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f ` <br /> � COAti?IR`IQHS'4F F8R24IT AFFZDAYiT - � <br /> � ° A. NOTICS OF DEED R$STRICTIONS , . <br /> Tbe andeniqat�naderstao�s thak thie penit rap be eub�ect to'deed cestrictimie'rhicb�be�pra�trlcti�e tLan City <br /> reg�ttatiaos. !be mide�igaed aBSEaea zeagonaibilitl for�plf�aca dtb emI applicable deed zeatt'ictfaaa. <br /> B. UNLICS2i88D COxi'PRACTORS AND CONTRAC'�OR RSSP02�1S�IBII.ITISS <br /> If t6Q 41lLBt L8i h�LE9 8 CoaET8CtOL Oc t:ORttdCtOta ttt UR�EL�!M6Ikr �'Y�Y�3 Yeg�ft�d t0 b!1#t�ltpEd�II i�GIdBIlCB M�th <br /> etate aaa la:al regalatia�. If the contractor is not liceneed ae nqaicW bp la,bot6 the a�mer amd cantractur r�be <br /> dpe�1 for a i�led�eanar violatton cnder etate lar. If tde amer or inteaded ooatractor ara aacertato as to r5at]ia�ui� <br /> requizraeata aap apglp f�tbs iatm�d rark, tbey are advi�]ta contsct#he City af�pbix3�21i Bni2�in9�t. {813) <br /> 786-6611. <br /> Bnrtl�enore. 3f#he t�t has 6irea a c�traetox ar c�►trac�re,he ia adriaed to bare tt�canErac#or{a1 sfga P�xtiaoc fff Lbe <br /> '�aatractor Seetioas'of thie appliwtiac for dii�tLep rIil be rpapoo�ibie. If toa, ae tbe amer dgn ee tbe antaractor, <br /> �on ere i�catiug tbat�, rat6er than tbe contractor, aze respomible far t6e Mpri�. tf the wntractor rd�es qoa to aiqa <br /> as Cnnisact�r tEat�ay be sn iaafcatfon il�t Le fa not pz�erlp 2iceased aa8 is�at�tftlEd to F��9 P���i�s in tbe <br /> Citp oY EepL�Uille. � <br /> C_ TRAIiSFQRTATIOId I1�JPACT �3 AND UTILITY CONHSCTIOIi FESlS <br /> D. CON89.'RUCTION LIBN IaAW (CEAPTBR 713, FLQRIDA STIIT�ITS3, 11S AMEINDED) <br /> I ce�tffi tbat I, tDe applicaat,hare been grctided rith a capp t►f'Plorida's Coosttaetf�t Lim La�t-Ha�aaer's Frotacti�a <br /> GniBe•PnPare�hl t6e FloriBa D�part�at af Egriealtare and C�o�tec lffaiire. If t6e applicaat ir�a�eme otter t6mu tbe <br /> 'orner'. I certit'p thak I have obt�ined a�p of tbe aba�ve describea�t aml pradae in good faith to delira it to t6e <br /> 'CIIIt9T'ptltlX tA CO�ACElRIIt. <br /> E. CONTRACTUR'S/OWNER"B AFF'�DAVZT <br /> i s�rtify t6&t ai2 tba infotsatioa ia tbis agplicatfan ia accurate and that alI rark�ili be dona in capIiaas�rith�II <br /> apgliCable 18�E regutat3n�j CaaettuCH.arl, s�inAr ana IeGd derelOprent. <br /> 1l�pglication is herebr�ade ta obtain a pauit to dn rork aad iastaliatioa as i�idicated. I certifY tha#ao rorY or <br /> iaetaliatfeo L��priar to ietaaace ef a peait a�tbat all�oxk ri12 M perto�dl ta ieat rteadmtda of alI iare <br /> r�alating c�anetroctia�.Citp crodes, :oning regalati�a, aed land deQelop�ent reqolatt�e in tha iuncLdicttoa. I aY�o <br /> certift tLat I�derBtaail that fi6e segnla#ioo�of otber garetntmtal�eaCiea ial appiY to tbe 3ntmdPd�Y, as�t�at it i8 <br /> =p reagonei3rl�ity to ideati$t�t actitme I�asfi tate ta be ia catplianca. 