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<br />~':.; . ' ,.
<br />
<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />!be undersigned understands that this penit lilY be subject to 'deed restrictions' ,bieb JaY be lOre restrictive ,
<br />regulations. !he undersigned asSUles responsibility for CCIIpliance lith any applicable deed Iestrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner baS hired a contractor or contractors to undertake IOrk, they lay be required to be licensed in accordance ,ith
<br />state and local regulatiOJl8. If the contractor is not licensed as required by law, both the owner and contractor lilY be
<br />cited for a lisdeJeallOr violation under state law. If the owner or intended contractor are uncertain as to Ifbat licensing
<br />reguireJents lilY apply for the intended work, they are advised to contact the City of Zepbyrbills Building DepartJent, (813)
<br />788-6611.
<br />
<br />FurtheIlOre, if the owner bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
<br />'Contractor Sections' of this application for wbieb they ,ill be responsible. If you, as the OIfIIer sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the IOrk. If the contractor ,isbes you to sign
<br />as contractor that lilY be an indication that be is not properly licensed and is not entitled to perlitting privileges in the
<br />City of Zepbyrbills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, bave been provided ,ith a copy of "Florida's Construction Lien Law - lbIeo1mer's Protection
<br />Guide" prepared by the Florida DepartJent of Agriculture and ConsUler Affairs. If the applicant is 8OI8ODe other than the
<br />"OIfIIer", I certify that I have obtained a copy of the above described dOCUleDt and pro.ise in good faith to deliver it to the
<br />'OlDer' prior to COlleDCl!leDt.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the infoIliltion in this application is accurate and that all work ,ill be done in COIpliance ,ith all
<br />applicable laws regulating construction, lORing, and land developaent.
<br />
<br />Application is hereby lade to obtain a peIlit to do IIOrk and installation as indicated. I certify that no IIOIk or
<br />installation bas co.IeDced prior to issuance of a perlit and that all work ,ill be perfoIled to Met standards of all laws
<br />regulating construction, City codes, loning regulations, and land developleDt Iegulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other goveruental agencies lilY apply to the intendedllOfl, and that it is
<br />If responsibility to identify ,bat actions I lust take to be in COIpliance. Such agencies include but are not liaited to:
<br />t DepartJent of EnviloDleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDl8Dtally Sensitive Lands,
<br />Water /Wastewater !reatJent
<br />t Southwest Florida Water Hanageaent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
<br />t Arty Corps of EnqineeIB - Seawalls, Docks, lavigable Waterways
<br />t DepartJent of Health i Rehabilitative Senices, EnvirODleDtal Health Unit - Wells, Wastewater !reatJent, Septic ranks
<br />t US EnvirODleDtal Protection Agency - Asbestos abatl!leDt
<br />I also certify that, if fill aaterial is to be used in Flood Zone lA' or "A,etc.', it is understood that a drainage plan
<br />addressing a 'cOlpeD8ating voluel ,ill be sublitted wbich is prepared by a professional engineer registered in the State of
<br />Florida prior to peIlit issuance.
<br />
<br />A perait issued sball be construed to be a license to proceed with the IOrk and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical codes, nor sball issuance of a peIlit prevent the Building Official frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Every perait issued shall beco.e invalid
<br />unless the IIOrk authorized by such peIlit is COIIeDced within sillOntbs of issuance, or if work authoriled by the peIlit is
<br />suspended or abandoned for a period of sillODtbs after the tile the work is co.enced. One 90 day Bltension of tile, lilY be
<br />allOled for the peIlit lith fee charge of $15.00. !be Bltension sball be requested in writing to the Building Official. An
<br />approved inspection lUSt be logged during each sil IDDth period, or the project ,ill be considered abandoned.
<br />NARHIHG '1'0 0IfIER: YOUR FAILUBI !O RECORD A IOI'ICE OF COIMDCEIlEI! MAY RESUL! IN YOUR PAYIIG !lICE FOR IMPROVIIIII!S !O YOUR
<br />PROPER". IF YOU IJDIO) !O OB'lAIN FIWCIIG, COISUL! WID YOUR LODER OR AI AnoRRIY BEFORB RICORDIIG YOUR DICE OF
<br />COMMEICEMD!. JOBS OlDER U,500 II VALUE 00 101' mD !O RECORD AID POS'l' A INOI'ICE OF ClJIMDCEMmI.
<br />
<br />
<br />&::g-~--z(
<br />~ UBI: (MIER OR
<br />
<br />SIGJf1!URB: COI!RAC!OR
<br />
<br />S'II1B OF PIlm~
<br />coum OF -0
<br />The foregoing i~rument was a~~ledged
<br />befor me this - / / - , 19..::t.:r by
<br />
<br />S'l'A!I OF FLORIDA
<br />coum OF
<br />The foregoing instrument was acknowledged
<br />before me this , 19_ by
<br />
<br />
<br />r who has
<br />
<br />ho is ersona 1y
<br />produce
<br />as identification and who did/did not>
<br />
<br />tat/at ~~J!~ ~T
<br />~ignatu e) .
<br />(Name.Typed,~.
<br />NOTARY PUBLI~,
<br />~1,~,
<br />
<br />who is personally known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an oath.
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />
<br />
<br />... e~ EXPIRES
<br />: · Septembel29. 1997
<br />IIONIlfD THfW TROY FAIN INSURANCE. INC.
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