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<br />i~ON))l Tl0NS r.'!" rr::;"Jvll'r ltFFI D/:.i::_"
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned understands that this pCl:JlI1l:. llIay be .su;;Je.:~I-. to "'deed ::estri.::t.1onc:;''- ....:\i.sb
<br />may be more restrictive than Ci t.y regulal.:iQns. Th,~ unciersigned aS5Wfi-es respOilsiLi.!.i tv for
<br />compliance with any applicable deed l:estrlctions.
<br />B. UNLICr;NSEp CON'IRACTORS AND CONTRACTOR RESP.)NSIBILITIES
<br />If the owner has hired a contractor or contractors to undertak~ ;..Iork. they may be r~q~li..re(J
<br />to be licensed ~n accordance with state and local ~egulations. If the contracta~ is not
<br />licensed as required by law, both the owner and cOlltraetor may be cited [or. ;} misdemecHlor
<br />violation under state law. If the mmer or intended contractor are uncertain 0'.5 to ub:l.1:
<br />licensing requirements may apply for t:le intended -"'orl~, they are ad"i~ed te. 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 the
<br />contractor (s) sign portions of the "Contractor Sections"- of this application fo:.: 1r:hich they
<br />will be responsible. If you, as the owner signs as the contractor. you are indica~illg that
<br />you, rather than the contractor, are responsic.le for ::he ..lork _ I f the contrac\:.or wishes
<br />you to sign as contractor that may be an iI!dication that he is not. properly licensed ,~nd -~.:'
<br />not entitled to permitting privileges in the City of ?ephyrhills.
<br />C. TRANSPORTATION IMPACT FEES AND UTIl.ITY CONNECTI':-N F'EES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 7l:~, FLOP-IDA S'I"NfUTES, AS AMr:I'IDED)
<br />I certify that I, the applicant, have been provided ,,,ith a copy of "Florida's Ccnsr.rllct..i_c.n
<br />lien Law - Homeowner's Protection Guide" prepared by the Florida Depa rtment ef l\g.ricul ture
<br />and Consumer Affairs. If the applicant is someOT,e other that. th~ "o;-mer", .'f ceri f.y that I
<br />have obtained a copy of the above described document and promise in ';o::>d Ld. th tc ;:leLc veJ.-
<br />it to the "owner" prior to comnencement.
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the information in this applicat.i_on is acc'-'rate and that aLL work \-d..U
<br />be done in compliance with all applicable laws regulating construction, z')ning, 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 conunenced prior to issuance of a permit. ;H~d tIJat
<br />all work will be performed to meet standards of all laws regulating construction, C]. ty
<br />codes, zoning regulations, and land development regulations in the jurisdiction. 1 also
<br />certify that I understand that the regulations ::>f othEr governmentat agenci~s Illay apply to
<br />the intended work, and that it is my responsibility t::> identify what actions I !':ust t'7-_ke t:o
<br />be in compliance. Such agencies include but are not limited to: *Department 0:)[
<br />Environmental Regulation-Cypress Bayheads, Wetland Areas and E!'lvironmenti.~lly Sensiti-/2
<br />Lands, Water/Wastewater Treatmer.t
<br />*Southwest Florida Water Management District-Wells, Cypress Bayheads, w<el:lard Areas,
<br />Altering Wat~rcourses
<br />*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
<br />*Department of Health & Rehabilitative Services, Enviror~~ntal 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 Flood Zone "A" or ~A,etc.", it is
<br />understood that a drainage plan addre:::sing a "'conpensating volume" will be submitted ../hj ch
<br />is prepared by a prof~ssional engineer registered in the State of Florida prior to pe[n~t
<br />issuance.
<br />A permit issued shall be construed to be a license to proceed \"ith the work pnd nr;t as
<br />authority to violate, cancel, alter, or set: aside ar,y provisions of ~he technical -::od;;o5,
<br />nor shall issuance of a permit prevent the Building Official from thereafter requiring a
<br />correction of errors in plans, construction, or violations of any code. Every periull
<br />issued shall become invalid unless the work authorized by such permit.. is comcencea lr/ithin
<br />six months of issuance, or if work authc:,rized by the perr:dt is suspended or aba!ldc,ned tor"
<br />period of six months after the time the work is commenced. One 90 day exten:oion 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 S.i.l',
<br />month period, or the project will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NO'rICE OF COHMENCEi-1ENT MAY HESUJJT ~ N YOUt<
<br />PAYIN,..G., TWICE FOR IMPROVEMENTS TO YOUF PROPlmTY. IF yO'U'INTEND TO OBTAIN F'HJANCING, CONSULT
<br />WITH ybUR LENDER OR AN ATTORNEY BEFvRE RECORDING Y0VR NOTICE O~ CO~1ENC&~ENT. JOR~ UNDEP
<br />
<br />$2;500tzVALU;, : N~,~Ff~TC~;:ORD AND PO",' A "ffIC~~ ~7;CFt)/{~
<br />/L-).L . (; i(/iGu, i / (./l/ '(77.. _--.E.X"'O PVt/VGL I 1__._____.
<br />SIGNATURE: OWNER OR AGENT SIGHATIJRE: CONTRACTOR
<br />
<br />STATE OF fo'LORJ Q4-.,
<br />COUNTY OF .t:"aSe i) _____
<br />The foregolnq instrument was ackuO\-lledged
<br />Befoq> n2e thi.s /1""'-- _day of J"vu'\. e ,]tit ~'O'f
<br />by L) L.- V1 V'- c~ kY\ l" 0 ,-
<br />", (name of person acknowl~dg€'dl
<br />g;ho is personaily known to me, or
<br />
<br />STATE OF F~IDA
<br />'COUNTY OF tA$ (! D
<br />The foregoing inst~ument was acknowledged
<br />Bef~e me this ~ day of .J lA V\. e . }(l1J,9.ti{)t{
<br />by UC"lYl(~ moo.......
<br />(name of person acknowledged)
<br />~who is personally known to me, or
<br />
<br />o who has produced
<br />(type of identification)
<br />and whoD did Ddid not take an oath.
<br />/, ../ /:
<br />J.~/.2.~' ~ P'~...L.&
<br />
<br />Signature of person taking acknowledgement
<br />
<br />o \-lho has pr0dll~ed_____________
<br />(type of identificat~on)
<br />and who Odid [):lid net take an oath
<br />,.-1 /I """1
<br />j'~:< /',/'("'"
<br />_/<L~ ~~ "'...... Ci:.-Uy->-L . , <<
<br />
<br />Signature of r)f~.cs:>n t'lkinq acknm.;1 edqrne;:t
<br />
<br />Name type
<br />
<br />
<br />Harne t " "Ii ~~I^~rLAVAfiHlnp d
<br />.. Notary Pubic - Stato of Rc~da
<br />~<'?m My Comm. Exp\"<os J;::;.;~~;Z::~4
<br />~ .~, Com!'Tll;;lcm t- C. -, - ~
<br />)""""._:~~~~''R>;''''l;"..",._"."~,,,,."li.''-'''''
<br />
<br />pcJU$.UI ^~ WMJg~
<br />t"ifari'PUbrc~ ~e~ i:."Ci ,.J.:l
<br />My Comm. Expres Jun Hl. 2.:,," i
<br />Commlsslon" CCY)_'7~.5
<br />~~!r:-"~-,.;J
<br />
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