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<br />CONDITIONS OF PERMIT AFFIDAVIT.
<br />A. NOTICE OF DEED RESTRICTIONS
<br />Tbe undersigned understands that this perlit lay be subject to "deed restrictions" wbicb lay be lOre restricti~ than City
<br />regulations. Tbe undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If tbe owner bas bired a contractor or contractors to undertake work, they laY be required to be licensed in accordance with
<br />state and local regulations. If tbe contractor is not licensed as required by law, both the owner and contractor lilY be
<br />cited for a lisdeleanor violation under state law. If tbe owner or intended contractor are uncertain as to wbat licensing
<br />requireleRts laY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
<br />788-6611.
<br />
<br />Furtberlore, 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 a~plication for wbicb they will be responsible. If you,' as the owner sign as the contractor,
<br />you are indicating that you, ratberthan the contractor, are responsible for the work. If the contractor wisbes 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 witb a copy of "Florida's Construction Lien Law - HoIeowner's Protection
<br />Guide" prepared by tbe Florida Departlent of Agriculture and ConsUler Affairs. If tbe applicant is sOleOne otber than the
<br />"owner", I certify tbat I bave obtained a copy of the above described docUlent and prolise in good faith to deliver it to the
<br />"owner" prior to couencl!lent.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforliltion in this application is accurate and that all work will be done in cOlpliance with all
<br />applicable laws regulating construction, loning, and land developaent.
<br />
<br />Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
<br />installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all laws
<br />regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. I also
<br />certify that I understand that the regulations of other govetnleDtal agencies lilY apply to the intended work, and that it is
<br />IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not 11lited to:
<br />t Departlent of HnviroDleDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDleDtally Sensitive Lands,
<br />Water/Wastewater Treatlent
<br />t Southwest Florida Water Hanagl!lent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
<br />t ArlY Corps of Engineers - Seawalls, Docts, Navigable Waterways
<br />t Departlent of Health i Rehabilitative Services, HnvirODleDtal Health Unit - Wells, Wastewater Ireatlent, Septic Tanks
<br />t US EnvirODlental Protection Agency - Asbestos abatl!lent
<br />I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
<br />addressing a "cOlpensating volDle" will be sublitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance.
<br />
<br />
<br />STAll OF F~
<br />COUIfY OF '~Q)
<br />The foregoi 9 instrument was acknowledged
<br />lre me this t ::; · 19~ by
<br />
<br />!Je~ hilA 0
<br />who is personal y known to me or who has
<br />produced tt ~,P.' /)L A? 5- L/ 'r
<br />as identif1ca ion and who did/did not
<br />li ~n oath~
<br />. /Ij\~. 1Af' ~..(f~
<br />( ignature)
<br />L,' AJ Oil- SUr 1:!:;!~5
<br />(Name ~yped, Printed 0 Stamped)
<br />NOTARY PUBLIC.
<br />NOTARY PUBLIC STATE OF nO,WA
<br />MY COMMISSION EXP ,1U?iF . :s~s
<br />BONDED THRU GEfGU\l. Ii.:,.
<br />
<br />STAfIl OF ~
<br />COUIfIY OF W f" ~
<br />The forego ng instrument was a~~wledged
<br />be~.e this >r, f ~ . 19~~ by
<br />
<br />~+ .C~
<br />
<br />w~o 's personally known to me or who has
<br />produced Pc f)J:?/{..).PK'-f t:' ,C~
<br />as identificat10n and who did/did not
<br />
<br />~~~ ~& fQ
<br />
<br />(S1gnature) ~
<br />~; f1lf)4 ,~/)~ ~C<)
<br />(Name Typed, PrJn ed I tamped)
<br />NOTARY PUBLIC
<br />
<br />NOTARY PUBLIC 5'" .t" ~
<br />MY COMMISSION !::,~~T;;'n?; [~f1~?~
<br />BONDED TW\"I G".....-... .J.... '-~ ....,.,.,
<br />r.... '':.f.Kkf:; f;,;'> ~,
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