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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />!be undersigned understands that this perlit laY be subject to 'deed restrictions" which laY be IOIe restrictive than City
<br />regulations. 'lbe undersigned asSUle& responsibility for COIpliance lith any applicable deed restrictions.
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<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the OIfIIer has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
<br />state and local regulations. If the contractor is not licensed as required by law, both the OIfIIer and contractor Iilr be
<br />cited for a lisd8leanor violation under state law. If the OIIl8r or intended contractor are uncertain as to IIbat licensing
<br />reguiraents lilY apply for the intended IOrk, they are advised to contact the City of Zepbyrbills Building DepartJent, (813)
<br />788-6611.
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<br />FurtheIlOre, if the OlDer has bired a contractor or contractors, be is advised to have the contractor(s) sign portions of the
<br />IContractor Sections' of this application for wbich they ,ill be responsible. If you, as the OlDer sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the IIOrt. If the contractor ,ishes you to sign
<br />as contractor that lilY be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
<br />City of Zepbyrbills.
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<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
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<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, have been provided ,ith a copy of 'Florida's construction Lien La, - lbIeoImer's Protection
<br />Guide" prepared by the Florida DepartJent of Agriculture and ConsUler Affairs. If the applicant is 8OI8ODe other than the
<br />1I0000er", I certify that I have obtained a copy of the above described docuIent and pro.ise in good faith to deliver it to the
<br />HOlDer" prior to co.mCl!leDt.
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<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the infoIlation in this application is accurate and that all IOrk IIi 11 be done in cOlpliance ,ith all
<br />applicable la'8 regulating construction, loning, and land developlent.
<br />
<br />Application is bereby lade to obtain a perlit to do wort and installation as indicated. I certify that no work or
<br />installation bas co.IeDced prior to issuance of a perlit and that all IOrk ,ill be perfoIled to leet standards of all laws
<br />regulating construction, City codes, zoning regulations, and land develOpll!llt regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other goveruental agencies lilY apply to the intended IOlk, and that it is
<br />If responsibility to identify ,hat actions I lUSt take to be in COIpliance. Such agencies include but are not liaited to:
<br />t DepartJent of EnviIODIeDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDleDtally Sensitive Lands,
<br />Water /Wast8later !reatJent
<br />t Southwest Florida Water Hanagel8Dt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
<br />t AIIJ Corps of Engineers - Seawalls, Docks, lavigable Waterways
<br />t DepartJent of Health i Rebabilitative Services, BnviIODleDtal Health Unit - Wells, Wastewater !reablent, Septic ranks
<br />t US BnvirODleDtal Protection Agency - Asbestos abat8leDt
<br />I also certify that, if fllllilterial is to be used in Flood Zone lA' or IA,etc. I, it is understood that a drainage plan
<br />addressing a '~ating volue' ,ill be sublitted Ibich is prepared by a professional engineer registered in the State of
<br />Florida prior to peIlit issuance.
<br />
<br />A perlit issued shall be construed to be a license to proceed lith the IOrt and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Every peIlit issued shall beco.e invalid
<br />unless the IOrt authorized by Bueb perlit is COIIeDCed within sillOnths of issuance, or if work authoriled by the perlit is
<br />suspended or abandoned for a period of sil IODths after the tile the IOlk is co.encecl. One 90 day extension of tile, lilY be
<br />allowed for the penit lith fee charge of $15.00. !be extension shall be requested in writing to the Building Official. An
<br />approved inspection lUst be logged during each sil IODth period, or the project ,ill be considered abandoned.
<br />WAIUlIIG 'fO OIlER: YOUR FAILURI !O RICORD A IOIICE OF aJlHBRCBHm HAY RESUL! II YOUR PAYIIG DICE FOR IHPROVIIIIIIJ'S !O YOUR
<br />PROPER'fY. IF YOU ImID 'fO OMAIM FIIAICIIG, COISUL! WIft YOUR LBlDER OR AI AnORDY 8BPORI RECORDIIG YOUR DICE OF
<br />COHHBICEHBIfI. JOBS OlDER $2,500 1M VALUE 00 100IfBID 'fO RECORD AID POS! A HIOIICE OF COHHBICEIIBIfI'.
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<br />S!ArB OF FLOR% S!A!B OF FLO)1DA
<br />COUI'fY OF c () coum OF 5'(. 0
<br />The foregoing instrument was ac~owledged The foregoing instrument was aCkn. owledged
<br />before me this 1.':,-rA."d~' 19~ by before me this 1Sd- ~ ' 19~ by
<br />
<br />tic LSD..} K'f ",,...! ~So.1 f..r rn~
<br />~is personally known to--lDeOf who has ~ ~e.Ll:juIlCllly known t~ Dtej>r who has
<br />produced _ prOduced ._
<br />as identification and who didfdid n.oD as identification and who 4id1dl~~
<br />
<br />take ~~;J-~ take:~ ~
<br />(Signa":' ,.----, (Signature) I' :-\ 2 I
<br />L oj DAD, r;; {) rJ;J I-- / /.,/ !) t7 0. A-f\../
<br />(Name Typed, Printed or Stamped) (Name Typed, Printed or 'Stamped)
<br />NOTARY PUBLIC NOTARY PUBLIC
<br />,,'"U,~ luna 0 SOAN
<br />'~~"'"'' UND'" 0 SOAN ~"~iI\'.t~~.. L_ .
<br />~:&"l~"' ~~~~~
<br />:~1' ':;~ Mi C<M.1lSSKlN , CC 209693 EXPIRES N ;*E Mi COMMISSION * CC 208593 EXPIRES
<br />~ _'S ~~~ .. ~ ~&~
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<br />"'~ ''':;'': .' BONDED THRU........ FAIN tNSllIWlCE IHe ''Jf.nr. !l\.' IONIJEI) TIIlll mqv FAIN 1NSUIlAHCE, INC.
<br />',Rf..\,,' Inyl I . ,..."
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