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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. ,NOTICE OF DEED RESTRICTIONS .
<br />The undersigned understands that this perlit lay be subject to "deed restrictions" which lay be lOre restrictive tban City
<br />regulations. The undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance witb
<br />state and local regulations. If the contractor is not licensed as required by law, botb tbe owner and contractor lay be
<br />cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
<br />requirelents lay apply for. the intended work, they are advised to contact the City of Zephyrbills Building Departleot, (813)
<br />188-6611.
<br />
<br />FurtherlOre, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of tbe
<br />"Contractor Sections" of this application for which tbey will be responsible. If you, as the owner sign as the contractor,
<br />you are indicating tbat you, rather than the contractor, are responsible for the work. If the contractor wisbes you to sign
<br />as contractor tbat lay be an indication that he is not properly licensed and is not entitled to per.itting privileges in the
<br />City of Zephyrhills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES "
<br />
<br />D. CONSTRUC'I'ION LIEN L'I\W (CHAPTER 713, FLORIDA STATUTES, AS- AMENDED)
<br />I certify that I, the applicant, bave been provided with a copy of "Florida's Construction Lien Law _ HOIeOIDer's Protection
<br />Guide" prepared by the Florida Departlent of Agriculture and ConsWler Affairs. If the applicant is sOl8ODe other than the
<br />"owner", I certify that I bave obtained a copy of the above described doeulent and prolise in good faitb to dellver~Jt tU the
<br />"owner" prior to COllenCelent.
<br />
<br />E. CONTRACTOR' SjOWNER' S AFFIDAVI'l'
<br />I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
<br />applicable laws regulating construction, zoning, and land de~~~oplent.
<br />
<br />Application is bereby lade to obtain a perlit to do work and instailation as indicated. I certify that DO worl or
<br />installation has COIIenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
<br />regulating construction, City codes, zoning regulations, and land developlent regulations in tbe jurisdiction. I also
<br />certify that I understand that the regulations of otber govefnlBntal agencies aay apply to tbe intended worl, and that it is
<br />IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
<br />* Departlent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
<br />Water/Wastewater Treablent
<br />I Southwest Florida Water Hanagelent District - Wells, Cypress B~yheads, Wetland Areas, Altering Watercourses
<br />I Arl' Corps of Engineers - Seawalis, Docks, Havigable Waterways '
<br />I Departlent of Health & Rehabilitative Services, EnvirODlental Health Unit - Wells, Wastewater rreatlent, Septic ranis
<br />t US EnviroDlental Protection Agency - Asbestos abatelent
<br />I also certify tbat, if fIll lateriaI is to be used in Flood Zone "A" or "A,etc.", it is understood that a dra10age plan
<br />addressing a "cOlpensating volUle" will be sublitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit. issuance.
<br />
<br />. A perlit issued shall be construed to be a license to proceed with tbe work and not as authority to violate, caacel alter, or
<br />Bet aside any provisions of tbe technical codes, nor shall is~u~ce of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. avery petlit issued shall hecoIe invalid
<br />unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if worl autboriled by the petlit is
<br />suspended or abandoned for a period of six IOnths after the tile the work is C08ellced. Ooe 90 day utension of UH, -f be
<br />allowed for the per.it with fee charge of $15.00. Tbe extension shall be requested in writing to the Building Official. An
<br />approved inspection lust be logged during each six IOntb period, or the project will be considered abandoned.
<br />WARlfIHG TO OIIHER: YOUR FAILURE TO RECORD A HOTlCE OF COHKHHCmmHT HAY RESULT IH YOUR PAnHC TWICI FOR IHPROVIIIBIrS TO YOUR
<br />PROPERTY. IP YOU IJfTEHD TO OBTAIN FlHAHCIHG, COHSULT WIrH YOUR LENDER OR AH ArTORlfEY BEFORE RlCORDINC YOUR NOTICI OF
<br />COIVtEHCHHENT. JOBS UHDER $2,500 IH VALUE DO HOT NEED TO RECORD AND POST A "NOTICE OF COHHBHCHHENl'"..
<br />
<br />. I
<br />
<br />SIGNATURE: ONKER OR AGEHT
<br />
<br />SIGNATURE: CONTRACTOR
<br />Poole Construction Co., Inc.
<br />
<br />East Pasco Medical Center
<br />
<br />STATE OF FLORIDA
<br />COUlflY OF
<br />The foregoing instrument
<br />before me this
<br />
<br />was aCknowledged
<br />, 19_ by
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument
<br />before me this
<br />
<br />was acknowledged
<br />, 19_ by
<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 />who is personally known to me or wbo bas
<br />produced
<br />as identification and wbo did/did not
<br />take an oatb.
<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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