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<br />
<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undereigned understands ~hat this permit may be subject to ~deed restrictions" which
<br />may be more restrictive than City regulations. The undersigned assumes responsibility tor
<br />compliance with any applicable deed restrictions.
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contractor or contractors to undertake work, they may be required
<br />to be licensed in accordance with state and local regulations. If the contractor is not
<br />licenaed as required by law, both the owner and contractor may be cited for a misdemeanor
<br />Violation under state law. If the owner 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 Zephyehills BUilding Depar~ment, 813-788-6611.
<br />Furthermore, if ~he owner has hired a contractor or conteactors, he is advised to have the
<br />contractoe(s) sign por~ions at the UConteactor Sections" of this application for which they
<br />will be responsible. It you, as the owner signs as the contractoe, you ace indicating that
<br />you, rather than the contractoe, are responsible for the woek. If the contractoe wishes
<br />you to sign as contractor that may be an indication that he is not properly licensed and is
<br />not entitled to permitting privileges in the City of Zephyrhills.
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<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. It ~he applicant is SOmeone other that the "owner", I cerity that I
<br />have obtained a copy of the above described document and promiae in good faith to deliver
<br />it to the ~ownerH prior to commencement.
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the informa~ion in this application is accurate 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 permit to do work and installation as indicated. I
<br />certify that no work or installation has commenced prior to issuance of a permit and that
<br />all work will be performed ~o meet standards ot all laws regulating construction, City
<br />codea, zoning regulations, and land development regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other governmental agencies may apply to
<br />~he 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 to: *Department of
<br />Environmental Regulation-Cypress Bayheads, Wetland Areas and EnVironmentally Sensitive
<br />Lands, Kater/Wastewater Treatment
<br />*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
<br />Altering WaterCOUrses
<br />*Army Corps of EngineerS-Seawalls, DOCks, Navigable Katerways
<br />*Department of Health , Rehabilitative Services, EnVironmental Health Unit-Wells,
<br />Wastewa~er Treatment, Septic Tanka
<br />.U,s. Environmental Protection Agency-A$bestos abatement
<br />I also certify that, if till material is to be us..d in FlOOd Zone "A" or "A, etc.", 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 the State of Florida peior 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 the technical codes,
<br />nor shall issuance of a permit prevent the Building OffiCial from thereafter r..quiring a
<br />correction of errors in plans, construction, or violations of any code. Every permit
<br />issued shall become invalid unless the work authorized by such permit is commenced within
<br />six months of issuance, oe if work authorized by the permit is suspended or abandoned tor a
<br />period of six montha after the time the work is commenced. One 90 day extension of time
<br />may be allowed for the permit with fee chaege of $15.00. The extension shall be requested
<br />in writing to the Building official. An approved inspection must be logged during eAch six
<br />month periOd, or the project will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT HAY RESULT IN YOUR
<br />PAYING !I'WICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF' YOU INTEND TO OBTAIN FINANCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY BEFORE Rl!:CORDING YOUR NOTIC!: OF COMMENCEMENT. JOBS UNDER
<br />$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A ~NOTICE OF COMMENCEHENTN.
<br />
<br />
<br />s; <:12_ CO ,-:rs
<br />SIGNATURE: OWNER OR AGENT
<br />
<br />STATE OF-~~A/I{{) /(011::j
<br />COUNTY OF /.. uS AM ~t 1~5
<br />The foeegoing i strument wa;_~cknowledged
<br />Before me th's . day of lIlJJY ,20.Q3
<br />by (;0 r'f.
<br />(name of person acknOWledged)
<br />o who ia persOnalltY known to me, or
<br />, 1/,--\ 1/ ,\
<br />~ has produced A-It 1-- .J... /t l' f}1LjJ
<br />(type ot identification)
<br />~d whoD did l3'Cii~ not I t~~ an oath.
<br />
<br />~.Jo...\.-\.J....''-./I'- /j-~~
<br />S~ature of p ,rson ~akln~aCknOWledge nt
<br />
<br />c,Jt /'- A../ L_ ,1; fJ. f ~ L
<br />Name typed, printed or sta
<br />
<br />
<br />Z . d
<br />
<br />6998' ON
<br />
<br />SIGNATURE: CONTRAcTOR
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The toregoing instrument was aCknowledZbed
<br />Betore me this _day of '...:.....
<br />by
<br />(name of person acknowledged)
<br />C1ho is peraona~~y known to me, or
<br />
<br />D who has pJ:'oduced
<br />(type of identification)
<br />and who Ddtd O:iid not take an oath
<br />
<br />Signature of person taking acknowledgment
<br />
<br />Name typed, printed or stamped
<br />
<br />SllIH~AHdjZ jO AIIJ
<br />
<br />IWP8:01 SODZ 'IZ <:/1
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