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<br />CUNIH'.I.'18NS 'JF !?ERMIT J\FFIDAVlT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />'l'he undersigned understands tqat this permIt may be suhJect.to "deed restrictions" which
<br />may be more restrlctive than City regulaU.olls. The undersl gnad assumes respotisibllity for
<br />compliance with any applicable deed restrictiolls.
<br />B. UNLICENSEIJ CONTRACTORS AND CONTRACTOR n"JSPONSIBIf,I1'IES
<br />If the owner has hired a contractor or conb:aul:ors to undertake work. they may be required
<br />to be licensed in accordance with state and local regulatIons. If th. contractor 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 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 "f Zephyrhills Building Department, 813-788-6611.
<br />Furthermore, if the owner has hired a contractor or contractors. he is advised to have the
<br />contractor(s) sign portions of the "Contractor Sections" of this application for which they
<br />will be responsible. If you, as the oWher signs as the contractor, 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 lndication 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 U'fII.ITY CONNECTION FEES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 713, F,LORIDA STATUTEtJ, AS AMENDED)
<br />.1 certify that I, the applicant, have been provided with a copy of "Florida's Construction
<br />lien Law - Homeowner's Protectlon Gulde" prepared by the Florida Department of Agriculture
<br />and Consumer Affairs. If the applicant is /.'Iomeone other that the "owner", I cerify that I
<br />have obtained a copy 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 that all the information 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 />certity that no work or installation has commenced prior to issuance of a permit and that
<br />all work will be performed to meet standards of all laws regUlating construction, City
<br />codes, zoning regulations. and land development regulations 1n the juriSdiction. I also
<br />certify that 'I understand that the regulations of other govern,mental 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 to: *Department of
<br />Environmental RegUlation-Cypress Bayheads, Wetland Areas and EnVironmentally Sensitive
<br />Lands, Water/Wastewater Treatment
<br />*Southwest Florida Water Management District-Wells. Cypress Bayheads, Wetland Areas,
<br />Altering Watercourses
<br />*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
<br />*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
<br />Wastewater Treatment, Septic Tanks
<br />*U.S. Environmental Protection Agency-ASbestos abatement
<br />I also certify that. if ;till material is to be used 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 prior to permlt
<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 requiring a
<br />dorrection 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, or if work authorized by the permit 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 peJ:mit with fee charge of $15.00. The extension shall be J:equesb!d
<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 'fO RECORD A NOTICE OF COMMENCEMENT MAY RESUI,T IN YOUR
<br />PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
<br />$2,500 IN VALUE Do N NEEI) TO RECORD AND POST A "NOTICE OF COMMENCEM T".
<br />
<br />
<br />SIGNATURE:
<br />
<br />
<br />~..'
<br />
<br />STATE OF FLORIDA ~ ^
<br />COUNTY OF ) ~u.
<br />The foregoing instrument was acknowledged
<br />BefoJ:e me this~day of d-;J.IO . a.~
<br />by ,~'t S ch~-t.J-
<br />(name of person acknotfledged).
<br />~o is personally known to me, or
<br />
<br />o who has
<br />
<br />S'l'ATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument was, \~~yOw] edged
<br />Before me this ~~ "IA '" -. ;18>Z2Z-
<br />by '- \IN,,'hi 5 r J-'
<br />,
<br />(name of person aCknOWledged)
<br />~is personally known to me, or
<br />
<br />YQ4.GO
<br />
<br />
<br />of identification)
<br />take an oath.
<br />
<br />[] who has produced
<br />(type of identification)
<br />~ an oatil
<br />
<br />
<br />9 e of penwn taking acknowledgment
<br />
<br />9i
<br />
<br />f person taking acknowledgement
<br />
<br />lJ"~ Suzanne Douglas-Allen
<br />~fi c;u~",;,,~;vlo C087-4298
<br />type ~ .".- x~~s08oter~~'8?Med
<br />."~ .
<br />
<br />
<br />Name
<br />
<br />lJ' . Suzanne Douglas-Allen
<br />
<br />Name typed,:~mlY~S'CWf~~~OJ
<br />\ ~. Expires October 25. 0
<br />'i.,t\~ .
<br />
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