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<br />COHV.i:... ~:ONS Or' PERMITi\FFIDAVIT
<br />A. NOTICE OF DoSED RESTRICTIONS
<br />!be Ulidertlg0e4 WllJeratlDtJa that thia panJt lay be eubjtct to "deed restriction." ..hieb 1M' be lOr. rutrlctlve than City
<br />regulltlD. !be nDdenigDld aaBUlBl reaponalbilitl for COIpliance Ifith any applicable deed rutdctl00e. .
<br />
<br />B. UNLICKNSRP CO~RACTORS 1~ CONTRACTOR RESPONSIBILITIES
<br />If the _'I bu hired a contractor or contractors to undertake JOrk, they say be required to be Uceaa84 In tCtlOrdance with
<br />state aDd local regWatiODl. If the contractor is Dot Hcenaed as require(! by In, both the OlDer IJld CODtrletar Ill' be
<br />cited for a 118dB1eanor violation under state law. If tbe owner or intended contractor are uncertain 18 to "bat llC8D8Ing
<br />requlr-.ntJ .,apply for the Intend84 JOd, they are advised to COIItact tile City of ZepJ!yrhi1l8 BuUdfDg DtPIItIMt, (813)
<br />788-6611.
<br />
<br />Furt.bermra, if the owner baa bired a contractor or contractors, be i8 advised to Mve the contractor(.) 11911 portion. of the
<br />'Coatllctor 8ectJoaal of tilil appUcaUon for which they "ill be responsible. If you, at the ower alvn II the cat1tractoI,
<br />you are iodicatlog that rou, rather than the contractor, ilre responsible for tba .oct. It the contractor .i8bq you to 8ivn
<br />u coauactor tbet laY be an indication that he is not properly Heensad aM i. not ent.1Ued to Pll'litting pdvillgu ill the
<br />City of lepbrrhilla.
<br />
<br />c. ~RANSPORTATION 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, have been prodded lith a copy of 'Floridat, Construction Lien Law . ~8I". Protection
<br />GuidI- prepared br the Florida Daparuent of Agriculture and Con8U18t Affairs. If lbe applicant il aeone otbu tban the
<br />"OIIIIell, I certify tJlat 1 ba'B obtained a copy of the above deaeribed dOCUlent and prClli8lJ ia good faitb to 4eH,er it to the
<br />"owner' prior to ~c_t.
<br />
<br />E. CON'.l'nCTOR t S/OWNER' S AFFIDAVIT
<br />I cartSf, that III the inforlation In thie application il accurlte and that all work will be Gone in COIPllance with all
<br />applicable 1118 regulating construction, laning, and land 4evelopl8llt.
<br />
<br />AppUcaUaa I, bIIrtbr Jade to obtain a (lIrait to do work and installation as indicated. I certify that no lOr. or
<br />il1ltaUatloo hBI co.encld prior to i8suance ot a perlit and that all wor' will be perfol'lld to lilt 8Wdarde of all law.
<br />requlltlng COOItrucUon, City codes, Boning regulati()ng, and land dQveloPlUt regulatloDl in tile 1urllcUCtiOll, I al80
<br />certIfy that I UDderatand that tlle regulations of other go'e.ruental aglllleJu JaY app1r to the btude4 IOrt, and that it is
<br />If reapooaihUity to identify wbat acUona I lUst tate to be in COIpl1ance. Sucb allendu include but are not lilite4 to:
<br />t DepartJut of Invlronaental Requlation . Cyprea8 Bayheada, Wetland Areas and Envit'ODllentallr Sensitive Landa,
<br />Ifater/llaateliJtur treatElt
<br />I Southwat Florida Water KanaOM8nt District - Wells, Cypru8 Bayheads, Wetland Aleu, Altering IMtercouraea
<br />I AmJ CURt of lDcIineera .. SUIIlls, .Docks, Navigable Waterway.
