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<br />~!jl}./W2['J5!THU 08 22 A!! ZEPHYIlHILLS fiI[LD[~
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<br />PAl P!. e'3 .78~-002!
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<br />t i)('11")
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<br />A. NOTICE or DEED ~ESTRICT!ONS
<br />Th" under.siqned underet9Jl.d8 that this pe:nnit may be subj ect to "d..ed restrictions" which
<br />~~y be ~~re restrictive than. City requ!atione. The undersi~~ec ~;sumes responsibility tor
<br />complia:nce with an}' applicable d>~ed restri.ctions',
<br />a. ilNLrcENsED COlfl'AACtORS AND CONTRACTOR RESI?ON.3IBIr.!Tlf:S
<br />It the owner has hir~d a contract.or or contr,otors to underta.<e w.;rk. they lIlay be required
<br />to te licensed in ..ccordance with state and. local re9ullltions. I;: the contractor is no.t
<br />licensed a. requir~d by law, bot~ the owner and ccntractor may be cited for e misdemeanor
<br />violation under st..te law. It the owner or intended contuctor a;:e ur.cll:::tain as to what
<br />licensinq requi:::e.""nts may apply to!: the intended l<ork, they are ;,d-,ised to contact the
<br />City of Zephyrhille Buildinq Department, 813-750-0020.
<br />Furtller:nOre, if thE- o-omer hall hi:::e(l e contraotor or contractors, he ill edviaed to have the
<br />contr~ctor(el 8i9~ po~~ions of the "Contractor Sections. of this ;~pplication for which they
<br />will be respons~bl!,. It you, as the owner si9I\8 as the oontr3Cto::, you are indicating that
<br />y.ou, rath.." than the contractor, are responsible for the work. .Il the contractor wi.."""
<br />ycu to sign as contractor that ll\o~y be an indication that he is no'; properly licensed. and. ill
<br />not ~nti tlsd to permitting pri vilegllliS in the. City ot Zephyr hills .
<br />c: TRANSPORTATION IM~ACT FE~S K~O OTILITY CONNtCTICN FEES
<br />~. CONSTRUCTOION LIEN LAtI (CBAPTER 713, FLORIDA STATuTES, AS lIME1WED)
<br />I oertify that I, the applicant, hare been provided with a copy'of "Florida's Construction
<br />lien LaW' - Homeown.,r's .Protlllctio,", GuideH prepared by thE! Florida )eJlart~".ent cf A';/riculture
<br />and Consumer Att:aJ.l's. It the applicant is someone other that tl:e "owner", :. cer:.!y that I
<br />ha'l'e obtained a co~,y cf the abo\7.; /iesoribec1 document and promise in good faith to d"l~ve:::
<br />it to the "owner" prior ':0 cOllllIIencemen'::..
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certHy that all the informatic.n in this application. ill accurat'~ and that ~ll work will
<br />be done ir. compliarccll with ali al?plicable l~w" requlatlnq constru.,tion, 2onlng, e.n\! lar.d
<br />development.
<br />Application is herN:lY made to obtdn a perlllit to do wark and inst.uiation as indioated. I
<br />certity that no wOI:k or in.5tallation hea cOllllllenced prio::: to i"sua:1ce ct il permit and that
<br />all work will be performed to me.t standards ot all laws regulati::.g construction, City
<br />codell, zoning regulations, snd hncl development regulations in th.~ juris.diction.. r also
<br />certify that I.undHstarld that t',e regulations of other govern.'Uen.~al agendes !ray apply to
<br />the intended work, and that it is my responsibility to identify W::)at action:! I must take to
<br />be in c~lisnc". Suoh agencies include but are not li~tQd to: 'Department of
<br />Enviror~sntal Re~Jlat1on-Cypress Bayheads, ~etland A:::eas and Envi~Qn.~ntally Sensitive
<br />Lan\!s, Water/Wastewate::: Treatment
<br />.Southwest ~lorida Watet Manage~ant Oistriot-Wellll, Cypress Bayhe.cts, Wetl~nd Ar~as,
<br />Alter~ng Watercourse~
<br />.Army Corps of Engineers-Seawall" Dockll, Naviqable Waterways
<br />.Departmsnt of Health & aehabilitstivQ Services, Environmental He.lth Unit-Well",
<br />Wa.5tewater Treatment, Septio Tanks
<br />· O. S. E:nvironmentel Protllotiort A9-ency-Asbestos abatement
<br />r a.150 cartlty that:, if fill mat.arial is' to be used in !'lood Zone "A" or "I\,eto.", .it 1"
<br />understood that a drainage plan ,llddressing a "co!ilpensatinq I'Oll.lll'.e" will be aubmitted woiol1
<br />is t;repared by 3. prOfessional en;rineer re<;/isteriid in the State of E'lorida prior to permit
<br />
<br />i~suance.
<br />
<br />
<br />.be .construedto be a lioens.. to proceed wit.~ the work a.nd not as
<br />cancel, alter, or set aside. any p:ovisions Jt the technical codes,
<br />
<br />Sl'ATE OF FLORIDA
<br />COUNty or
<br />The foregoing inscrumant was acknowledged
<br />Before me this ~ day of -'---_, 2U--
<br />by
<br />....nL (name of per:!,m acknowledge'1l
<br />~WhO i~ pereonally known to me, or
<br />
<br />Owho hall produced
<br />(type of identification)
<br />1d not take an oatb.
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />.The fore<;/oing instrument wa"
<br />Before me. this _-J1eY of
<br />by
<br />
<br />acknowledged
<br />, 20
<br />
<br />)l~o
<br />
<br />(name of perllon acknowledged)
<br />is per.5onalLy known to ~e, or
<br />
<br />
<br />rson taking a!,knoi<lled9elDent
<br />
<br />
<br />aking acknowledgment
<br />
<br />. Sig'nature 0
<br />
<br />Pd~ ~4!II~1~ ~1tIH8n(l
<br />. . My CommlS8lon 00129893
<br />~ 01 ~ Expire~ June 30. 2000
<br />
<br />NlUIle typed,
<br />
<br />Na.... typ..d,
<br />
<br />pr1nt..d..if~taQ1Ii'_'~d .
<br />F:..."" vlrglma l McCIe/tand
<br />. ,'I; My~00129893
<br />01' Expires June 30, ~
<br />
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