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<br />CONnITIONS OF PERMIT AFFIDAVIT
<br />A. ,tiOI J CI!!: OF p~ED RESTR I CT IONS
<br />Thl Undl~'I.nfd under...nd, thlt this per.lt 1', be ,uhJ.ct to -died rlltrlctlon," which I'Y bl ,or. r..trictivl thin City
<br />t.,al.tl,n" T~. uftltrll,ntd ,.,a*,. responllblllty for ro.pll,ncl with Iny .ppllc.b], dlld rtltrl~ItDnI.
<br />
<br />9. UNL~CEN$EQ ~QNTRACTORS AND CONTRACTOR ~E~PONSIBILITIES
<br />If th. oWftlrh,1 hlrl' I contr.ttor or contrlctor. 10 und'rt,k, work, they .ay bl r!qulr.d to be ticlnsld In accord,nc. with
<br />51.1. and IlcII rlgulatiDns. If Ih. eDfttrlcI'r II,not llcens.d 15 requir!d by I'M, both tht Olnlr .nd cDntrlctor .ay b,
<br />cited for I Itld...IDOr ,iDlation In',r stitt IIN. If the OM",r or lnl!nd!d contractor .rr unc,rt.in II to "hit Ilclnst"v
<br />rtquir,.rnt. I'Y Ipply for th. Intended lork. they Ire advisfd to tontact the City of 2.phyrhlll. Building Depart'lnt, rB13)
<br />7BS-661 I ,
<br />
<br />.
<br />
<br />FurthlrlOr'r if lh, Olntr hi' blrld a contrlctDr or cpn'rlctof', hi II advised t& blVI the centrlctorfl) Ilgn 'Drtloftl af the
<br />'Contrlclor It~llonl' ., 'his .ppllcltlDn for Which they Mill bt r.spon.ibll. II you, II th, o~ntr .Ion '1 thl tlntrlctlrr
<br />you Ir. Indte.tl"f thlt you, r.ther than th. con'tactor. Ire relpDnlibl. fir the Mori. If tht tOntrlctDr ,ishll you te slVn
<br />II cDntrlctor th.. lay be In ladlc.llDn that h. i. not properly licenled and is not 'ntitled to peralttlng prlylllges In the
<br />City of Z.,hyrhllll.
<br />
<br />c. J~eNSPDRTATION IMPACT ,~~~S AND UTILITV CONN~QtION FEES
<br />
<br />D. CONSTRUCTION LIEN LA~ (CHAPlER 713, FLORIDA STAlUlES, AS AMENDED)
<br />I ttrtify lhlt I. lhl applicant, havl blln prDyld.d .ith . copy of 'Florida'. Conltruttlon Llln La. . "olte.n.r'. Protection
<br />Guidi- pr.,.,.. b, thl flDrida Dlp.,t.enl'Df Agriculture and Conlul.r Affairs. If thl .ppllclnt 1. I..ton. oth.r th,n the
<br />"own,r', I elrtlfy Ihal I hlv, o"llned I copy If Ih. IbOYI dllcrlbld dotu.tnt '~d prollle In loed faith to dlll~lt It t. th,
<br />'o.ntr' prior tl cDlllnerllnt.
<br />
<br />, E. CONTRAC~081~(QW~ER"S AFFIDAVIT
<br />r certlf, thlt .11 lhl llferlltt,n In thl1 .,pllt.tloa 1t accurate Ind thlt III Mlrk will le don. in to.plllnel .ith III
<br />IppltClbl. 11.1 tltul.tl"9 construction, lonlng, and land dIYtlop~lftt.
<br />
<br />AppllclIlln il htr,by ..d, to Dbt,in I plrllt tD do MOrk Ind Instlllllion a. indiratld. I certify thlt ftO 'Dr~ or
<br />inlt.ll.tiIR hi. CDelented prior to lssulnce of I p.r.it and thlt 111 Mork Mill b! plrfGrlld tD I.et stand.tds 0' .,1 JIW'
<br />r,vullting conltructlon, City COd'S, toning regulations, Ind land d,vllope.nt rlgullticns In lh. Jurisdiction. 1 .lso
<br />errtif, thlt I undlrstlnd th.t 'hi regula'lon. of othlr govern..ntal 19!nell' I'y .pply to th, intendld lorkr Ind thlt it i,
<br />IY r"pDnsibllity to identify Ihat IctiDnl t lust t.kl to bl In coeplilnc,. Such Agencies Include but Ite not llllted 101
<br />f D'D.rt'lftt of ~,vlron.tntll ~laulltiDn - Cypress Blyhllds, Metllnd Ar'll Ind Environ.,nt.ll, S,nlitlYI llndl,
<br />Ulllr/M.stIMlt,r Treat.lnt
<br />f South~llt Florid. Ull" JI~t.efttjtl.ttJct - Wells, Cyprlss B.yhelds, M.tland Ar.a., Altlrlng UAtlreOur...
