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<br />STATE OF FLORID
<br />COUNTY OF
<br />The foregoing ilst,rument ~dgfl\)
<br />Before me this~ day 0 .' , 2~
<br />by
<br />(name of person acknowledged)
<br />Owho is personally known to me, or
<br />
<br />!iJ..;;lho has produced\N~~~~O
<br />(type of id' )
<br />not take
<br />
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned understands that this permit may be Subject to "deed restrictionsH which
<br />may be more restrictive than City regulations. The undersigned assumes responsibility for
<br />compliance with any applicable deed restrictions.
<br />B. UNLICENSED CONTRACTORS 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 accordance with state and local regulations. If the contractor is not
<br />licensed as required by law, both the Owner and contractor may be cited for a misdemeanor
<br />violation under state law. If the owner or intended contractor are uncertain as to what
<br />licensing requirements may apply for the i~tended work, they are advised to contact the
<br />City of Zephyrhills Building 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 portions of the "Contraetor SectionsH of this application for which they
<br />will be responsible. If you, as the 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 may be an indication that he is not properly licensed and is
<br />not entitled to permitting priVileges in the City of Zephyrhil1s.
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that T, the applicant, have been provided with a copy of "Florida's Construction
<br />lien Law - Homeowner's Protection GuideH prepared by the Florida Department of Agriculture
<br />and Consumer Affairs. If the applicant is someone other that the "ownerH, I cerify that I
<br />have obtained a copy of the above described document and promise in good faith to deliver
<br />it to the "ownerH prior to commencement.
<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 in compliance with all applicable laws regulating construction, zoning, and land
<br />development.
<br />Application is hereby made to obtain a permit to do work and installation as indicated. I
<br />certify that no work or installation has Commenced prior to issuance of a permit and that
<br />all work will be performed to meet standards of all laws regulating construction, City
<br />codes, zoning regulations, and land development regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other governmental agencies may apply to
<br />the intended work, and that it is my responsibility to identify what actions I must take to
<br />be in compliance. Such agencies include but are not limited to: *Department of
<br />Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
<br />Lands, Water/Wastewater Treatment
<br />.Southwest Florida Water Management 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 Tanks
<br />*U.S. Environmental Protection Agency-Asbestos abatement
<br />I also certify that, if fill material is to be used in Flood Zone "AH or "A,etc.H, it is
<br />understood that a drainage plan addressing a "compensating volumeH will be submitted which
<br />is prepared by a professional engineer registered in the State of Florida prior to permit
<br />issuance.
<br />A permit issued shall be construed 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 prevent the Suilding Official from thereafter requiring a
<br />correction of errors in plans, construction, 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 time the work is commenced. One 90 day extension of time
<br />may be allowed for the permit with fee char~e of $15.00. The extension shall be requested
<br />in writing to the Building Official. An approved inspection must be logged during each six
<br />month period, or the project will be consid~red abandoned.
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
<br />PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
<br />
<br />
<br />S~~~"D TO ",CO'D AND MST A .NOnc~zs~ )
<br />
<br />~ATURE: OWNER OR AGENT SIGNATUR: CONTRACTOR .
<br />
<br />STATE OF FLORIDA i~' '{. ~ '
<br />COUNTY OF t::::::
<br />The foregoin? iniwument ~ flI~i~gedD
<br />Before me th1s -..Ut.-Pay o~\ 20_
<br />by _
<br />./ (name of person acknowledged)
<br />~ho is personally known to me, or
<br />
<br />
<br />
<br />Owho
<br />
<br />acknowledgement
<br />
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<br />a
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