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<br />CONDl'rLONS r)F PE.i.>.Ml'r A.FFID.c',V::_T
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned underst:<lnds that. this permit. may be
<br />may be more restrictive than City regulations. Th~
<br />compliance with any applicable deed restJ:'.Lctions.
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contractor or contractors to undertak~ OoIod~, they may be req~li.red
<br />Lo be licensed in accordance with state aod local ~egulations. If the contractor is not
<br />licensed as required by law, both the owner and contractor may be cited for rr misdemeaIlor
<br />violation under state law. If the mmer or intended contractor aJ:e uncertain ':'5 tc. H/:31:
<br />licensing requirements may apply for the intended wod:, they are ad"i~ed tc. contact 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 fo~ which they
<br />will be responsible. If you, as the owner signs a~ the contractor, you are indica~illg that
<br />you, rather than the contractor, are responsible for the work. If the contracLor wisJles
<br />you to sign as contractor that may be an ir~dication that he is not properly licensed ,-.nd .:.'"
<br />not entitled to permitting privileges in the City of Zephyrhills.
<br />C. TRANSPORTATION IMPACT FEES AND UTIl,ITY CONNECTION E'EES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLOP-IDA S'I'l-\TUTES, 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" pre;>ared by the Florida Department ef l-\griclll ture
<br />and Consumer Affairs. If the applicant is SOlneOr1\~ other that. the "owner", 1 eerify that r
<br />have obtained a copy of the above described document and promise in good ["i th to (leL~ veJ-
<br />it to the "owner" prior to cooonencement.
<br />E. CONTRACTOR' S/OWNER' S AFFIDAVIT
<br />1 certify that all the information in this applicat.i.on is
<br />be done in compliance with all applic;'lble laws regl~lating
<br />development.
<br />Application is hereby made to obtain a permit to do work and installation as illdicated.
<br />certify that no work or installation has commenced prior to issuance of a permit al:d I:hrtt
<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. ] a.Lso
<br />certify that I understand that the regulations of other governmental agencies may apply to
<br />the intended work, and that it is my respons.i.bility to identify what actions I E!USt I:c.ke t.o
<br />be in compliance. Such agencies include but are not limited to: *Department of
<br />Environmental Regulation-Cypress Bayheads, Wetland Areas and E~vironment~lly Sensitive
<br />Lands, Water/Wastewater Treatment
<br />*Southwest Florida Water Management District-Wells, Cypress Bayheads, W(~t:lar~d Areas,
<br />Altering Wat.rcourses
<br />*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
<br />*Department of Health & Rehabilitative Servic~s, Environmental 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 ~'lood Zone "A" or ".A, etc,", it. is
<br />understood that a drainage plan addressing a "conpensating volume" will be su.blTLitted ",hi ch
<br />is prepared by a prof~ssional engineer registered in the State of Florida prior to permit
<br />issuance.
<br />A permit issued shall be construed to be a license to proceed \"ith the work and nr;t as
<br />authority to violate, cancel, alter, or set aside ar,y provisions of ;:'he techniccLl cod",s,
<br />nor shall issuance of a permit prevent the Building Offi.cial 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 work authorized by such permit is cooonenced within
<br />six months of issuance, or if work authc.rized by the perr.lit is suspended or aba!ldc,ned tor <l
<br />period of six months after the time the work is commenced. One 90 day exten:sion of time
<br />may be allowed for the permit with fee charge of $15.00. The extension shall be req~e5t~d
<br />in writing to the Building Official. ?Jl approved inspection must be logged during each sl1'.
<br />month period, or the project will be considered abandoned.
<br />WARNING TO OWtIER: YOUH FAILURE TO RECORDA. NO'l'ICE OF COHMEtICEi"!ENT MAY RESULT 1 N YOUK
<br />PAYING ~ICE FOR IMPROVEMENTS TO 1'OUI< PHOPf:RTY. IF YOU .9I.-~ND TO OBTAIN E'HlAN-:;ING, C:.JNSULT
<br />WITH )lOUR LENDER OR AN ATTORNEY BEE'ORE RECORDING YC'UR ~TIc'E O~ CO....MENCE.."'lENT. ,JOB':: UNDEP
<br />$2000 IN VALUE DO NOT NEED TO RECORD AND POST A "NO'1;ICE OF COl~EHCEM~N1'''.
<br />
<br />j..i:ff/j/ -4/[/1 {./))~__ ~y~ ~ ;~~
<br />;L/"/TPL./t/LA... -?<///&...LI~. _ t?{) , ~.k-~/~~-
<br />SIGNATURE: OWNER OR AGENT 3IGIU\'rURE: CONTRACTOR
<br />
<br />subject to "'deed .::est ri,~tt('nc;'-. Y\:J~.Ldi
<br />undersigned asswo':':s respoils~_LiJ ity for:
<br />
<br />accurate and that. ilL1
<br />cOllstruction, z')ning,
<br />
<br />W0 r); \-, j .j. .l
<br />and laud
<br />
<br />I
<br />
<br />S'l'ATE OF l"LORI Dl\
<br />COUNTY OF ~c....s: W ____
<br />The foregoin9 instrument was acJaloHledqed
<br />Befo.r:.Rme this If)'l+-day of ,M.~. ~q..()(),/
<br />by l.ji) Y1 lAc...- 1'1,:1 0 0- '--
<br />(name of person acknowledg~dl
<br />~~ is person;:~ily known to me, or
<br />
<br />STATE OF ~RIDA
<br />'COUNTY OF "lSC-D
<br />The foregoing instrument was acknowledged
<br />BefQl:e me this 10'/--'r-.. day of fY1.~, -.EL.C6L(
<br />by DCIt\V\.~ V~l--...
<br />(name of person acknowledged)
<br />~ho is personally known to me, or
<br />
<br />o who has produced
<br />(type of identification)
<br />and whoD did Odid not take an oa th.
<br />
<br />~~~~~
<br />
<br />o ,."ho has prod.\(;ed____._________
<br />(type of identific~t~oll)
<br />Odid !lot take i:lO ooth
<br />
<br />and who Odio
<br />
<br />~a~~
<br />
<br />Name typed, p_
<br />
<br />
<br />:,ir %I~Iidt,VAll[;i:
<br />i Nofrny Pubfc - Stato of Rc-'-'"
<br />-r. ~J.}f :<-,:".... My Comm4 &:Pies Jun 1 B. ~:~::4
<br />~",._.':U"\', ~lnmb!l{1n t C~'746
<br />... ". Hi4i~~,~~.....,-w,,-,'
<br />
<br />Signature of r)f~.csan t:.tking acknol\l-' edgme::t
<br />
<br />f:{;;;~':;.:'- ....~ <-~,...,,"-.~. ~t-..
<br />~:J ~_ -r.. ....
<br />---- ~ ~t1...... ! i:IdX H ..[loll.!. "nll_~. ----..--.---
<br />l! alOe t y . .:~.. i.., ::rJift~ek-Il:HStu1i>loat8p.e
<br />-~ .._;~ ,~_ ' (~ My C0r:1m. Exp:'C3 Jun 1 D. 1 :::4
<br />~~" :~~fe:~~~~~:-t:~::;~,'.~I~...:
<br />
<br />Signature of person taking acknowledgement
<br />
<br />t.~
<br />
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