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<br />11';"'1_ 11'_'.
<br />
<br />CONDITtONS OF PERMIT AFFIDAVIT
<br />A. NOTI~iiiB! DUD R1r8TRICTIOlfS
<br />!be Wldenl,. tendII tbat tIIla penlft ., be .ubJect to "deed reatrlctlonl- whleb ., be lOre rhtrlctlve than Cit,
<br />reguJatlOdl. '" UDder.Sgaed .1111I. rllpoDlJbJl1ty for COIplllDCI 11th any applicable dIed re.trlctiODl.
<br />
<br />B. UNL%CBlfSBD CO MeTORS AND CONTRACTOR RESPOH81BIL TIS
<br />If the ownef.... It I contractor or connectorl to undertake wor., tile, ISf be required to be 1 cen.etS In Iccordance with
<br />state and lOCI! regulation.. If the contractor 18 not licensed .1 required bylaw, both the IMler end contnctor .a, be
<br />cftec1 for I .1.....or 'Solation under atate 181f. If the OImer Dr Intended contractor are uneert.ln u to .bet I1cenllng
<br />requlrlllDtI .., Ippl, for the Jntended worl, they 8re advlled to contact tbe City of lepbJrhlll. Building D8p1rtltnt, (813)
<br />788-&611.
<br />
<br />FUrtherlOre, If tbe owner bas hired a contractor or contractor., he is advised to have the contractor(l) algn portions of tbe
<br />-Contractor IecUaal' of tbll appUcoUon for trbicb they ,Ill be rlBponelble. If you, al the owner sign II tbe contractor,
<br />fOU Ife lndleatlDf tblt rou, rltblr than the contractor, are responsible for the work. If the contractor wllb.. rou to algn
<br />.s contraetor tbat IIJ be 1ft indication that he Is not properly licensed and Is not entitled to perlittlng prl,ilegll in the
<br />tlty of ~lll..
<br />
<br />c. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />
<br />D. C9--!TRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMSNDBD)
<br />I certify t I, tbe IpplJcant, bl" been prOVided with I copy of -Florida's Construction Lien LBW . HOIIOIDer'. Protection
<br />Guide' prlplre<< br tbI Plorl4. Dtplrtllnt of Agriculture and Con8U1er Affeirl. If the eppllcant II eDItOR, otblr tbIn the
<br />'cnmer", I certlf, tJlat I b8" obtained a cop, of the loon described docUJent and prOlile In good f,lth to dell,er it to the
<br />-owner- prior to COBIDC..t.
<br />
<br />E. COltt~ t S/OWHBR' S AFFIDAVIT
<br />I certlf, tbit~t6i nforlltlon In this application il accurate and that all work will be done In cOIpliance witb .11
<br />IppHcabl. 1_ ngaJIUng COIIItRction, laning, 1nc1 Illld de,elopaent.
<br />
<br />Application I, berebp ..ae to obtein a pet'lt to do work and Inltallation 18 indicated. I certify that no vor. or
<br />In.tlJlltlon hll CGIIIncea pri~r to Illuance of I petlit an4 that III work will be petfotted to "It .tanO.rd. of .JI 1111
<br />reguI.tln, CDnltructloa, eltr code., loning regulatlonl, Ind land 4e'eloplent regulationa In the juriedlction. I allo
<br />certify that I under.tInd th.t the regulation. of otblr goyernlental agencie8 tay apply to tbe Intended vorl, and tbat it i.
<br />'y re.ponllbllltr to Identl'r what actions I lUst takl to be in cOIpliance. Such agencies Include but Ire not Illlted tOl
<br />· DepartleDt of snYlrODllDtal 'Iaulatlon - Cypress BayheRds, Wetland Areas and BnfironJentallr Sen.iti.. Lan41,
<br />later/Waltewater Ireltient
<br />I Soutblelt rlqrl,. liter Nanl:::rtt DIstrict - VeIls, Cypress B1ybeads, Wetland Areas, Altering Watercour.88
<br />t ~ .. lei. I, Doc", Ilvlgable !fatervaye
<br />· De~IIbab-llltatJ.e Serrlce., anyirODlentl1 Health Unit - Wall., Va8tlllter IreltleDt, Septic Ian..
