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<br />V,j/U~/LUUi/reu~ U4:UO rM ltrtll~tljLL~ BuILVINL
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<br />FAX No, 813-780-0021
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<br />p, 002
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<br />A, NOT1CE OF OttO RtSTRICTIONS
<br />ThQ undersigned understands that this permit IIlaY be subject to "deed restrictions" which
<br />may b9 more restrictive than City regulations, The underSigned assumes respon8~bility for
<br />cORpliance with any applicable deed restrictions.
<br />B, !.lNLICEN9ED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />It the owner has hired a contractor ot contractcre to undertake work, 'they may be required
<br />to be licensed in accordance with state and local regulation.. If the contractor i. not
<br />lioensed as required by law, both the owner and contractor may be cited for a a1sdemeanor
<br />violation under .tate law. If the 'owner or intended contractor are uncertain ae to what
<br />licensing requiremants may apply for the intended work, they ere adyised to contect the
<br />City of Zephyrhills Building Department, 813-780-0020,
<br />Furthenuore, if the owner haa hired a contraotor or contractors, he is advised to have the
<br />contractorls) sign pOrtions ot the ~Contractor Sectiona* of this application for which they
<br />will be responsible, It you, as the owner signa a. the contractor, you ere indicating thAt
<br />you, rather than the contractor, are responsible for the work. ,If the contrActor wishes
<br />you to .1gn.. contractor th~t may bean ind1oa~ion that'he is not properly licenSed and is
<br />not entitled to permitting privileges in the City or Zephyrhills.
<br />C, TRANSPORTATION IMPACT r~ES AND CTILITY CONNECTION FEES
<br />D. CONSTRCCTUION LIE:N LAW (CIiAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applic~nt, haye been provided with a copy 'of -Flor1da'. Construction
<br />lien Law - Ho~eowner's'Protectlon Guide" prepared by the rlorid4 Department of Agrioulture
<br />and Con"uner Affair", If the applicant 18 sOllUlone other that the ~owner", I cerity that I
<br />have obtained a copy of the above desoribed document and promi.s in good taith to deliver
<br />it to the -owner" prior to cOllll1lencement.
<br />E.. CONTRACTOR' S/OWNER' S AFFIDAVIT
<br />I certify that all the information in this application is accurate and that all work will
<br />be done 1n co~li&nce with all applicable law" regulating conatruotion, zoning, ana land
<br />developruent,
<br />Appliqation is hareby made to obtain a pernit to do work and instaliation a. indioated. I
<br />Certify that no work or in.tallation haa comnanced prior to isauahoe of a permit and that
<br />all work will be p~rformed to meet etandarde of all laws regulating construction, City
<br />codes, %oninq regulation", IUld land denloPIMrit regulations in the jur18C1iction. I also
<br />certify that I understand that the reOUlation. Of other governmental agencie. may apply to
<br />tha intended work, and that it 1s my re8Ponsibility to ident1ty wnat actione I must take to
<br />be in compliance. Such agencies include but are not limited to: *Department of
<br />EnVironmental Requlation-CyprQSs Bayheads, Wetland Area. and EnVironmentally Sens1tive
<br />Lands, Water/Wastewater Treatment
<br />.Southwest florida Water Management District-Wells, Cypress Bayheads, Wetland Azeas,
<br />Altering Watercourses
<br />"~y Corps of &ngineers-Seawalls, Docke, Navigable Waterways
<br />"Department ot Health. Rehabilitative Service., Environmental Health Cnit-Wells,
<br />Wastewater Treatment, Septic Tanks
<br />'0,9. ~nvironaental ~rotection Agency-Asbestos abatement
<br />I also certify thst, if fill material 1e to be used in Flood Zone -A" or ~A,etc.", it is
<br />understood that a drainage plan addresa1ng a .OOmpen.~ting volume" will be submitted which
<br />1a preperea by a protessional engineer registered in the State of Florida prior to permit
<br />issuance,
<br />A permit issued shall be construed to be a licen.e to proceed with the work and not as
<br />authority to violate, cancel, a,lter, or .et a.ide any proyisions ot the technical codes,
<br />nor shall issuance ot a permit prevent the Building Official trom thereatter requiring a
<br />correction or errors in plans, construotion, or violation. ot any code. ~very pernit
<br />issued shall became invalid unless the work authorlzed by such permit 1s commenoed within
<br />.Lx months of 1s8uance, or it work authori~ed by the permit i. suspended or abandoned for 'a
<br />period of six ~onths after the t~e the work i. COhMenced. One 90'-day extension of time
<br />mAy be allow.d tor the permit with fee charge of $15.00. The extension shall be requested
<br />in wr1t1nq to'tha B~lding Otticial. An approved in8pection must be logged durinq each six
<br />month period, or the project will be cOn.idered abandoned.
<br />WAJl.NING TO OWN~R: YOCR !7.ILOR! TO kECOao A NOTICE or C~NC!:H!:NT HAV RESULT IN YOUII
<br />PAYING TWICE FOR IN~ROVEHENTS TO'YOOll PROPERTY. Ir VOU INTEND TO OBTAIN rINANCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE or COMMENCEMENT. JOB'S UNDER
<br />$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A ~NOTICt OF COHMENCENENT".
<br />
<br />SIGNATURE i OWN~R OR AGENT
<br />
<br />SIGNATURE I CONTRACTOR
<br />
<br />STATE or rLORIDA
<br />COON'H or
<br />The toreqoinq instrunent wa"
<br />aefore lI>e this _ day ot
<br />by
<br />
<br />acknowledged
<br />,2L
<br />
<br />STATE or FLORIDA
<br />COUNTy or
<br />The toregoing instrument was
<br />Before me this ----...day of
<br />by
<br />
<br />acJcnowledged
<br />,20_
<br />
<br />(name ot person acknOwledged)
<br />o who is personally known to lie, or
<br />
<br />o who has produced
<br />(type of identification)
<br />and wlioO did Odid not t~x...an oath.
<br />
<br />(n~ at per eon acknowledged)
<br />~ho ie personally known to me, or
<br />
<br />o who has produoed
<br />(type of identification)
<br />and who Odid D:lid not take an oatil
<br />
<br />Signature ot person taking acknowledge.ent
<br />
<br />Signature of peraon taking acknowled~ent
<br />
<br />NamQ typed, printed or ~tamped
<br />
<br />Nama typed, printed or etamped
<br />
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