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<br />COND:ITU))fS OF E'EJlHl:T A!TIDAVIT
<br />A. NOT.:ICE OF DEBD RBSTRICT:IOMS
<br />The undersigned understanda tbat this perlllit IlI&Y be aubject to "deed re.trictiona" which
<br />may be more re.td,Cltive than City requlaeionJ!l. The under"igned a.aumes responsibility for
<br />compliance with ~y applicable deed r.st~ictions.
<br />B. UNLICENSED CONnlACTORS AND cotr1'JlACTOR' RESPOMSIBILtTIES
<br />If the owner haa hired A contractor or contraceora to undertake work, they ~y b. required
<br />to be licensed in accordance with state and local regulationa. If the cODtractor is not
<br />licensed a. required by law, both the owner and contractor _y be cited for a 1ll1sdem&anor
<br />violation under state 1.... If the owner or intende<! contrActor IU:. uncertain aa to Wh.t
<br />licensing requir_nts -y apply for the intended work, they are advised to contact the
<br />City of Zepbyrbills Bttilding Depar~t, 813-788-6611.
<br />FUrtbermore, if the owner has hired II contrActor or cODtractors, be i8 advised to have the
<br />contractor(s) sign portions of the "Contractor Sections" of thia application for which they
<br />will be responsible. If you, .. the owner signa aa the contractor, you are indicat~ng that
<br />you, rather tban the contractor, are responsible for the worle. It the contractor wishes
<br />you to sign as contractor th~t may be an indication that he ie not properly licen.ed and is
<br />not eQtitled to perlllittiU9 privil8ges in the City of Zepbyrhille.
<br />C. 'rRAlfSPORTATION IMPACT PEES AND UTILITY CONllECTION FEES
<br />,D. CONS!'RUCTUION LIEN IJ>M (CHAPTER 713, i'LOIUDA S'l'ATU'rIS, 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 Department of Agriculture
<br />and Consumer Artaira. xf the applicant is someone other that the ~own.r", 1 eerify that I
<br />have obtaJ.ned ~ copy or the above described doClUllloent and prolll1s. in good tuth to d.el1.ver
<br />it to the .owner" prior to commencement.
<br />E. CONTRACTOR' stOWNER' S AFFIDAVIT
<br />I certify that all the into~~ion in this application i. accurat~ and that all work will
<br />be done in compliance with all applicable laws regulating construction, zoning, and land
<br />development.
<br />Application is hereby made to obtain a pe~t to do work and installation as indicated. I
<br />certify that no work or installation ha. c~ced prior to issuance of a permit and that
<br />all work ~ill be porfoDDed to meet standards of all laws regulating cODBt:ructiou, City
<br />codea, .oning regulations, and land development regulations in the juri.~ction. I aleo
<br />certify that.l uuderatand that the regulations of other govermaental ilgencJ.es _y apply to
<br />the intended work, and that it is my responsibility to identify what actions r Dlst take to
<br />be in c~liiU1ce. SlIch agencies include but are not lillli.ted to: .Department of
<br />Environmental Regulation-Cypress Bayheads, Wetland ~eas and Bnviroamantally Sensitive
<br />Landa, Water/Wastewater Treatment
<br />.Southwest Florida WAter Hanawement District-Wells, Cypress Bayhead$, Wetland ~eee,
<br />Altering Watercouraes
<br />*Army Corps or Envineera-SeawallS, Docks, Navigable Waterways
<br />.Department of Health , Rehabilitative Services, BnviroDmeQtal Health Unit-Wells,
<br />Waatewater Treatment, S.ptic Tanks
<br />.U.S. Environmental Protection AgenCY-Asbestos abatement
<br />I also certify that, it fill material is to be used in Flood Zone ~A" or ~A, etc.", it is
<br />understood that a drainage plan adcire$sing a ~comperurating volume" will b. submitted "tftdch
<br />is prepared by a protessional engineer regi.tered in the State of FlOrida prior to P.~t
<br />issuance.
<br />A perRdt issued shall be ~onstrued to be a license to proceed with the work and not aa
<br />aUthority to violate, cancel, alter, or set a.ide any provisions of the technical codes,
<br />nor sh21l1 iSsuance ot a permit prevent the Bu1ldinl1 Official trOlll thereafter requiri.ng ..
<br />correction of errors in plans, construction, or violatio~s of any code. Kvery pe~t
<br />i..lIed shall become invalid unle.. the work authorized by auch pe.tlllit ia commenced within
<br />.ix months ot issuance, or if work authorized by the permit is .usPended or abandoned for a
<br />period of six montha after the t1me the work ~a c~nced. One 90 day extension ott1me
<br />may be allowed for the permit W1th tee charge of $15.00. The extenaion shall be requested
<br />in writing to the Bttil<iing Official. An approVed inspectioll lIlU.t be logged during each six
<br />IllOnth periOd, or the project Will t:>e considered llb..ndoned.
<br />WARlfl:NG TO 0liNEll: YOUR FAILURE TO RECORD A NOTICE OF COHMEliC!JCENT ~ RESULT
<br />PAYING TWICE IKl'ROVEHENTS TO YOUR PROPERTY. IF YOU IlilTDrn TO OBTAIN !'I
<br />WI'1'll YOUR ATTORlfEY BEPOJ\E lUtCORDJ:NG YOUR NOTI
<br />$2,500 NEED CO AND POST A "NOTrC!!:
<br />
<br />
<br />
<br />STATE or !'LoR DA
<br />COUNTY OF
<br />The foregoing instrument was acknowledged
<br />Before me this _ <lay of . lL
<br />by
<br />(name of person acknowledged)
<br />o who is personally known to me, or
<br />
<br />o who has produced
<br />(type of identification)
<br />and who[J did [Jdid not take liD oath.
<br />
<br />STATE OF FLORI
<br />COUNTY OF .
<br />The foregoing instrlllllent was
<br />Before me thia ~y or
<br />by
<br />
<br />acknowledged
<br />, 19....;...
<br />
<br />(name of ~erson .cknowledged)
<br />CLho ill personally known to me, or
<br />
<br />Owho ha. produced
<br />(type of ~dentificetion)
<br />and who Odid. DUd not take an oath
<br />
<br />Signature of person taking ~cknowledgement
<br />
<br />$1.gnature of person taking acknowledgment
<br />
<br />Name typed, printed or stillllped
<br />
<br />Name typed, printed or st:aJI1)ed
<br />
<br />. d
<br />
<br />Z6ZI'ON
<br />
<br />SlllHHAHd3Z jO AIIJ
<br />
<br />N~9E:OI ZOOZ '8 .uer
<br />
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