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` � CONDITIONS"OF PSRMIT AFFIDA�IT . - _ <br /> � ' A. HOTICS OF DESD RSSTRICTIONS ' <br /> ihe andereig�eE mder�Woda tbat tbie penit�af be eabiect to'deed r�trictiooe'r6i��af be�ore reatrictiQe than Citp <br /> tegalatiaas. Shs umdereig¢ed aaam�es�pooai6ilitY far coepltence dth a�applicable dted iestcictima. <br /> B. UNLICSNSSD CONTRACTORS AND CONTRACTOR RESPONSIBILITIES <br /> If the oimer bae hice8 8 caotractor ar cantractare tn tmdertate rort, tLep�ap be raqulred to be lice�sed in accordaaca rith <br /> etate and local regolattaos. If the contractor is not lioenee�as reguirad E9 lar, both tbe amer and coa��ap be <br /> cit�for a dsdeaeanor�folatioa oader etate lar. !f tde amer or iatended oontractor aze oncertain as to rLat llcenaing <br /> sequire�te iap applp for tbe u►teaded rork, tbep are advised to ooat�ct tde Citp of Leph7cGille Bnfldin9 Gepact�t. (613) <br /> 788-66I1. <br /> Furtbenon. if t�orner haa hire8 a contractac or contractora, 6e ie advieed to 6are the o�tractor(�) sign portioms of tha <br /> 'Cantractor Sectime'of t6ie applicatim for rhich tDep rill be reeponeiDie. If�oo, as the or�er ai�as tLe caattactar, <br /> yoa are iadicatIng that pon, ratber than t�contracbor, are respaoeible for the aort. If the c�twctac rirhea yoa to aigo <br /> as cantcactor tbat�ag be an iodiwtim that he fs not prnperly liansed and 38�t mtttIed to P��9 P�vileg�a in tLe <br /> Citp of Laphirhille. � <br /> C. TRAN3PORTATIOH IMPACT F$ES AND UTILITY CONNSCTION FSBS <br /> D. CONSTRUCTION LIEN LAW (CHAPTSR 713, FLORIDA STATUTS3, A3 AM$NDSD) <br /> I certifp tbat I, the applicant, hare been pro►ided ritb a cnQp of•Florida'a�anet�octian Lim bar-Bo�eamer'a Pmtecti� <br /> 6nide'prepared bp t�Florida Depart�t oE dgriwitace and Conaiaer lffaire. If t!�a�licant ia sa�one otDer tEan tbe <br /> •amer', I ce�tify t6at I 6are obtained a c�pp of tde above deecribed do�eat aIId pca�iea in good faith to deliver it tn tha <br /> •omer'prior ta co�enc�eat. <br /> S. COHTRACTOR'S/OWNER'S BFFIDAVIT <br /> I certiFq t6at all t6e infonation iu this appiicatian te accnrate and that all�rort rill be doae ia capliance rit6 all <br /> applicable lare regnlatiag cm�struction, s�in9► and la�derelop�eat. <br /> lpplidtien fe herebp�e to o4ta9a a penit W do rock am]inetaliati�ae iaaicatea. I certifq tEat�rort oi <br /> installation Eaa ao�eacea prioi to iesnance of a penit and tEat all rork rill be perfonea to aeet etandarae of all lare <br /> regalating canetracU�, City cades. caning cegulatione. and laod developrent regiiletiane in Me f ori�6iction. I also <br /> certifp that I m�deretand tbat tLe regnlations of ot6er gorernrental age�i��al aPN9 to tbe 1AtmDed rark, an�that it ie <br /> ,�r reeponsibilitp to identifp rhat actione I�ust tate to be fa cxipliance. Sach�encies incluae�t are oot 1Litea to: <br /> *Depart�at of eavirn�ental 9egulatian-Cypress Bep6eade� Yetlard Ilreas a�Bnvfra�ntal118eneiti�e Lands� <br /> Yaterl�aeterater lreatamt <br /> �Soatlorest Plarida Ynter!lana_gesent D'utrict-fTelle. L}ptesa BaYheade► Metland�e, eltering Yatercaoteea <br /> *�Cotas of&�gineecs-Searalie, Docke, lavigable Yate�rale <br /> •Deaartaent of Health i IIehaDilitati�e 6ecrices,Bnviran�ental Hwlt6 Onit-Yells, Yasterater lceatamt, SeptiC iente <br /> �W�otirm�tal Protectian AyeneP-�ebestos abataent <br /> I also certifq tLat, if fill iaterial ie to be osed in Fload L�e'e'ar's,etc.', it ie underetmd tEat a draiaage plan <br /> addreesing a'co�peaeating vola�e'rfll be ea6aitted rhicL ie prepared bp a profeseiaaal e�ineer regiatered in the 8tate of <br /> Flarida prior to penit iesoauce. <br /> s peadt iseued ehall be const�to be a lfcenae to praceed dth t6e rork anD not as authoritY to dolate. canal alter. or <br /> set aaide anp provieiooe of tbe tec5oical aodea, �r ehall iQseaace of a penit pree�t tbe Hatlding OfEicial fm th�fter <br /> requiriag a correctioa of ercore in plane, caoet�ncti�, oi.iulatioos of anj�e. 8�peait ieooe0�hnll bec�e imalid <br /> amleea tha rork authori:ed bp eac6 penft io ca�enced�itLin��ont6e aE ieeuaaw, ar if rort aathori�d bp tEe pendt ia <br /> auepende�or absadm�l foc a perioa of eu�after tLa ti�e tLe r�rt ie ca�ena�. One 90 daq�steoeion of tLe.,iaY b� <br /> allarea far t6e penit rith fce c�acga of�15.00. !6e erteoiion eLall be requeated in rtit3mj to tEe Buildinq OEficial. M <br /> eppimea inepectfon iuet 6e lagged duting eatfi su routh period.or t6e pzoj�ect uII be consideled a6an8aned. ' <br /> tlAA�A6 i0 Of�: Y008 PAI60�t0�!�!!t�OF NI�[!�i➢iSQL!IN t00Y PA[IN6!Y[l8 P�Il�IfB!0 YOOB <br /> P80P�f➢. IP YOp INl�!0 OSi1IN FA�CII6, �{SQL!YIlB YO!!R 6�iA�llf bli�Y DBP�B R�II6100H ll0lICB OF <br /> CQ4�t. J�S 1��1►500 I119AIAE DO�i�iIl�IUID POSi 1"AO'[IC6 OF�'. <br /> SI61�fUHB:OIIABR OB b�li SI�: CUAlRACI'6H <br /> SfeT6 OF F(AAIDI SiAiB�FL�IDI <br /> (70011![OF OOONli OF <br /> The foregoing instrnsent rae acknowl�qed The foregeing instrusent xas aclmorledged <br /> before ie thia , 19_ bq before � t61s , 19 bp <br /> rho ie pereonallp lmrnm to ae or r6o has �ho is personally lmo�w to � or rho has <br /> produced prodnced <br /> ae identificatiom and rho did/did not as identification and rho did/did not <br /> take an oath. take aa o�th. <br /> (Signatnre) (Siqnature) <br /> (Naae.Tgped. Printed or Stamped) - (Naae Tpped. Printed or Sta�pedl <br /> NUTIIRY PIJBLIC NOTAAY PUALIC <br />