<br />t ArlY CorDI of Enaln..rl - SlaMIIIS. Dotta, M.vl,.bll Nltlr"IYI .
<br />· ~~Irtllnt DI "'llth , Rlhl'.lll.tlvl Itrvlcll. Envlron.,nt.1 "tilth Unit - N,III, Wllt,"at,r Tr.lt.lnt, S.ptlc Tanks
<br />, US En,lrDn..ntl' Pr.tte'.on AG.nty - Asb,.,o. .b"'.'n'
<br />t 11ID clrtlty Ih.I, If ftll .,',rl,l I. t. b, u..d 1ft FIDOd ZOnt 'A' Dr 'A,ltC.', tt II under.tood thlt . drllnlOI plln
<br />Iddr'llinv I 'COlplnlltl", volulI' .ill b. lub.ltl.d which 1* pr.p.r.4 by I prof,ssionel engtnllr rlvlltered in thl Bt.tl of
<br />Florid. prior te pere" l.Iuanc..
<br />
<br />A ptrelt Ilsued sh.ll bl eOnstrued to bt a Iletn'I lD procltd lith thl Mork Ind not II authority to viol.", t.nc'l alt.r, or
<br />Itt .Ild. Iny prDvlllonl of thl tlthnicll COd.l, nor sh.ll l'lolncl 01 I p.rllt pr,vent the lutldln, Offlelll "01 thlt,.ft"
<br />requirinv I torrlctlon Df ,rrOf' in pl.n" construetlon, or ,lolatlonl of Iny code, Ev.ry p.rllt illu.d Ihlll b.coI. in'llid
<br />unl.ls thl lor. luthori!,d by ,ueh perllt 11 cOI"neld .ithin Sil lon~h, of llsolnce, or if Nor' .uthorlaed by the p.r.tt Is
<br />IUlp'ndld or .blndoned fDT I ,Iriod of si. Jonth. Ifter the Iltl th. .Drk i. COII.nc,d, One 90 day extension of tl.e, "y be
<br />IlloWld lor 'h, plrllt "Ith f.. chlrtl of $151001 The tlttnslon Ihall b. rlquIsted in "riling ID the Building Olflclll, An
<br />Ipprov.d In.p.~tIDn Iblt b. Jogg.d during tlch al. 'Dnth plrlod, Or 'hi proJ.cl "ill bl eonsid,red IblndDned. ,
<br />UARNING TO OWNER. YOUR FAILURE to RECORD A NOTICe O~ COKft~NCEKE"T "AY RESUlT IN YOUR PAviNG TWICE FOR IMPROVE"ENTS TO YOUR
<br />PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUlT NITH YOUR LENDER OR AN ATTORNEY BEfORE R'CDRDIN8 YOUR NOTICE OF
<br />COMMENCEMENT, JO.9 UNDER .2,500 IN VAtUE DO NOT NEED TO RECORD AND POST A -NOnCE OF CO""ENCUEMT-,
<br />
<br />Sf_TUREI MER 0" AGEIIT
<br />
<br />.~
<br />SIINATUREI CONTRACTOR
<br />
<br />DtAtr OF FLORIDA
<br />ClltnlTY .. Pasco l l
<br />The foregoing In.tru..nt
<br />blPf~r. lIIe thi_ .
<br />
<br />wa. acknowledged
<br />, 19 _ by
<br />
<br />STATl OF FLORIDA
<br />tOUIITY lW Pasco
<br />The foregDing instrument
<br />before me thll
<br />
<br />wa. actcnowledged
<br />, 19_ by
<br />
<br />who i. perlonally known to me or who ha.
<br />produced
<br />.. ldentlflc.tlo~ and who did/did not
<br />take an oath.
<br />
<br />who 1s perlonally knQwn to me or 'who has
<br />produced
<br />as ldentification and who did/did not
<br />take an OAth.
<br />
<br /><Slgnature)
<br />
<br />~I
<br />
<br />(SlgnAturl!)
<br />
<br />,
<br />(Name Typed, Printed Dr Stamped)
<br />NOJARV PUBLIC
<br />
<br />-~
<br />(N.me Typ.d, Pr~nt.d or Stamped)
<br />fII0TARV PUBL.IC '
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