<br />I ~t Df !ea1tb i RebabUltati,e Services, EnvirtmlMtaI Health Unit - Ve118, Wastewater 'reabent, Septic ranka
<br />I US 1Zl1i.roa.ta1 ProtectlOD Agency - bbestos abatuent
<br />I dIG certlfJ tIIIt, it till IIterill i8 to be used in Flood ZOne "A" or "I,atc.., it is underetood that a drainage plan
<br />addreulDg a Icmpenalltlng lOI.- Ifill be sw.itt84 lIbith Is prepared bl a professional engineer registered in th, State of
<br />Florida prior to petllt issuance.
<br />
<br />A petitt baaed lUll be conatrued to be a lic8I1Se to proceed with the wort and not sa authority to violate, cancel alter, or
<br />set a8ide anr plO,iBIOD1 of tbe technical codel, nor shall issuance of e petl1t prevent the Building Official ftal thereafter
<br />requir1Dg I correcUOIl of errors in plana, conatructlon, Of YiolatiOll8 of any code. ifary P8lIU i81t1ec1 allallllecxlle invalid
<br />unlea. the IIOr. autboriled by such penit is ~ced withill six IOnth. of liau.ance, or lfwork autborlled by the penit is
<br />Suspended or abaDc100ea for a perJod of ail IOllths after the tile the lor. is ~C8d. One 90 day IItBDIion of tile, -J' be
<br />allowed for lbI petllt 11th fee Charge of '15.00. !ho eatenslon ahall be requeated in writing to the Building OffIcial. An
<br />approved 1DIpectllll IUIt be 109984 during each sil .:lnth period, or the project will be COIIIldered abandoned.
<br />WIG ro (lOR: YOOR PAILURJ fO RECORD A NOTICI OP ctIIMBNCEMiJIJ MAY RESULt 1M YOOR PIYIIfG !VIa fOR 1JfPROVBIlu1'8 to YOUR
<br />PROPERtY. 11 YOO II'fDD to OBtW PIKAlCIIG, COMBUL! 11110 YOOR WDBR OR AIr AnoRUY BIPORI RiCOfIDIHC YOUR lOtICS OF
<br />COIMDCDIBft. Jt1I8 l1IDIR $2,500 1M VALUB 00 lot mn to RiCORD AND POSr I 'NotIC! 0' Cl1IHDCim1I.
<br />
<br />
<br />~~/ &~"6~
<br />
<br />Stan or PLCIllDl
<br />coam OF O~ ANO c
<br />The foregoing 1Datrument was acknowledged
<br />before .. this ~~mS'R'f+19~ by
<br />
<br />~f'3t:>R.F\- S\'t,q uE.12
<br />who 11 p'@I'8ooalll' known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an oath ~ " .
<br />~.~ ~\.A )A. Q \) \. 0l ~ D
<br />(S1gnatur
<br />
<br />(Hue Typed, Printed or StUlped)
<br />NOTARY PUBLIC
<br />
<br />sun OF
<br />coom OP
<br />The foregoing in twas a~~OWledged
<br />before me this , 19 by
<br />
<br />
<br />..::i1s ~~r~~~_to IDS or who bas
<br />produced
<br />as identification and who did/did no~
<br />take ~ oetb,l ~
<br />
<br />(Signat~;~Y'l'l.~ ~ITh:j
<br />
<br />(Name Typed. Printod Or St-.ped)
<br />NOTARY PUBLIC
<br />CONNIE L BAILEY
<br />Notary Public, State of Florida
<br />My oomm. expires March 14, 1997
<br />Comm. No. CC265919
<br />
<br />
<br />"~^~-t>
<br />*~*
<br />d'.il"lf1A~
<br />"~Off\.Il"".
<br />
<br />DESRE J WU.LIAUS
<br />My ComrnI88IoR CC3a8073
<br />Expires Aug. ur, 1998
<br />80nded ~ HAl
<br />800-422-1555
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