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QC;/J4/2004/MON 04:08 PM ZEPHYRHILLS BUILDING FAX No, 813-780-0021 p, 002 A. NOTIC.E 01' Dli:i:D RtSTRIC'fIONS Thll unlier~igned undet'stalld$ that this permit may be subject to "deed restriction~" which may be more restrictive than City requlation~. The under~igned aesumee reeponsibility for co~pliance with any applicabla deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITI!S If the owner has hired a contractor or contraotors to undertake work, 'they may be required to be liceneed in accordanoe with state and local requlations. If the contractor i. not lioensed as required by law, both the owner and oontractor may be cit.d for a misdemeanor violation under atate law. If the'owner or intended oontractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contsct the City of Zephyrhills Building Department, 813-180-0020, Furthermore, if the owner hae hired a contraotor or contractors, he is advised to have the contractor(s) sign po~tions of the "Contractor SeotioneN of this application tOr which they will be responsible. It you. as thll owner siqna as the contractor. you are indicating that you, rather than the contractor, are responsible tor the work. .It the contraotor wishee you to sign as contractor that may be.an indica~ion thet. he is not properly licQnsed and is not entitled to permitting privileges in the City of Zephyrhills. C, TRANSPORT~TION IMPACT FEES AND UTILITY CONNECTION FEES D, CONSTROCTUION LID! LAW (CHAPt'!ll. 713, n.oP.IOA STATUTES. AS ~ENOEO) I ce~tity that I, the ~pplicant, haye been provided with a copy.of ~Florida's Construction lien Law - Homeowner's.protection Guide" prepared by the Florids Department of Agriculture and Consuner "ffairs, If the applicant is eomaonll other that the ~owner", I.cerity that I have obtained a oopy ot the above desoribed document and promise in qood faith to deliver it to the ~owner" prior to cOlllllencement. E. CONT~CTOR'S/OWHER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be dene in compliance with all applioable laws regulating construotion, zoninq, and land developnent. Appliqation is hereby medII to obtain a permit to do work and instaliation as indicated. I certify that no work or installation has oamn_nced prior to i.suahoe ot a permit and that all work will be perto~qd to. m.et standards of all lews regu~ating construction, City codes, zoninQ reQulations, and land develOpl1l8nt regulations in the juri.diotion. I also certify that I understand that the reOUlation. ot othllr governmental agencies may apply to the intended wQrk, and that it is my responsibility to identifY what actions I must take to be in co~pliance. Such agencies include but are not limited to: *Department of Environmental RegUlation-Cypress Bayh.ads, Wetland ~rea8 and i:nvironmentally Sensitive Lands, Water/Wastewater Treatment 'Southwest Florida Water Management District-Welle, Cypress Bayheads. Wetland Areas. Alterinq Watercourees 'Army Corps of Engineers-Seawalle. Docks, Naviqable Waterways 'Department et Health , Rehabilitative Servicee. Environmental Health Unit-Welle, Wastewater Treatment. Septic Tanks *U.S. ~vironaental Protection Agency-Asbestos abatement I also certify that, if fill material ie to be used in Flood tone ~AH or ~A.etc.", it is understood thet a drainage plan adaressing a ~Oe=pena~ting volume" will be submitted which 1s prepared by a protessional engineer registered in the State ot rlorida prior to. permit 1ssuance. " permit issued shall.be construed to. be a license to proceed with the werk and not as authority to violate, cancel, a.lter, or set aside. any previsions of the tochnical codes, nor shall issuanco ot a permit prevent the Buildinq 0'ticia1 from thereafter requiring a correction at errors in plans, construotion. or. violations ot any cod.. !very permit issued shall became invalid unless the work authorized by suoh permit is commenced within six ~nths or issuance. or it work authorized by the permit i8 suspended or abandoned for 'e period of six months after the time. the work is co~onced. One 90 day extension of time may be allowed for the permit with fee charge ot $15.00. The extension shall bll requested 1n writing to 'the Buildin~ Ottioial. An approved inspection must be logged during .ach six month period, or the project will be considered abandoned. WARNING TO ONNER: YOUR rAILUkE TO RECORO A NOTICE 01' COMMENCtMENT HAY RESULT IN YOUR PAYING TWICE FOR INPROVEMEIilTS TO. YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR )IOTICE O. COMMENCEMENT. JOa-S UNDtR $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A ~NOTICE OF COMMENCEMENT". SIGNATURE i OWNi:R OR AGENT SIGNATURE I CONTRACTOR STATE OF FLORIDA COUNTy or The toregoing instrument wae Before me thie --->lay of by STATE or FLORIDA COUNTY OF The toreqeinq instrum.nt was acknowledged Before me this _ day ot . 2L by (name or person acknowledged) Owho 1s personally known to me, or o who. has produced (type of identification) and wtioOdid Odid not take an oath. aclcnow1edged .20_ (name ot person aoknowledged) C1ho is personally known to me; or Owho has produced (type ot idllntification) and who Odid Q:iid not take an oath Signature of person taking acknowledgement Signature of person taking acknowledqnent Name typed, printed or e~amp.d Name tyPed, ~rinted or stamped