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<br />MAR/07/200S/NON 09: 17 AM ZEPBYRHILLS BUILDING
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<br />FAX No, 813-780-Q021
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<br />P. C02
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<br />~.: ~orl~t OF DEBD RESTRICTIONS
<br />The undersigned unclerstaRds that tiU.. perai.t ally b. Ilub:le~t to "deed r."'triot.i.ons" which
<br />miy b. more re,trlctiVQ than City reOUlatiohs. The undera1qned assumes reaponsibility,tor
<br />cOIIpliaN:lIl with any appiicabl. deed reatl'J,citiollll: i
<br />B. UNLICENSED CONTRACTORS .AND CONTRACTOlt lE3POWsaUITlltS. . f
<br />It. t .he owner hall hired.. contrac. tor or contJ:aot;on' to UIldeJ:talc. work, . they _y be requj. ed
<br />to be lleenaea in acoordance with atate and.loeal r.gulations, J~ the aantractor 18.no
<br />lieen..d as ~squired ~y law. both the own.r and contractor ~aY'b. clte~ ~oJ: a ~isd8Ne~ r
<br />viOl~tion und.r state law. I~ the Owner or inteDdad contractor are uncertain .. to wha
<br />licensing r.quir.~ts may apply i~ the intende~ wort, they are advi.ed to OOntact the
<br />City ot Z.phyrhill. 8ullQing D.partment, B13-180-0020.
<br />Further"ore,. it' the owner has hired a ccmtractla' or con tract oz:e, b. 16 a.;r...i.c-.;l ~o have ~h.
<br />Contractor I S'. e1~ po~t:i.o"s of thll... 'contraCJt.o r sec. tiohe.... o~ th:l.. appllc.tJ.on for WhiCh. h.y
<br />will be reaponsib~e. If YOU, a. the owner lign. .c the con~ractor, you aJ:e indicating bat
<br />you, nt.her than the contractor, are responsible for the worle. .If tM contracto!; N1ahe
<br />you to aiqn a3 contractor that may be an lnd10ceiaa that he i.. net properly lioen'ed an i.
<br />not entiUed to permit.ting privileges in the City o~ kphyrh.il1s. .
<br />C: '1'AANSI'ORJATION IMPJlCT !'B!3 All1D UTILITY Cotl1l!:CTION Fbs I
<br />D. CDNS'I'RlJC1'OIOlf tIEM lAW (CIlAP1'Ea713, FLORIDA STATU:n:s,: AS Altl:NDKDI . ,
<br />I certity that I, the appl:l.c.n~, ba,e been prOVided with a copy 'Of ~~lorida'. Ccnatructi~n
<br />lien ~.w - Rom.owner'. . Protection Guide" .prepared by the Florida Departaent at Agr1cUltut.
<br />and Ccns~r Affairs. I~ the apPlicant i. eomeone other that the ~owner~, I.eerity thatlI
<br />have Obtatned a COPY' of the aho.. described doouaent .nd PJ:omiee in qood faith to del~ve~
<br />it .to tho "o"nerN prior to 9oanencen.nt"1 I
<br />!:. CONTRActOR' S/Olil!Q:p" S AFFIDAVIT '.
<br />I Certify that all tne informatloQ in thia applioation i. accurate and that all work Wil,
<br />be done in oompllance witb all applioable lawe requlating constructio~, zoning, and land
<br />cievelOPlllent.. .
<br />Application i. hereby made to obtain a permi~ to do work and installation 8. indicated. r
<br />oartiEy that. no .work or ineta~l.tlon has c~'need prlor to i.auance 4f a permit and that
<br />all Nork "li! be performed to meat standards ot all laws regUlating. construction, City
<br />cOdea, zoninq regulation., and lend develOPMent requlationa in the jurisdiction.. I eleo I
<br />certifY. that 1 .Under8t.n~ thAt the regUlations Of other qovernaental Aqenciee aay apply t
<br />the intended Hark, and that it 1& my ra,p~nelbility to identify what ~etlons r ~ust tske 0
<br />be In comp~ianc.. fucn aganoie. include but are not limited to: .Oepart.ent or
<br />Cnvironmental ftequlation-CYPre.a Bayheada, Hetland Areas and EnVironmentally Senaitive
<br />Land., ~ater/~ast.wate~ T~8atment . I
<br />-Southwest Florida Water Management District-Welle, Cypress .aYhBad8, WetlaDd Areas, I
<br />Al~ering Watereour.as . . . .
