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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTR]CTIONS
<br />The undersigned understands that this permit may be subject to "deed restrictions" which
<br />may be more restrictive ~han City regulations. The undersigned assumes responsibility for
<br />compliance with any appl~cable deed restrictions.
<br />B. UNLICENSED CONTRACTO~S 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 accord~nce with state and local regulations. If the contractor is not
<br />licensed as required by w, both the owner and contractor may be cited for a misdemeanor
<br />violation under state la If the owner or intended contractor are uncertain as to what
<br />licensing requirements m y apply for the intended work, they are advised to contact the
<br />City of Zephyrhills Buil ing 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 portio s of the "Contractor Sections" of this application for which they
<br />will be responsible. If ou, as the owner signs as the contractor, you are indicating that
<br />you, rather than the cont actor, are responsible for the work. If the contractor wishes
<br />you to sign as contractor that may be an indication ~hat he is not properly licensed and is
<br />not entitled to permittin privileges in the City of Zephyrhills.
<br />C. TRANSPORTATION IMPACT PEES AND UTILITY CONNECTION FEES
<br />D. CONSTRUCTUION LIEN LA (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the app icant, have been provided with a copy of "Florida's Construction
<br />lien Law - Homeowner's Pr tection Guide" prepared by the Florida Department of Agriculture
<br />and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
<br />have obtained a copy of t e above described document and promise in good faith to deliver
<br />it to the "owner" prior t commencement.
<br />E. CONTRACTOR'S/OWNER'S FFIDAVIT
<br />I certify that all the in ormation in this application is accurate and that all work will
<br />be done in compliance wit all applicable laws regulating construction, zoning, and land
<br />development.
<br />Application is hereby mad
<br />certify that no work or i
<br />all work will be performe
<br />codes, zoning regulations
<br />certify that I understand
<br />the intended work, and th
<br />be in compliance. Such a
<br />Environmental Regulation-
<br />Lands, Water/Wastewater T
<br />*Southwest Florida Water
<br />Altering Watercourses
<br />*Army Corps of Engineers-
<br />*Department of Health' R
<br />Wastewater Treatment, Sep
<br />*U.S. Environmental Prote
<br />I also certify that, if f
<br />understood that a drainag
<br />is prepared by a professi
<br />issuance.
<br />A permit issued shall be
<br />authority to violate, can
<br />nor shall issuance of a p
<br />correction of errors in p
<br />issued shall become inval
<br />six months of issuance, 0
<br />period of six months afte
<br />may be allowed for the pe
<br />in writing to the Buildin
<br />month period, or the proj
<br />WARNING TO OWNER: YOUR F
<br />PAYING TWICE FOR IMPROVEM
<br />WITH YOUR LENDER OR AN AT
<br />$2,500 IN VALUE DO NOT NE
<br />
<br />
<br />SIGNATURE:
<br />
<br />OWNER
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument
<br />Before me this _ day 0
<br />by
<br />(name of person
<br />Owho is personally
<br />
<br />o who has produced
<br />(type
<br />and whoO did Odid not
<br />
<br />I I'
<br />
<br />to obtain a permit to do work and installation as indicated. I
<br />s,tallation has commenced prior to issuance of a permit and that
<br />to meet standards of all laws regulating construction, City
<br />and land development regulations in the jurisdiction. I also
<br />that the regulations of other governmental agencies may apply to
<br />t it is my responsibility to identify what actions I must take to
<br />encies include but are not limited to: *Department of
<br />ypress Bayheads, Wetland Areas and Environmentally Sensitive
<br />elatment
<br />ahagement District-Wells,
<br />
<br />Cypress Bayheads, Wetland Areas,
<br />
<br />eawalls, Docks, Navigable Waterways
<br />hlabilitative Services, Environmental Health Unit-Wells,
<br />it Tanks
<br />tion Agency-Asbestos abatement
<br />11 material is to be used in Flood Zone "A" or "A,etc.", it is
<br />plan addressing a "compensating volume" will be submitted which
<br />nlal engineer registered in the State of Florida prior to permit
<br />
<br />onstrued to be a license to proceed with the work and not as
<br />el, alter, or set aside any provisions of the teChnical codes,
<br />~it prevent the Building Official from thereafter requiring a
<br />ans, construction, or violations of any code. Every permit
<br />d unless the work authorized by such permit is commenced within
<br />~f work authorized by the permit is suspended or abandoned for a
<br />the time the work is commenced. One 90 day extension of time
<br />mit with fee charge of $15.00. The extension shall be requested
<br />Official. An approved inspection must be logged during each six
<br />ct will be considered abandoned.
<br />ILuRE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
<br />NtS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
<br />O~EY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
<br />D TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
<br />
<br />
<br />1i"ll1~ /1 Liha~
<br />
<br />SI ATURE' CONTRACTOR
<br />
<br />~ 0 \ "'"
<br />
<br />as acknowledged
<br />, 2'L-
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing ins~ent was acknow~edged
<br />Before m~ this ~ay' of ()c..~t( , 20 ~
<br />by ~c.~~ \..\\ \\\"'~~
<br />(name of person acknowledged)
<br />~o is personally known to me, or
<br />
<br />o who has produced
<br />(type of identification)
<br />~d not take an oath
<br />
<br />~rf'\ ~
<br />
<br />and who Odid
<br />
<br /><c:Jlli> i'r'\
<br />
<br />Signature of person taking 9cknowledgement
<br />
<br />Name typed, printed or st
<br />
<br />Signature of person taking acknowledgment
<br />
<br />...O"-:'V.':~B(/r, ELLEN ANN ERICKSON
<br />Name ;~PfiMllt:GOOMlaSI~~128
<br />..~" EXPIRES: June 11,2008
<br />4h0F ,,0<1' Bonded Thru Budget Notary Se'lices
<br />
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