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<br />I I'
<br />CONDITIONS OF PEI~IT AFFIDAVIT
<br />A., NOTICE OF DEED RESTRICTIONS
<br />The undersigned 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 />compiiance with any applicable deed restrictions.
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner has hired a contra9tor or contractors to undertake work, they ~ay be required
<br />to be licensed in accordance wit~ state and local regulations. If the contractor is not
<br />licensed as required by law, bot~ the owner and contractor may be cited for a misdemeanor
<br />violation under state law. If t~E~ owner or intended contractor are uncertain as to what'
<br />licensing requirements may apply for the intended work, they are advised to contact the
<br />City of Zephyrhills Building Department, 813-788-661l.
<br />Furthermore, if the owner has hi~ed a contractor or contractors, he is advised to have the
<br />contractor(s) sign portions of t~e "Contractor Sections" of this application for which they
<br />will be r~sponsible. If you, aSlthe owner signs as the contractor, you are indicating that
<br />you, rather than the contractor, are responsible for the work. If the contractor wishes
<br />you to sign as contractor that uy be an indication that he is not properly licensed and is
<br />not entitled to permitting privi eges in the City of Zephyrhills.
<br />C. TRANSPORTATION IMPACT FEES D UTILITY CONNECTION FEES
<br />D. CONSTRUCTUION LIEN LAW (CHAP ER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, Ihave been provided with a copy of "Florida's Construction
<br />lien Law - Homeowner's Protectio Guide" prepared by the Florida Department of Agriculture
<br />and Consumer Affairs. If the ap licant is someone other that the "owner", I cerify that I
<br />have obtained a copy of the abov described document and promise in good faith to deliver
<br />it to the "owner" prior to comme cement.
<br />E. CONTRACTOR' S/OWNER' S AFFIDAVI
<br />I certify that all the informatio in this application is accurate and that all work will
<br />be done in compliance with all ap~licable laws regulating construction, zoning, and land
<br />development.
<br />Application is hereby made to obt~in a permit to do work and installation as indicated. I
<br />certify that no work or installat~on has commenced prior to issuance of a permit and that
<br />all work will be performed to mee standards of all laws regulating construction, City
<br />codes, zoning regulations, and la d development regulations in the jurisdiction. I also
<br />certify that I understand that th regulations of other governmental agencies may apply to
<br />the intended work, and that it is UIY responsibility to identify what actions I must take to
<br />be in compliance. Such agencies nclude but are not limited to: *Department of
<br />Environmental RegUlation-Cypress ayheads, Wetland Areas and Environmentally Sensitive
<br />Lands, Water/Wastewater Treatment:
<br />*Southwest Florida Water Manageme~t District-Wells, Cypress Bayheads, Wetland Areas,
<br />Altering Watercourses
<br />*Army Corps of Engineers-Seawalls~ Docks, Navigable Waterways
<br />*Department of Health & Rehabilitative SerVices, Environmental Health Unit-Wells,
<br />Wastewater Treatment, Septic Tank~
<br />*U.S. Environmental Protection Ag ncy-Asbestos abatement .
<br />I also certify that, if fill mate ial is to be used in Flood Zone "A" or "A, etc.", it is :
<br />understood that a drainage plan a dressing a "compensating volume" will be submitted which
<br />is prepared by a professional eng~neer registered in the State of Florida prior to'permit
<br />. ,
<br />l.ssuance.
<br />A permit issued shall be construe 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 pre ent the Building Official from thereafter requiring a
<br />correction of errors in plans, con truction, 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 tim the work 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 writing to the Building Officia An approved inspection must be logged during each six
<br />month period, or the project will e considered abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
<br />PAYING TWICE FOR IMPROVEMENTS TO Y UR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY BE ORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
<br />$2,500 IN VALUE DO NOT NEED TO REC RD AND POST A "NOTICE OF COMMENC ENT".
<br />
<br />SIGNATURE: OWNER OR AGENT
<br />
<br />SIGNATURE:
<br />
<br />
<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument was
<br />Before me this _ day of
<br />by
<br />
<br />of identif'cation)
<br />take an oa h.
<br />
<br />
<br />STATE OF FLORID~ U
<br />COUNTY OF \ (\~ "S
<br />The foregoing instrument was~ac4nowledged .
<br />Before me this J,Lday of L C , )AC S-
<br />by .d/IN <fP?..u~
<br />~ (name of person acknowledged)
<br />~ is personally known to me, or
<br />
<br />,
<br />'.
<br />
<br />(name of person acknowledged)
<br />Owho is personally known to me,
<br />
<br />ackno ledged
<br />, 19_
<br />
<br />o who has produced
<br />(type
<br />and whoO did Odid not
<br />
<br />o who has produced
<br />(type of identification)
<br />and who Odid DUd not take an oath
<br />
<br />~ Jw~ m lY).4LL/-6
<br />Signature of person taking acknowledgment
<br />
<br />Signature of person taking acknowle
<br />
<br />Name typed, printed or stamped
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<br />
<br />~"~. tI_1f/\DE
<br />.cd' 1\ F!<':rlda Name typed, printed
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<br />or straniiJ'~ M. M~AD[ .
<br />N"t~"v ()u[)lic, State 01 Florida
<br />~"', . (H 5 "007
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