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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />Tbe undersigned understands that tIlis perlit JaY be subject to .deed restrictionsilililcb IIIf .be lOre restrictive than City
<br />regulations. !be UIldersigned assoles responsibilitJi_ COIpliance ,ith any applicable deed restrictions.
<br />
<br />B. UNLICEN$ED. CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner bu' bired a contractor or contractors to undertake IIOrk, they JaY be required to be llcensed in accordance ,ith
<br />state and local regulations. If the contractor is not licensed as required by In, both the OlDer and contractor IIY be
<br />cited for a lisdeJeanOr violation under state law. If the OIIIl8r or intended contractor are uncertain as to wbat licensing
<br />reguir8l8l1u JaY apply for the intended work, they are advised to contact the City of Zepbyrhills BuilcUng Departlent, (813)
<br />788-6611.
<br />
<br />Furtheraore, if the owner bas bired a contractor or contractors, be is advised to bave the contractor(s) Sign portions of the
<br />.Contractor Sections. of this application for wbieb they will be respoosible. If you, as the OIIIler sign as the COIltractor,
<br />you are indicating that you, rather than the contractor, are responsible for the IOr1. If the contractor ,i8IaeS you to sign
<br />as contractor that JaY be an indication that be is not properly licensed and is not entitled to pmitting privileges in. the
<br />City of Zepbyrbills.
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<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNBCTION FEES
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<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, bave been provided with a copy of .Florida's Construction Lien Law - 8CIIl!OIIIler's Protection
<br />Guide. prepared by the Florida Departlent of Agriculture and ConsUII!I Affairs. If the applicant is SOl8Ol18 other than the
<br />.owner., I certify that I bave obtained a copy of the above described docUIent and prolise in good faith to deliver it to the
<br />lowner' prior to COIIeIlCl!ll!llt.
<br />
<br />E. CONTRACTOR'S/OWER'S AFFIDAVIT
<br />I certify that all the iofoIlltioo in this application is accurate and that all IIOrk will be done in COIpliance lith all
<br />applicable laws regulating construction, loning, and land developleDt.
<br />
<br />Application is hereby lade to obtain a perlit to do IOrk and installation as indicated. I certify that DO IOrk or
<br />installation has CDlenced prior to issuance of a perlit and that all IOrk ,ill be perforB to leet standards of all laws
<br />regulating construction, City codes, loning regulations, and land deve1Op18Dt regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other gOYerDl8Dtal agencies lay apply to the intendedwori, and that it is
<br />If responsibility to identify what actions I lUSt take to be in CQlPliance. Such agencies include but are not lillited to:
<br />* Departlent of Invirolll8Dtal Regulation - Cypress Baybeau, Wetland Areas and InviroDleDtally Sensitive Lands,
<br />Water/lfastewater freatlent
<br />* Southwest Florida Water Hanagl!ll!llt District - lIells, Cypress Baybeac1s, lIetland Ireas, Iltering lIatercourses
<br />* lIlY COIPs of Engineers - Seawalls, Docks, Havigable Watenays
<br />* Departlent of Health i Rebabilitative Services, InvirODl8Dtal Health Unit - lIells, Wastewater freatlent, Septic lanb
<br />t US InvirODleDtal Protection Agency - Asbestos abatl!lH!Dt
<br />I also certify that, if fill IIterial is to be used in Flood lone .1. or .A,ete.., it is understood that a drainage plan
<br />addressing a .COIpeD8ating vol.. ,ill be sBitted ,bieb is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance.
<br />
<br />A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical codes, nor sball issuance of a perlit prevent the Building Olficial frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Ivery perlit issued shall belDe invalid
<br />unless the IOrk authoriled by such perlit is ~ced within sil IODtbs of issuance, or if IOrt authoriJed by the perlit is
<br />suspended or abandoned for a period of sil IODtbs after the tile the work is ~ced. One 90 day 81tension of tiE, lay be
<br />allOlfed for the perlit with fee charge of $15.00. the 81tension sball be requested in writing to the Buil4ing Official. In
<br />approved inspection lUSt be logged during eaeb sil IODth period, or the project ,ill he considered abandoned.
<br />IIARIIING TO (BD: YOOR FIILURE ro RECORD I ROIICE OF ~ HlY RESULT IH YOUR PIYIKG IIfICE FOR IIIPUIIIIII8 TO YOOR
<br />PROPERTY. IF YOU IftlllD ro 081111 FIIIKCIIG, COISULT WITH YOOR LIIDIR OIlIlTIORDY BIFORIl RICOIIDIIIG YOUR HOIICI OF
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<br />A;=I.:;;;:ro_MD~'. ~
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<br />SIGKI~ IGIMt SIGIII!URI: COllI
<br />
<br />SrArE OF FLORIDA
<br />Cmy OF
<br />The foregoing instrument was acknowledged
<br />before me this , 19____ by
<br />
<br />Sf ArE OF FLORIDA '....1/".0
<br />coom OF p", ':> C
<br />The foregOing instrument was acknowledged
<br />before me this 1.-' 2 ,. 2OQ1i>y
<br />
<br />'y(lkNUc; M,- L{(\ia1-
<br />who is personally known to _ or who has
<br />produced
<br />as .dentifi ation and who didldid not
<br />ta .
<br />
<br />who is personally know.n to me or who has
<br />produced
<br />as identification and who didldid not
<br />take an oath.
<br />
<br />
<br />(Signature)
<br />(Name 'fyped, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />(Name Typed, Printed or Sta.ped)
<br />NOTARY PUBLIC
<br />
<br />"""'\~"""" R. ~rk Willett
<br />f:frA.f.~% MY COMMISSION # 00262312 EXPIRES
<br />~~.~.~.f December 8, 2007
<br />..t.i".....~.. BONDEDTHRU TROY FAIN 1NSU!lANC~ INC.
<br />"'Ilftt~\'"
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