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<br />A. NOflCE or DtiD RtSTRICTIONS
<br />The W1O,eu1gned u.ndlluta.nCU thOlt thil permit uy be .\Il)ject to "deed rutrict1on:s" which
<br />m~ be more r.'triot1ve th.nCity requletion,. fhe undersigned aa8~e. re.pone~bility tor
<br />conpli.nce with any applicLblll deed re.triction,~
<br />a, lIllLICENSED CONTRACTORS ~D CONTRACTOR RESPOtISI8ILI'I'I!S
<br />It tn. ololn.r hu hired.. contractor or c:ontraotora to underteke work, 'thllY IUY be required
<br />to be 11cenaed in accordanoe with .tate end loc:~l regulation.. If the contractor i. not
<br />lioen.ed .. required by llw, both the owner and oontractor IUY bll cited for a aisdemeanor
<br />viol'tion under .tate law. If th,'own.r or intend.d contractor are uncertain a. to what
<br />11cenlin9 requirements may apply for the intended work, they are advised to contact the
<br />C1ty ot Zephyrhill. Building Department, 813-780-0020.
<br />rurthernore, if the owner hae hired I COntraotor or contractor., hll i. advi.ed to havll the
<br />contrectorl5) sign po~tion:s of the, ~Contraotor 811otion.M of thi. app110ation tOr which they
<br />will be responsible. It you, a. the owner 'iqne a. the oontraotor, ydu are ind1cating that
<br />you, r.ther than the contr.ctor, ar. re'ponlible tor the work. ,If thll contractor wishes
<br />you to .ign .. contr.ctor th.t ..y be'an in410<<~1on that'he 1. not proper!y lio.n.ed and 1s
<br />not entitled to permitting prlvilege. in the City or Zephyrh1l1..
<br />C, TIVJoISPORT"TION II1PACT rEES AND DTILIT't CONNECTION rEU
<br />0, CONSrRDCTUIOH I.It~ t.AW (CtiAPTtk 11-3, I'LOP.IDA STATUTtS, M AMENDED)
<br />I oertiry that I, the Jpplicant, h~ye b..n prOVided with a copy 'of ftFlorida'. Conatruction
<br />lien Law - Homeowner/.,Protection Quide" prepared by the Flori~ Department of Agrioulture
<br />.nd Con'URer T\f!dr., If the ..ppl1cant 11 'OIUone other that tl)s ~own.r", I cerity that I
<br />have obtained · COpy ot ~he above de.oribed document and proal.e in good raith to deliver
<br />1t to the "owner" prior to COMenO_nt.
<br />E, COWTRACTOR'S/OHHER'S ArFIDAVIT
<br />I certity that all the Information in thi. application is sccurate and 'that all work ~111
<br />be done In co~li&nc. with all applioable law. regulsting con.tr~otion, zonino, and land
<br />developnent.
<br />Appli~atlon 1. hereby made to obtain a pernit to do work and in,tali.tion a8 indio.tlld. I
<br />Certity that no work or in.tallation ha, oomq.noed prior to i,auanoe of a permit &nd that
<br />all WQrk 14'111 be plilrt'ormqd to m..t .ta,nd.rd. of all law. nqillat1nq construction, City
<br />codes, zoninq regulations, and land' d.....loPIMnt raqulations in the jurhc1.1otion. I aha
<br />certity thlt I under:stlnd that the reOulationl at' other qove~ntal ag.noi" ~y apply to
<br />the intended WOrk. and that it i. my re.pon.ibility to identity wn.t aotion. I muat take to
<br />be in co~li.nQe. Such agencie. 1nclude but are not limited to: -o.partm.nt of
<br />Enviro~entOll Regul.tion-Cyprg$& I.yhead., Wetl.nd "rea. and Environaentally Sen:sitlve
<br />Landa, W.tar/W.stewater rreatment
<br />'Southwe.t ,lorid. W..tei ~.n49eaent Di.trict-Wells, Cypre,s Sayhead:s, Wetland T\z,a.,
<br />Alterino Watercour,e,
<br />..\nty Corps of &ng1J\eer:s-Seaw..lla, DoCk., 'Navigable Watllrwaye ,
<br />'Department ot K.alth ~ Rehabilitati.ll Servicea, Environmental Health Dnit-Wells,
<br />w..tew.ter Treltaent, Septic rinks
<br />'U,S, Lnvironaent.l ~rotection Aqency-A:sbesto:s abate.en~
<br />I also certify th..t, if fill ~torial i. to b. u.ed 1n Flood Zone "AN Or ~A,etc.N, 1t i.
<br />understood that a drainage plln addre.11no a .oo~en'lIting yolume" will bt '~tted which
<br />1. prepared by a prote..ional engineer reoi'tered in the State ot rlorida pr10r to permit
<br />luuance,
<br />A pe~t issued shall'be construed to be a lie.n., to proceed with the work and not as
<br />.utnority to violate, cancel, a,lter, or lilt lIid., any provisions ot tile technical Cad",
<br />nor .hall i:ssuance ot .. permit prevent ths 8u1la1nq ~tr10ial trom tller.att.r requ1ring a
<br />correctlon oC errors in plans, OOnltruotion, or, violation, ot any cod.. Every pernit
<br />1.,ued shall bec~ invalid unle., the work authorlZed by ,uoh permit i. conmeno.d within
<br />.~x ~nth. oC i'.uanee, or it wort .uthori~ad by the pernit 1. .usp.nded or abandoned rorla
<br />p..1od of six IIonthl .fter the ti.Jll',th. work 11 conaenced. One 90 "day elltension of tillS
<br />may be allowed tor the permit with tee charge ot $15.00. The extension ,nall be reque:sted
<br />~n writlnq to'the Building Ottioial. An approv.d 1n.pection mu.t be 109ged dur~ng each six
<br />/lonth period, or the pro}ect wil! be oOn.idered abandon.d.
<br />lfl'.ANING 'l'O OWNER: YOOR l'l'.ILORE TO JU:CO~O A N01'1C& or llCtHlINT HAY Il2SULT ni YOUII
<br />PAYtNG TWICE roll. tNPROVEHENTS TO'YOOR PROPERTY. IF Y U I END TO OBTAIN FINANCING, CONSULT
<br />WITH YOUR LENDER OR ~ ArrDRH uroRJ: RECORDING YOU lIO'I'I E or COHHENCUfEN'I'. JOB'S UNDeR
<br />", 00 " 'ALOE 00 ""''' T ....., , " . .., '''' _'"~. TN . '/; ,'..
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<br />8 IGNATURE I CONTRACTOR (J'
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<br />STATE or f1..ORlDA OA -:':> C- U
<br />COUNT\' or ,
<br />Th. toregoing in.tr~ent wa ackryo~
<br />8efore DIe thi,' )I. of
<br />by ,
<br />(n... ot per,on aoknowl.dged)
<br />~ho 1a p.rsonally known to me, or
<br />
<br />~ho hu produo,d C'- \:>!2.U LL u.. ~
<br />i>ype ot identi!ication)
<br />and who Odld I9!Id not take an Olth
<br />
<br />~.. . ro.r-. ~~
<br />Signature of peraon tating aoknowlod~ent
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<br />II ....
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<br />" ~ _ n ~l · UJDrf''bD609664
<br />..- OmllllSSlO
<br />!~ Expires October 29,2010
<br />....... "'" ~.'" , IftlllliIlil, IRE .'."1'
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