<br />*~nny Corp" of EngineerS-Seawalls, Oocles" Navigable' Haterways I
<br />*Oepartmant o~ Health , ftehaOilitative Servic.., EnViro~sntal K~alth on1t-Wal~~,
<br />Naattewater Treatment, Septio Tank.s '.. .
<br />.U.~. EnVironmental fJ:otectiori AgenOY-ASbesto" abatoeont I
<br />I also o.ztiry Ulat. if iill Illater.1al Jo. to b. Il_d in Fload Zane "A" or "A.ate.H, .1"t is
<br />~nderstoOd that a drainage plan addre.ainq . ~Co~en~tingYolUNeN will be a~itted whichl
<br />is prepared by a profe.aional enqineer raqistered in the State of rloxlda pcio~ to per~t
<br />i..ssuancfI. .
<br />A permit iSsued shall b. done trued to 08 . 110eo.. to proceed with the work and not as
<br />authority to uiolato, cancel, alter, or Set aside. any prov1810ns of the technioal cOdes, I
<br />nor ahall issuance ot a per.~t prevent the Bu11d~q Official tr~ there.~ter r.quiring a
<br />correCtion of ertors in Plana, . COlllJtrucuori, or Violation. of any cOdo. Every p8rlUt . ~
<br />iSSUed shall become inva~id unloa~ th._ work authorized by 8Uch perait is ac~nCed Within
<br />six ~nths ot iaauanee. Qr it work autho~~zed by the permit i. sUspended or abandoned ror'
<br />p8r:l.'?d ot 8I1x IIOlIthe aZtel: the tim. the work 1. cO.Inenced. On. 90 day -teneion o~ ti... i
<br />may b. allo..ed for the' pernl1.t with te. abarge of ~lS, 00. The exte4s1on .1I..ll be requested I
<br />in writ1.ng to'the 8uilding Officiel, An .,pproved inspection llIust be lOlll1ed during each a1~
<br />month periOd. or the project will be COnsidered abandOned.
<br />WAIUIING TO OWN!:R: 'fOlia riuLORR TO RECORD Jl. HOTZC! OF COMIfI:NCtMgt .~" RI:SUI.'1' IN' '(OOll .
<br />PAYING TWICE roll.' IHPRO'lDJEN'l'S 'XO ~Ol1R l'RoP8RtX. IF YOU IlI'1'I:NO TO OBTAIN FINANcrNG, CONSun
<br />WITH YOUR LENDER OR AN l\"roRNEY 8EFOR& RilCOlWrNG YOUR Norlce OJ' COMHItNCP.MEIiI'l'. JOB's [JIiIDE!\
<br />$2,500 Ul VJU;.UI: 00 NOT lfaD TO lIECORO 'AND POST A "NOTICE or CO*Il~CE;IO:NT".
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<br />SIGlUlTUIlE:
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<br />OWNER 01 AGE>>'!'
<br />
<br />SIGlJAt'tiUr
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<br />COIfTftACTOI.
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<br />STA'l'E OF FLORI M
<br />COUN!t'Y OF'
<br />The foregOing 1natl'UI1ent was 'clcno..~edqed
<br />lIetorR Ille thi,s ___ day of " ::lL
<br />'by
<br />In.~e' ot p.rson ~cknowledQed'
<br />[J "ho .1. personally known to .e, . or
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<br />a who has produced
<br />!type of identification)
<br />and wJioO did 0 d.1.d no t t.ke an OAth.
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<br />STAtE OW FLORIDA
<br />CODN'l"r Or .
<br />.The toregoing instrllllent _. llCknOWledged
<br />lIefore lIl8. thJ.. ----slay ot . 20_
<br />by .
<br />(nUle or parson acknowJ.8Ciqacll
<br />Oho is llaJ:8onaUy !cno'.m to 11\8. 0"
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<br />a who ~. produceci'
<br />. (type Of lc1ent1.t1caUon)
<br />~id 'not take en oatll
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<br />and who OdJ.d
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<br />Signature of p.r.on taking ackhowledqeaent
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<br />Name tYPed, pr~n~.d Or stamped
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<br />Sitinature 0: Pusan tald.l1lI acknow.1.dg_nt
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<br />II.... typed, prJnted or etllmped
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<br />Wl::jvE:Ol SOOZ 61 ~dl::j
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