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<br />I:ONDIT10NS r.,!" PE"..Ml'(' AFFID.\\i::_"
<br />
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned understands that this perm! t may be sU~Ject.. to "deed J:esl:ri,~ttons': v.:hLsh
<br />may be more restrictive than City regulati';,ns. Th'7! ul10ersigned asswn,=s respOi:s1.bi.] ii.-Y fOl:
<br />compliance with any applicable deed restrictions.
<br />B. UNLICE;NSEP CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contractor or contractors to undertak'7! ~ork, they may be required
<br />La be licensed in accordance with state aCId local .cegulations. If the contract..").:: is not
<br />licensed as required by law, both the owner and contractor may be cited for Q misdemeclilol:
<br />violation under state law. If the mvner or intended contractor are l.!Ocertain ':'5 to Hl:?lt
<br />licensing requirements may apply for the intended worl:, they are adv:i~ed te. c0ntact the
<br />city of Zephyrhills Building Department, 813-786-6611.
<br />Furthermore, if the owner has hired a contractor or contractors, he is advised to have ~he
<br />contractor (s) sign portions of the "Contractor Sections'.- of this application for ...:hich Uwy.
<br />will be responsible. If you, as the owner signs as the contractor. you are incticatillg that
<br />you, rather than the contractor, are responsil:>le for the \olOrk. If the contracLor wishes
<br />you to sign as contractor that may be an il~ctication that he is not properly licensed <,nd .~.:'
<br />not entitled to permitting privileges ill the City of '!'ephyrhills.
<br />C. TRANSPORTATION IMPACT FEES AND UTIl,ITY CONNZCTl0N E'EES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLOP-IDA S'I'J\TUTES, AS AMeNDED)
<br />I certify that I, the applicant, have been provided with a copy of "Florida's Conslruction
<br />lien Law - Homeowner's Protection Guide" pre!>ared by the Florida Depa rtment ef 7\gricuJ. tun~
<br />and Consumer Affairs. If the applicant: is someone other that tho:'! "owner", 1 '~erif}' that I
<br />have obtained a copy of the above described document and promise in good [~li th te (leLc veJ:
<br />it to the "ownerH prior to commencement.
<br />E. CONTRACTOR' S/OWNER' S AFFIDAVIT
<br />1 certify that all the information in this application is aCCHrate and that i11.1 w0rJ; \-,L11
<br />be done in compliance with all applicable laws regl~lating cOllstruction, Z')nilly, and laud
<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 comm..mced prior to issuance of a Permit ar:d th<tt
<br />all work will 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 :Jf other governmental agencies may apply to
<br />the intended work, and that it is my responsibility to identify what actions I F::USt take ::-'0
<br />be in compliance. Such agencies include but are not limited to: *Department of
<br />Environmental Regulation-Cypress Bayheads, Wetland Areas and E~vironmenta11y Sensitive
<br />Lands, Water/Wastewater Treatment
<br />*Southwest Florida Water Management District-Wells, Cypress Bayheads, We\::lar}d Areas,
<br />Altering Watii-rcourses
<br />*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
<br />*Department of Health & Rehabilitative Servic~s, EnvironIr..ental 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 i~ F'lood Zone "A" or ".A, etc:.", it is
<br />understood that a drainage plan addressing a "'conpensating volume" will be sublldtted 1.1hj ch
<br />is prepared by a prof~ssional engineer regist~red in the State of Florida prior to pE.!r~dt
<br />issuance.
<br />A permit issued shall be construed to be a license to proceed \1Iith the work and n'Jt as
<br />authority to violate, cancel, alter, or set aside a~y provisiol1S of the technical cod~s,
<br />nor shall issuance of a permit prevent the Building Official from thereafter requiring CI
<br />correction of errors in plans, construction, or violations of any code. Every permll
<br />issued shall become invalid unless the wo::k authorized by such permit is cOllUnenced within
<br />six months of issuance, or if work authorized by the per~it is suspended or abandoned tor ~
<br />period of six months after the time the work is conmenced. One 90 day exten~ion of time
<br />may be allowed for the permit with fee charge of $15.00. The extension shall be request~d
<br />in writing to the Building Official. 1m approved inspection must be logged during each 51;'.
<br />month period, or the project will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORDA NOTICE OJ!' COMMEttCEi'1ENT MAY HEsuvr } N YOUf{
<br />PAYING TWICE FOR IMPROVEMENTS TO YOUF PHOPE:RTY. IF YOU INTEND TO OB'l'AIN E'I1JANCING, CONSUl;r
<br />WJ;,'11CYOUR LENDER OR AN ATTORNEY BEFORE RECORDING Y6lm NOTICE O!'" COI"'J.tENCE..~ENT. ,JOB':: UNDEP
<br />$2,500 IN VALUE DO NOT NEED TO RECORD AND POS,'l' A "NO'rICE OF COl~ENfEMEN'l'''.
<br />
<br />'-.- ( ~ '! ,1 ,( . .-1,'?
<br />'~__ JflVJL/A a ~./ / ~ _k~ ~/ ~___
<br />
<br />SI;-A.uR~: - vO;N~ O~ AGENT SIGNATURE: CONTRAC'\'OR
<br />
<br />STATE OF ~RIDA
<br />- COUNTY OF lS ~ .
<br />The foregoing instrument was a~Jmowledged ,
<br />Bef~ me thi~ day of /1f!!:i1-, .:J[()lf
<br />by 1/ V\!L {I n "-
<br />(name of person acknowledged)
<br />~ho is personally known to me, or
<br />
<br />STATE 0:<' FLOIU llA-:--. -; _
<br />COUH'l'Y OF _.!'fiS ~ c> ________
<br />The foregoinq instrument WClr. ~cknO\'lledge~ .
<br />Before Ime this ~day of,~' I , V-t :UJt.>'f
<br />by l../C r') //\.c.... {TICOJ:::- _
<br />(name of person acknowledg~dl
<br />~tlo is personL~J.ly knoh"l1 to me, or
<br />
<br />o who has produced
<br />(type
<br />and~ whoD did Ddid not
<br />/'
<br />
<br />of identificationl
<br />take an oath.
<br />
<br />o who has prvd'.I~;ed .__________
<br />(type of identific3t~Qn)
<br />and ~Iho Odid []::lid not ta!(E' an oath
<br />1; J //
<br />~ GL4,--,<-- i..---~fl.L ______
<br />
<br />Signature of ~e.cs::>n t'lkinq acknm...J edgme::t
<br />
<br />""/,1
<br />~ (..lA, ..L~a.u-o...t/yilL!
<br />- ~
<br />Signature of person taking acknowledgement
<br />
<br />Name type ,
<br />
<br />
<br />e or stamped
<br />SUSAN ANN tMLlB!
<br />tIaIarY NlIlo. SIale r:A RcI1da
<br />IllfCDr/llft. ... Jun 18. 2lXl4
<br />o..l.'~ . CC9'-.~7~.
<br />41' ........ 1........... r..... ""< , . i. ~"t_l::-~
<br />
<br />!lame
<br />
<br />
<br />rinted oJ: staml d
<br />NlM l.'vAI1EI! .
<br />SUS~. S1ale rJ Aol'da
<br />HaIaY e.pteII .lull 1 B. 2004
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