55�c4 agancies iaclt�de bat ac'e not l�ited ta: <br /> k Departaent af�uuviran�ental R ne�lati�-Cpprese Bapheade, Yetlend 1lreafs and Bn�llq Seoeiti�e k'sode, <br /> i�tetjYas�rater lseat�ent <br /> #Southreat�lorida Nater Baaa�eat Diatrict-1ie12s, Cpprt�e 8a�beade. iietland l�ceae. Eiterittg Itateit�oateat <br /> *�r Co�ak 6�ineezs-Sea�alis, Uocke, Navigable Mat�enap� <br /> �D�t oF fleslth i peliabilitetire SetsiceaR B�itocaental 8ealtb Uoit-Mall�, Yaste�ter lnqftxnt,Septic lants <br /> ;t�Bm3tnweataI PmtEction 1lgeac4-,�6be�tos abateaatt F <br /> I also certifq that� if fill�aterial fe ta be ased in Flaod Sane'A'or "A�etc.', it ie unaeceboo�t6at a draiaage p2an <br /> a�reasing e'cnpeasaLl�j toluNe'ri11 6e ea6rittea rbidt ig�by a profeeaicaal engfaeer regLteral ia tise 8tate of <br /> Ftarida prior t�pentit issaanc�. <br /> E pez�it iesaed a6a11 be�straed to be a 11t�aee to ptoceed ritA the+rot�k ar�d not aa�ttazity to Tfalate� cacce181terr dr <br /> eet aeide aay provieftanu oF tha technical wdes� �r a6all,i�uance uf a penit prereat t�e�ildiag Of#iciat fro�t4r�eafter <br /> reqnfiria�J a oaxrecl:ion of errars in plauama� cmatroction+ or.iolaki,�s of aap oode. Bierq penit itwed ahi11 b�a�e inralid <br /> untese tDe t�tc'k aathuri�ed bp euch�nit!e cx�rraaced rithia afs aoetha of fsenan�, or if teacl aut6ori:ed bt 13�e pecait ia <br /> s��speaded ar aba�e�9 far a�arioa of eu amthe aE�r tha tiie t6e rortt ia oo�. One 40 tla�utduian of ti��e,a�lns <br /> alia�l for t6a P�t ritL fe�c6atge af 115.00. i6a esteaaim e4a11 6fl cequested in rritiag to t6e BuilAtng OEficial. !n <br /> agpsoved iaspectfm sq8t be i#�gea d�iag each ait aouth pericd,cr the pxrDj'ect tdll be t�atidazd!abaa�ood]. <br /> �I!@IIu6 i0 0lt�: YDOB PAILOiliB T��E IOtItB OF��I�R!`�T t�LT I�t001t FaTi�G lftiCB YOit II�JP@�R8 t0 tOQE <br /> P90P�. IF�II�ID!0 OSlIIN FU�CU6, CpM�!Illf'810�t Ll�t Od M A!i'OA1BY�6Y�➢pli6 IWA IO'fICE OF <br /> CQ4�lfClQ�il. 30B$OIDffit�2r504 I6 Y6608 DQ M�T(I R�DR4 ENQ YDS!11"iDftC6 OF�!'. <br /> t���-G/� � <br /> --� .,� <br /> SI£!(bttt�:iA�R OA 116�1{T SI6'ttal�tRS: Cp1f8bCl�R � <br /> $t�tB Og Flf�llD� STATB OF F1� <br /> f.OUAlT OP CqUA�¢OP S i',�\'� <br /> The �oregoing inatzvsent ras acknarledged R�e fozeqoinq inatzur�ent was aclma�ledged <br /> before ne this , 19_ by 3sefore �e tt�is t\lct . 19��t by <br /> ( _ / � <br /> �CLC� �. l�ul(�P <br /> who is perscmally kuc»m to ne ar �eho i�as xho is ersoaal2p��o`� or rho 2tae <br /> produCed praduced .� N�A-.. <br /> as ideatificatian ana rho did/did not as tificatal��an r 'd/did not <br /> taice an oa�th. ,c�t�. <br /> � (Signatnre) (Siqnaturej�` ���_r� <br /> (Na�e,Tpped. Pzinted or Staaped) (Naae fiyped, Priated or Sta�ped) <br /> NOTB1tY PUHLIC NOTIlRY PUBLIC <br /> �ottg.�+� v�unta.Forto <br /> , y'...7G . My�n CC�B3392 <br /> . • �,at�..r�.r as.�wr <br /> ' tl+,dl.benyA..od.ca.rw <br /> ���OFF4���OT ��•1655 <br />