
<br />o who ha=s produc~
<br />11 (type Qf identification I
<br />updid not take an oath.
<br />
<br />STATE 05' fLORIDA~. \" b ~
<br />COUNTY OF cJ ,t~ D... ~
<br />Tho t.....in. in~t~t ..~Wled.od,r.,l
<br />::fore~h~~~~~S r W~
<br />
<br />\..../ (name of per"on ackraow-ledged)
<br />~o is personally known to me, or
<br />
<br />o who has produced
<br />~_(type of identification)
<br />~ WQ: []~ld ~id not take an oath
<br />
<br />... ~I ~ ~~
<br />Signature of ~er.on takin6EWe~Nbment
<br />Notary Public. State of Florida
<br />
<br />Name typed, Print@d"~n'atHO. 12, 281M
<br />\I . O. C 9589B4
<br />
<br />
<br />nature of per50n taking acknowledq~ent
<br />FELICIA KRUMM
<br />
<br />Name tYP@~~ftp.~~~M
<br />Comm. No. CC 956984
<br />
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