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<br />CONDI'l'IONS OF PERMIT An'IDAVIT
<br />A. NOTICE OF DEED RESTRICTIoNS
<br />The undersigned understands thqt this permit may be subject to "deed restriqtions/~ w.l2tc~1
<br />lUdY be more restl.'ictive than City regulations. '1'he under:signed assumes responsibility fo.!.~
<br />compliance wi th any appli cable deed restrictions.
<br />B. UNLICENSED CONTRAC'l'ORS AND CON'l'RACTOR RESPONSIBIJ,I'l'IES
<br />If the owner has Ilired a contractor or contractors to undertake work, they may be required
<br />to be li ceused 1n accordance v~ith state and local regulations. If the contractor is not
<br />li censed CIS required by lav~, both the owner and contractor may be ci. ted far a misdemeanor
<br />violation under state laH. If the owner or intended contractor are uncertain as to VlhClt
<br />licensing requirements lllay apply for the intended work, they are advised to contaot the
<br />City of Zephyrhil1s Building Department, 813-788-6611.
<br />Furtherlllore, if the ovmer has hired a contractor or contractors, he is adv1sed to have the
<br />contractor(s) sign portions of the "Contractor SectionsN of this application tor Hhicll they
<br />wiLl be n::sponsible. If you, as the ol-mer signs 'IS the contractor, YQlI are indicating that
<br />you, rather than the contractor, are responsible for the Hork. If the contractor wishes
<br />you to sign as COlltractor that may be an indication that he is not properly licensed and is
<br />not entitled to permitting pr1vileges in the City of Zephyrhills.
<br />C. 'I'RANSI:'OR'l'ATION IMPAC'l' FEES AND UTUI'I'Y CONNECTION IfEES
<br />D. CONS'fRIlC'l'UrON LIEN LAW (CHAP'l'ER 713, FLORIDA STA'l'UTES, AS AMENDED)
<br />1 certify that I, the applicant, have been provided with a copy of "Florida's Construction
<br />lien Law - HOllleowner's I:'rotect10n Guiden prepared by the Florida Department of Agr1culture
<br />and Consumer Affairs. If the applicant is someone other that the "oHnerN, I cerify that I
<br />have obtained a copy of the above described document and promise in good faith t~ deliver
<br />it to the "owner" prior to conunencement.
<br />E. CONTRAC'l'OR' S/OWNER' S AFFIDAVI'r
<br />I certify that all the information in this application is accurate and tllat all work will
<br />be done in compliance with all appU.cable laws regulating construction, zoning, and land
<br />development.
<br />Applioation is hereby made to obtain a permjt to do Hork and installatioll as indicated. I
<br />certi fy that no vwrk or installation has conunenced prior to lssuance of a permi t and that
<br />all work will be performed to meet standards of all laws regulat1ng construotion, City
<br />codes, zoning regulations, and land development regulations in the jurisdiction. I alBo
<br />certify that I understand that the regulations of other governmental agencies lllay apply to
<br />the intended Hork, and that it is my responsibility to identify what actions I must Lake to
<br />be in compliance. Such agencies 1nclude but are not limited to: *Department of
<br />Environmental Regulat1on-Cypress Bayheads, Wetland Areas and Environmentally Bensltive
<br />Lands, Water/Wastewater 'l'reatment
<br />*Soutllwest rlorida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
<br />Al tering vJatercourses
<br />6ArlllY Corps of Engineers-Seawalls, Docks, Navigable Waterways
<br />*lJepar.tlllent of Health & Rehabilitative Servlces, Environmental Health Unit-Wells,
<br />Wastewater 'l'reatment, Septic 'l'anks
<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./I, it is
<br />understood that a drainage plan addressing a "compensating volume" 'will be submitted which
<br />is prepared by a professional engineer registered in tlle State of Florida prior to permit
<br />issuance.
<br />A permit issued shall be construed to be a license to proceed with the work and not as
<br />authority to violate, cancel, alter, or set aside any provisions of tile technical codes,
<br />nor shall issuance of a permit prevent the Building Official from thereafter requlring a
<br />correction of errors in plans, con~truction, or vio!iiltions of any code. Every permit
<br />issued shall become invalid unless' the work authorized by such permit is cOllunenced Hithin
<br />six months of issl/ance, or 1f work authorized by the permi.t is suspended or abandoqed for a
<br />period of six months after the time the work is conunenced. One 90 day extension of time
<br />may be allowed fo~ the permit Hith fee charge of $15.00. The extension shall be 'equea~ed
<br />i.n writing to the Buildi.ng Official. An approved inspection must be logged during each /:iix
<br />1I10nth period, or the project i.Jill be considered abandoned.
<br />WARNING '1'0 OWNER: YOUR FAILURE TO RECORD A NO'l'ICE OF COMMENCEMENT MAY RESUL'l' IN YOUR
<br />PAYING 'rWlcE FOR IMPROVEMENTS '1'0 YOUR PROPERTY. IE' YOU IN'rEND TO OB'rAIN f'INAlH:;INq,~9N@UI/I'
<br />WITH YOUR LENDER OR Al-J A'f'rORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMEN'I'. JOBS UNDER
<br />$2,500 IN VAl,UE DO 1'10'1' NEED '1'0 RECORD AND POS'l' A "NO'nCE OF COMMENCEHEH'l'''.
<br />
<br />
<br />~~
<br />
<br />S IGNA'l'l1RE: OWNER OR AGENT
<br />
<br />S'f,'ATE OF FLanDA
<br />COUNTY' OF _~ S:C 0
<br />'l'he foregolng in~r\lment w6:9J ~wledged
<br />Bef~:. fie trta rt-- d~ay,....Q.f [11 fl- "" ~"5-
<br />by _ ..:1t f't-IL~ u IT~ S ( IA r 11I<
<br />- ~ame of person acknowledged)
<br />~h~is personally knoHn to me, or
<br />..../
<br />
<br />~JitS~~D'A.'-'.ocu0
<br />SIGNA'f'URE: CONTRACTOR
<br />
<br />STA'l'E OF FLORIDA ~A 5:( D
<br />COUNTY OF ~
<br />The forego.ing instrument Wf\ftJl",~ledged
<br />Before m("vtltis i3 _daY...,Pf-!flr .,,~_
<br />by _ If 1I-K.-~ ~ _U L.11-e~
<br />(name of person acknoHledged)
<br />~ is personally knol"ln to me, or
<br />Lk/~I If7/'f/ f;- '-...1
<br />05 producedfbL ~ , ' ___J!:!...
<br />lJ;.!tPe of identifioaUon)
<br />o did []j.1'f~:~e an Oil th
<br />II /f1( ~.__-=-____
<br />
<br />Signature of person taking acknowledgment
<br />
<br />
<br />"roduced FULIt',65", Inwf;;C/o
<br />/(type of identification)
<br />~ot take an oath.
<br />/1/1 (~._
<br />
<br />~ taking acknowledgement
<br />
<br />,1
<br />
<br />utWho
<br />
<br />
<br />DD024754
<br />~--~-~
<br />~ or stamped
<br />
<br />",""~ Susan A McCollum
<br />
<br />-N~jr;j:;1~~ ;~1~~ s t .;;;;-i)e(l----------~~-
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