<br />t US 1tlY1!!l!lttl ~U~J .. ....toa llbatuent
<br />I allo certu, tJIIt, IlfiitiiIil II to be usee! In Plood lone "I- or IIA,ttc. -, it 11 _rltood tIIat . dtalnap plan
<br />.dal'8lllDf I '.....UDg yol.' wll1 be IUblitted whlcb iI prepareel by I prof...l0011 .ngineer registered In tilt St.t. of
<br />Plorlel, prior to perllt I"UIIl.ct.
<br />
<br />A penlt felued .ball be construed to be 8 license to proceed Iltb tbe work and not II authorltr to ,lolate, clDcel alter, or
<br />set ..14e anJ pro'lllona of the technical codes, nor shall iS8uancI of a per.it prevent the Building Offlclll frol thereafter
<br />requldng I correct!OQ of errorl In pIa, Conltructionr or dolation8 of tII! code. BYlr, perllt Issued IbalJ beCOl8 In,alid
<br />unle.. tile tIOr. .,tharllec1 bJ sucb perllt 18 CC*8RCed within Iii IODths of Issuance, or if .ork authorlled by the petllt 18
<br />8u.peuded or IIbIndoDed for a perJ04 of .1. IDntll. Bftlr the tile the work II ~ence4. One 90 d., ..tension of till,., be
<br />allowed for the pltllt with fee charge of ,15.00. !be extenlion shall be requested in writing to the Building Official. An
<br />appro,ec1 In.pectJon IUIt be logged during each II. IOntb period, or the project will be con.ldered abandoned.
<br />WARMING TO 0ImR: YOUR nlLURI 10 RICORD A 1l0rlel 01' COIlMIIlCIJIINf HAY RBSULT IN YOUR PAYING nUCI FOR I"PROV.lIra 10 YOUR
<br />PIIDPBRfY. IP YOU 111'1IO ro OIlflIIf FIJlIICltlG, CONSUtT WITH YOUR LINDER OR AX AIIORIIY 81toRB RlCORDING YOUR JIOfICI or
<br />COMMI"CIfIN!. JOBS UNDIR tz,500 III VAtuS DO NOI HIID TO RICORD Arm posr A "HOTICI or COMHIICIMUTII.
<br />
<br />
<br />G~
<br />~ n-.
<br />51 AfURB: COil TRACTOR .
<br />
<br />
<br />SIlrr or ~
<br />COOllY or .uVl
<br />The foregoing instrument was acknowledved
<br />before tile thi ~ , 19 '1 Y by
<br />
<br />SIGIfAfURI: OIIIIR OR HID
<br />
<br />IrAJI OP noalDA
<br />coum OP
<br />'The foregoing lultrument .a8 acknowledged
<br />before.. this , 19____ by
<br />
<br />who is person.fir known to me or who has
<br />produced
<br />88 identification and who did/did not
<br />take an oath.
<br />
<br />ho 8 ereona1! or who hOB
<br />p ed
<br />as identification and who did/did not
<br />
<br />~(~1~. #LJ7V-L
<br />(ll~nature)H~c-v. "e ~~? ~ ~ ell",)'
<br />(Hame Typed, Printed or StamPed)
<br />HOT.... 1&
<br />
<br />
<br />(Signature)
<br />(N..e TYPed, Printed or Stamped)
<br />HOTARY ..,ILIC
<br />
<br />~AV
<br />'" '"
<br />o ,..
<br />z: n
<br />
<br />MICHAEL J. RINGLEY
<br />Notary Public, State of Florida
<br />My comm, expires April 23, 1995
<br />Comm, No. CC102075
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