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<br />~vnU~X~W"5 OF PERMIT AFFIDAVIT
<br />A. HOTICE OF DEED RESTRICTIONS
<br />T~. und'ersigned understands t~at this permit: may be subject :.to "deed' restrictions" which
<br />may be more restrictive than City' ~egulat:ioJls. The undersigned assumes responsibility for
<br />compliance with any applicable deed restrict:ions.
<br />B. UNLICENSED CONTRACTORS AND CONTRACToR RESPONSIBILITIES
<br />If the owner has hired a oontractor or cont1:actors to undertake work, they lIlay b~ required
<br />to b. licensed in ~ccordance with state ~nd loc~l regulations. If the contraotor 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 owne~ or intended contractor are uncertain as to what
<br />licensing requirements may apply for the intended work, they are advised to contact the
<br />City of Zephyr~ills Building Depart~ent, 813-788-6611.
<br />Furthermore,. if the owner has hired a contractor or:contractors, he is advised to have the
<br />oontractor(s) sign portions of the "Contraotor Sect!ons" of this application for which they
<br />will be responsible. If you, as the owner signs as the contr.ctor, you are indicating that
<br />you, rather than the contractor, are responsible for the work. If the contractor wishes
<br />you to sign as contractor that may be an indicati~n that he is not properly licensed and is
<br />not entitled to pe~tting pri~ileges in the City of Zephyrhills.
<br />C. TRAH~PORTATION IMPACT FIES AND UTILITY CONNBCTION FIllSS
<br />D. CONSTRUCTUION LIEN LAW (CHAPTI!:R 113, FLORIDA S'tATUTEa, AS ,AtfBHDED)
<br />I certify that I, the applicant, have been provided with a copy of "Florida's Construction
<br />lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
<br />and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
<br />bave obtained a oopy of the abOve described document and promise in good faith to deliver
<br />it to the "owner" prior to Commencement.
<br />E. CONTRACTOR' S/OWNER' S AFFIDAVIT
<br />I certify t~atall the information in this application is accurate and that all work will
<br />be 40ne in compliance with allap.plicable laws regUlating construction, zoning, and land
<br />development.
<br />Application is hereby made to obtain a penmit to do work and installation as indicated. I
<br />certity that no work or installation has commenced prior to issuance of a permQt and that
<br />~ll work will be perfor.med to meet standards of all laws regUlating construction, City
<br />codes, zoning regulations, and land development regulations in the jurisdiction. I also
<br />certify that"r understand that the regulations of other gove~ntal agencies may apply to
<br />the intended work, and that it is my responsibility to identify what actions I must take to
<br />be in compliance. Such agencies include but are not limited tal *Department of
<br />Environmental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
<br />Lands, Water/Wastewater Treatment
<br />*S.outhwest Florida Water Management District-Wells, Cyp~ells Bayheads, Wetland Areas,
<br />Altering Watercourses
<br />*Army Corps of Bngineers-Seawalls, Docks, Navigable Waterways
<br />*Department of Health , Rehabilitative Services, Environmental Health UniE~Wells,
<br />Wastewater Treatment, Septic Tanks
<br />*u.s. Environmental frotection Agency-~bestos abatement
<br />I also certify that, if fill material is to be used in Flood Zone ~A" or "A,etc.", it is
<br />understood that a drainage plan addressin~ a "compensating volumeR will be submitted which
<br />is prepared by a professional engineer registered in the State of Florida prior to petmit
<br />issuance.
<br />A permit issued shall be construed to be a license to proceed with' the work ~nd not as
<br />authority to violate, cllncel, alter, or set aside any provisions of the technical oodes,
<br />nor shall issuance of a permit prevent the Building Official from thereafter requiring a
<br />correction of errors in plans, construction, or violation. of any code. BverY.peDmit
<br />issued shall become invalid unless the work authorized by 8uch permit is commenc~d ~ithin
<br />six months of issuance, or if' work authorized by the penmit is suspended or abandoned for a
<br />period of six months after the time the work Is commenced. One 90 day extension of time
<br />may be allowed for the permit with fee charge of $15.00. The extension shall be requested
<br />in writing to the Building Official. An approved inspection .ust be logge~ during each six
<br />month period, or the project will be considered abandoned. \
<br />WARNING TO OWNER: YOUR FAILURIl TO RECORD A NOTICE OF COHMBNC_SNT MAY RI!:SULT IN YOUR
<br />'iAYING TWICI!: FOR IHl'ROVI!lHIlHTS TO YOUR' PROl'BRTY. IF YOU INTEND TO OBTAIN I'IHAHCING, CONSULT
<br />WITH YOUR LINDIllR OR AN ATTORNEY BBJ!'Of\& RBCORDING YOUR NOTICI!i OF COMMBNCI!lMENT. JOBS UNDI!iR
<br />$2,500 IN VALUE DO NOT N!:I!iD TO RECORD AND POST A "NOTICE or COMMENCEMBHT"'.
<br />
<br />r,~t
<br />
<br />STATE or FLORIDA
<br />COUNTY OF
<br />The fcregoing instrument was
<br />Before me this _ day of
<br />by
<br />
<br />~..~j
<br />SIG~ ~ COHT OR tjJ-/l'
<br />
<br />. SIGNATURlih OWNIllR OR AGEN'!'
<br />
<br />acknowledged
<br />, 1'L-
<br />
<br />STAT!: OF FLORIDA
<br />COUNTY 01' "
<br />The foregoing instrqment was ac~nowledged
<br />Before me this ~ay of , 19 ~
<br />by
<br />(name of person aCknOWledged)
<br />[Lho is personally known to me, or
<br />
<br />(name of person .ckno~ledged)
<br />'0 who is pEJrsonally known to me, or
<br />
<br />o who has produced
<br />(type of identification)
<br />and whoD did Ddid not take an oath.
<br />
<br />Signature of person taking acknowledgement
<br />
<br />Signature of person taking acknowledgment
<br />
<br />Name typed, printed or stamped
<br />
<br />Name typed, printed or stamped
<br />
<br />...._....._________e
<br />
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