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<br />CONDI'rIONS OF PERNa AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />-The crnder:signed understands thijt thio5 permit may be subject to "deed restdotion,s" which
<br />may be more .[estd oti ve than City regulations. '1'he undersigned assumes responsibi 11 ty for
<br />compliance with any applicable deed restrictions.
<br />B. UNLICENSED 'CON'I'RAC'l'ORS AND CON'l'RACTOR RESPONSIBII,I'l'IE:S
<br />If the owner- has hired a contractor or contractors to undertake work, they may be required
<br />to be Ii censed 1n accDrdance ~dth state and local regulatJons. If the contractor is !lot
<br />lioensed as required by law, both the owner and contractor may be cited fDr a mJliidemeaUDl:
<br />viol ation under state laH. I f the owner or intended contractor are uncertain as to ~Ihat
<br />licensing requirements may apply for the intended work, they are advised to contact: the
<br />City of Zephyrh.ills Building Department, 813-788-6611.
<br />Furthennor'e, it the owner has hired a contractor or cDntractors, he 113 advised to have tbe
<br />contractor(s) sign portions of the "Contractor Sections" of this application for whiell they
<br />~liJl be r.esponsible. If you, as the owner signs as the contraotor, YQll are indicating that
<br />you, lather than the contractor, are responsible for the work. If the contl'actor' wishes
<br />you to sign as CDlltractor that may be an indication that he is not properly licensed and is
<br />llot entitled to permitting privil~ges in the City Df Zephyrbills.
<br />c. 'I'RANSPOR'l'A'rroN IMPAC'l' jf'EES AND U'l'ILI'1'Y CONNECTION FEES
<br />D. CONS'rRlJCTUION LIEN LA\iJ (CHAP'l'ER 713, FLORIDA s'rATUTES, AS AMENDED)
<br />J certify tllat I, the applicant, have been provided with a copy of "Florida's Construct10n
<br />lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
<br />and ConsUlner Affairs. If the applicant is someone other that the "owner", J cerify that I
<br />have obtained a copy of the above described document and promise in good faith to deliver
<br />it to tht:: "owner" pr10r to conunencement.
<br />fiL COWI'RAc'l'OR' S/OWNER' S AFFIDAVI'r
<br />I certify that all tbe information in this application is accurate and tllat all work will
<br />be done in compliance with all applicable .laws regul ating constr'uction, zoning, and land
<br />development.
<br />Application is hereby made to obtain a permit to do work and installation as indicated. 1
<br />certify that no work or installatJon has cormnenced prJor to issuance of a permit and that
<br />all work Hill be performed 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 I understand that the regulations of other governmental agencies Inay apply to
<br />tile intended work, and that it is my responsibility to identify what actions I IDUSt take to
<br />be in compliance. Such agencies include but are not limited to: *Department of
<br />Environmental RegUlation-Cypress Bayheads, Wetland Areas and Environmentally Bensj.tive
<br />Lands, Water/Wastewater Treatment
<br />*Southwest Inorida Water Hanagement District-Wells, Cyp.t;esa Baybeads, Wet] and Areaa,
<br />Altering Watercourses
<br />*Anny Corps of Engineers-SeawallS, Docks, Navigable Waten,aya
<br />*Department of Health & Rehabilitative Services, EnvironrnentaJ Health Unit-Wells,
<br />Wastewater Treatment, Septic Tanks
<br />.U.S. Environmental Protection Agency-Asbestos 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 dralnage plan addressing a "compensating volume" 'w11l be submitted Hbleh
<br />is prepared by a professional engineer registered in tile State of Florida prior to permit
<br />]ssuance.
<br />A permit issued shall be construed tD be a license to proceed with the work and not as
<br />authority to v1olate, cancel, alter, or set aside any p.l;'ov1sions of the technical codes,
<br />nor shall 1ssuance of a permit prevent the Building Official from thereafter requiring a
<br />correction of errors in plans, con~truction, or violations of any code. Every permit
<br />iSsUed shall become invalld unless the work authorized by such permit is cOllunenced ~.lthin
<br />six montlls of issuance, or if work authorized by the permit is suspended or abandoQed for a
<br />period of six months after the time the work is cormnenced. One 90 day extension of time
<br />may be allowed for the permit with fee charge of $15.00. The extellsion sball be tequeated
<br />in wri ting to the Bu1.1 dJ.ng Official. An approved inspection must be logged during each ::d x
<br />month period, or the project Hill be considered abandoned.
<br />WARNING TO OWNER: 'x'OUR FAILURE '1'0 RECORD A NO'I'ICE OF COMMENCEMENT MAY RESUl/1' IN YOUR
<br />PAYING '!'WICE FOR It1PROVEMEN'l'S TO YOUR PROPER'ry. IF YOU IN'rEND TO OB'l'AIN l"INAlH1INq,P9N@UL'I'
<br />WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'I'. ,JOBS UNDER
<br />$2,500 IN VALUE DO NOT NEED '1'0 RECORD AND POST A "NOTICE OF COMMENCEMEN'll/1.
<br />
<br />_~~_k::~ /1.~f!6rMh
<br />
<br />'SI GNA'l'URE: OWNER OR AGEN'l' SIGNA'l'URE: ONTRAC'l'()R
<br />
<br />S'l'A'l'E OF FLORIDA
<br />COUNTY OF-
<br />The foregoing instrument was acknowledged
<br />Before we this _'__ day Df _____, 19---,-
<br />by_
<br />(name of person acknOWledged)
<br />Owho is personally known to me, or
<br />
<br />STA'l'E OF nORIDA
<br />COUN'I'Y OF
<br />'rhe foregoing instrument we,s aoknoVll edged
<br />Before me this _-----.Jiay of---, 19 -.:.__
<br />by
<br />(name of person aoknowledged)
<br />Ovho 105 personally known to me, or
<br />
<br />o who has produced
<br />(type
<br />and who[J did (]did not
<br />
<br />of identification)
<br />take an oath.
<br />
<br />[J Vlho has produced___ ____
<br />(type of identification)
<br />and Hha Ddid DUd not t.ake all O<lth
<br />
<br />Signature of person taking acknowledgement
<br />
<br />Signature of person taking acknowledgment
<br />
<br />--------~---------~--._------~----
<br />
<br />I'lame typed, printed or stamped
<br />
<br />-
<br />Name typed, printed or stampi::ld
<br />
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