|
<br />-- F EB-22-' '941 UI::: 1 J.. : '-11,:'
<br />
<br />l ~I: ,_ [ ",' Uf' "T?rl,FH; '_,_c.
<br />
<br />] E:L ILl:;::: L:::,
<br />
<br />"3~!l:?3
<br />
<br />t:I(J44 >:U.2
<br />
<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A~ NQTICE OF DEED RBS~RICTIONS
<br />. , Ibe under.igned un4er.tands tbat tble peratt .ay be sUbject to 'deed restrictions" wbicb '~f be lOre t81trictive tban City
<br />regulation.. Ib, under8Jgned 188U1e8 reiponeibillty for cOIpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the OlDer bls blred-, contractor or contractors to undertake work, they IIY be required to be licenled In accordance with
<br />.tate and local regulation.. If tbe contractor is not license/! liS requind by law, both the owner and contractor la, be
<br />cited for a 111d8l8anor violation under state law. If the owner or intended contractor are uncertaIn 81 to what licen.inq
<br />requlr8lentl lIy Ipply for the intended work, they are advised to contact the City of Zepbyrbilll Building Departlent, (813)
<br />788-6611.
<br />
<br />PurthlIlOr., if the owner bas bired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
<br />'Contractor SecUon.' of this appHcaUon for wbieb they will be responsible. (f you, as the owner sign 18 the contractor,
<br />you are Indicating that you. rather than the contractor, are responsible for the work. If the contractor wishes you to slgn
<br />as COQtrlctor that I'y be an indication that be 18 not properly licensed and Is not entitled to per.itting privileges in tbe
<br />City of Zepbyrhille.
<br />
<br />C. TRANSPORTATION I MPAC'l' FEES AND UTILITY CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify tb.t I, ~. applicant, ba.. heiR provided with a copy of IFlorid~'s Construction Lien Law. HOIeownar'. Protection
<br />Guide' prepared by the llodda Departaent of Agriculture and ConsUller Affain. If tha applicant is IOleone ot!ler tban the
<br />'owner-, I certify that 1 have obtained a copy of the above described docUlent and prOlise in good faith to deliver it to the
<br />lowner' prior to COIIIDcllent.
<br />
<br />E.. CONTRACTOR' SIOWNER 'S AFFIDAVIT
<br />I certi'f that III the infoflltlon in thi, application i. accurate and that all work wIll be done in COIpllanc8 wIth all
<br />applicable 11.1 regulating construction, loning, and land deveJoplent.
<br />
<br />Application i. hereby IIde to obtain a per_it to do work and installation as indicated. I certIfy that no JOrk Or
<br />install,tlon b., COIIeDced prior to Issuance of a per.it and that all work viII be perforJed to leet standard. of all law8
<br />re9Ulating con.truction, City codea, lonlng regulations, and land develop.ent regulations in the jurisdiction. I also
<br />certif1 that I un4lt.tand that the regulations of other g0gel'nlental agencies .ay apply to the intended vork, and tbat it is
<br />.y rllp0ft8lbl1it, to identify what actions I lust take to be in co.pliance, Sucb agenciee inelude but are not li.ited to:
<br />t Dep!rtJent of InvironJental Reoul.tion - Cypress Baybeads, Wetland Areas and Bnvironlentally Sensitive Land.,
<br />Water/Wastewater Treatlent
<br />t 8ou~lest Florl4. Vater Hanag8l~t District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
<br />t Art' COrDI of laGin..rl . Seawall., Docks, Navigable Weterways
<br />t Departllat of HlIltb , Rehabilitative Services, InvJrOftlental Health Unit - Wells, WaBtewater freatlent, Septic fartks
<br />· US Indrcuentl1 Protection AllenCY - Albestos abatuent
<br />1 alao certifr tblt, if fill laterial J8 to be used in Flood Zooe lAW or "A,etc.l, it Is understood tbat I drainage plan
<br />addre'ling a 'CDIpInI.tin9 volute. will be aubtItted wbich is prepared by 8 professioDal engineer registered 1n the State of
<br />Florida prior to perlft lssulI\ce,
<br />
<br />A petlit Issued 8hall be construed to be a license to proceed with the work and not as authority to viollte, cancel alter, or
<br />let alide an, provi.ion8 of the technical codes, not .hall issuance of I perlit pre.ant the Building Offlcill fral thereafter
<br />requiring . correction of Irforl in plans, con8truction, or violations of any cods. Bver, perJit i81Ue4 ,ball beCOll in'llid
<br />un!eSl the IOrt luthorhed b, IUcb P8l'11it 11 COll8need wit.bin ailllOnths of il8uMes, or if lork autbor1le4 br tbe per.it is
<br />'uspen4e4 or abInc10ned for a plrlod of Iii IOnths after the tile the work Js couenced. one 90 day uten.ion of t_, lay be
<br />allowed for tbt perlit with fee charge of $15.00. fbe extension 8ball be requested in writing to the Building Official. An
<br />approved inlpectioo 1U8t be logged during each six IOntb period, or the project .ill be considered abandoned.
<br />WWING TO lMD: YOUR IAILURI fO RlCORD A HO'lICE or COHMBlfCiMlNf MAY RESULf IN YOUR PAYING f1IlCB POR IMPROVEMBIl1'S fO YOUR
<br />PROPIRn. IF YOU IIfUD to 08!lIH PJfWfCING, COJlSULf WITH YOUR LJJlDIR OR AN ArfOJU1IY BBYORI RBCORllllfG YOUI IO'I'ICI OF
<br />COHMBIfCIMBMt. JOBS UNDER f2,500 IN VAWI DO Nor NEED '1'0 RECORD AHD posr A "NOnCR OF COHMBNCIXENY".
<br />
<br />---/~
<br />
<br />SIGMAfURI: maR O'A~1 ~--- SIGHArUMB;
<br />
<br />
<br />srA'E OF FLORIDA
<br />coumo,~.
<br />The foregoing 1DBtrum~ was acknowledged
<br />before ID8 this _d;::} "::- , 19..:1::L by
<br />~\arvAr~ D\
<br />... --r]Y'\'1 D fYll.o
<br />who 18 pereonally known to me or who has
<br />produced '<.t--Sb I ;\)vJ~ ^'-L
<br />ae identif1c and wb did/~ot
<br />take an oath. oJ-P d '~_
<br />
<br />(Sign8tur.~~. L, ~JSO
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PVBLl!;
<br />~.,.y 'UI,ofo RACHEL L RUSSO
<br />":0 My Commis.ion CC303185
<br />:. " Expir.. Jul. 28, 1997
<br />. . B,nded by HAl
<br />"'.., ~..
<br />-"'lOffl.'I>'tl 800-422-1555
<br />
<br />srUB OF FLORl~ \ \
<br />coom OF . 5.
<br />The foregoing instrument wal acjnowledged
<br />beforA me this .d.a"..1 , 19.5L by
<br />~ -eJ::,v---uA"1 'To{"\.'-1 BIAA ~
<br />who 18 personally known to me or who haa
<br />produced p-Rr .JO^.a-t \:::a J..v\"'''''''''''''''-t-
<br />as idelltifDl and who id/, ot
<br />take an 0" .
<br />. .....-.,
<br />(Signature)
<br />~A~-e.\ L3~sS'C:)
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />I ---._
<br />
<br />~
<br />
<br />
<br />"~'ofo RACHEL L RUSSO
<br />.~ . My Commission CC303185
<br />. Ii' Expir.. Jul. 28, 1997
<br />. .
<br />'" ,. B>nded by HAl
<br />?''lOFf\.fII''~ 800-422-1555
<br />
|