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<br />NOV/15/2004/MON 09:02 AM
<br />
<br />ZEPHYRHILLS BUILDING
<br />
<br />FAX No, 813-780-0021
<br />
<br />p, 002
<br />
<br />A. NOTICE O~ DEED RElSTRICTIONS
<br />The unde;signed understands that this permit may be subject to "deed restrictions" which
<br />may be more restrictive than City 'regulations. The undersigned assumes responsibility for
<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 i.s not
<br />licensed as required by law, both the owner and contractor may be cited tor a misdemeanor
<br />violation under state law. 'If the ownelC or intended oontractor are uncertain as to what
<br />licensing requirements may apply for the intended WalCk, they are advised to contact the
<br />City of Zephyrhills Building Department, 813-780-0020,
<br />Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
<br />contractor(s) sign po~tions of the "ContlCactor Sections" of t:his application for which they
<br />will be responsible. If you, as the owner signs as the contractor,yoq are indicating that
<br />you, rather than the cQntractor, are responsible for the work. If the contractor 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. TRANS&ORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />D.' CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, haye 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 Aftairs. If the applicant is someone 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 tlone in compl~ance with all applicable laws regulating construction, zoning, and land
<br />development.
<br />Appli"ation is hE>reby 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 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 of other governmental 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, Wetlapd Areas.
<br />Altering Watercourses "
<br />.Army Corps of Engineers-Seawalls, Docks, Navigable waterways
<br />.Department of Health & Rehabilitative Services, Environmental Health Onit-Wells,
<br />Wastewater Treatment, Septic Tanks
<br />.U.S. Environments* Protection Agency-Asbestos abatement
<br />I also certify that, if fill material is to be used in Flood Zone "AU or "A, etc.", i't 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 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 requiring 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, or if work authorized by the permit is suspended or abandoned for 'a
<br />period of six months after the time the wor~ is commenced. One 90 day extension of time
<br />may be allowed for the permit with fee charge of $15.00. The extension shall be requested
<br />in wr1ting 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 ~AILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YO OR
<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 />$2,5 0', IN VALOE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
<br />
<br />
<br />~~
<br />
<br />SIGNATURE: CONTRACTOR
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF J.l1c..Lr pbLiUJf; H
<br />The foregoing instrument was acknowledged
<br />Before me this..LL day of """"Q"1I\i!.~ 2Q.Q.t.{.
<br />by "D€All"';- cS-It,Sr...J I
<br />/ (name ot person acknowledged)
<br />9'who is personally known to me, or
<br />
<br />o who has produced
<br />(type of identification)
<br />and wrioD did Ddid not take an oath.
<br />
<br />STATE O~ ~LORIDA
<br />COUNTY OF
<br />The foregoing instrument,was
<br />Before me this --'pay of
<br />by
<br />
<br />acknowledged
<br />,20_
<br />
<br />(name of person acknowledged)
<br />C1ho is personally known to me, or
<br />
<br />o who has produced
<br />(type ot identification)
<br />and who Odid Ociid not take an oath
<br />
<br />
<br />acknowledgement
<br />
<br />Signature of person taking acknowledgment
<br />
<br />Judith M &limo
<br />stampe . MyCommilSion0933!l~tped, printed or stamped
<br />~..~ ExpiluSeptlmber07 2008
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