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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />The undersigned understands that this perlit aay be subject to 'deed restrictions' Ibieb laY be lOre restrictive than City
<br />regulations. !be undersigned assBles responsibility for COIpliance with any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the owner bas bired a contractor or contractors to undertake work, they aay be required to be licensed in accordance lith
<br />state and local requlations. If the contractor is not licensed as required by law, both the owner and contractor .y be
<br />cited for a lisdeleanor violation under state lal. If the owner or intended contractor are uncertain as to Ibat licensing
<br />reguiretents lay apply for the intended work, they are advised to contact tbe City of Zepbyrbills Building Departlent, (813)
<br />788-6611.
<br />
<br />FurtherlOre, if the OlDer bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
<br />IContractor Sections' of this application for wbicb they lill be responsible. If you, as the owner sign as the contractor,
<br />you are indicating that you, rather tban the contractor, are responsible for the work. If the contractor wisbes you to sign
<br />as contractor that .y 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 with a copy of 'Florida's COnstruction Lien Law - ROJeOIIIler's Protection
<br />Guide" prepared by the Florida DepartJent of Agriculture and ConsUJeI Affairs. If the applicant is SOJeODe other than the
<br />lowner", I certify that I bave obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the
<br />"01fl1er" prior to COIIII8DCetellt.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforlation in this application is accurate and that all work will be done in cQIPliance lith all
<br />applicable lals requlating construction, loning, and land developlent.
<br />
<br />Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no wort or
<br />installation has cOlleDced prior to issuance of a perlit and that all wort will be perfoIJed to leet standards of all laws
<br />regulating construction, City codes, loning regulations, and land developl!Rt requlations in the jurisdiction. I also
<br />certify that I understand that the regulations of other govelDleDtal agencies laY apply to the intended IOrt, and that it is
<br />IY responsibility to identify wbat actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
<br />t DepartJent of EnviroDJeDtal Regulation - Cypress Baybeads, Wetland Areas and BnviroDJeDtally Sensitive Lands,
<br />Water/Wastewater Treatlent
<br />t Southwest Florida Water HanageJeDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
<br />t ArlY Corps of Engineers - Seawalls, Docks, lavigable Waterways
<br />t DepartJent of Health , Rebabilitative Services, EnvirODlental Health Unit - Wells, Wastewater Treatlent, Septic !ants
<br />t US EnvirODJeDtal Protection Agency - Asbestos abatelent
<br />I also certify that, if fill aaterial is to be used in Flood Zone IAI or IA,etc.l, it is understood that a drainage plan
<br />addressing a 'cOJpenSating volDle" will be sublitted wbich is prepared by a professional engineer registered in the State of
<br />Florida prior to perlit issuance.
<br />
<br />A perlit issued sball be construed to be a license to proceed with the wort 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 frUl,thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Bvery perlit issued shall becoIe iovalid
<br />unless the work authorized by such perlit is COll8Dced within sillOoths of issuance, or if work autborilecI by the penit is
<br />suspended or abandoned for a period of sillOntbs after the tile the work is co.encecI. One 90 day l!Itension of tile, ., be
<br />allowed for the perlit with fee charge of $15.00. Tbe extension shall be requested in Iriting to the Building Official. An
<br />approved inspection lUSt be logged during eaeb silaonth period, or the project lill be considered abandoned.
<br />WARIING TO OWIER: YOUR FAILURE TO RECORD A IOT[CE OF COIlHDCKHBIft' MAY RlSULt' [I YOUR PAYIIG D[CE FOR IHPROiBIIDTS TO YOUR
<br />PROPERTY. IF YOU Ilft'BIID TO OBTAIH FIHAIICIHG, COIISULT WITH YOUR LBJIDIR OR All AnoRIEY BEFORI RICORDIH' DICE OF
<br />COHHENCEHBIft'. JOBS UIDBR $2,500 II VALUB DO lOT NBBD TO RlCORD AJID POST A "IOT[CB OF "
<br />
<br />
<br />M 1-1 j I . ,/ tI
<br />S[GjATURB: <*IBR OR AGBIft' SI AT B: COIft'RACTOR
<br />
<br />
<br />STATB OF FLORIDA
<br />COUNTY OF
<br />The foregoing instrument was acknowledged
<br />before me this , 19____ by
<br />
<br />STATE OF FLOR[DA
<br />COUlft'Y OF
<br />The foregoing instrument was acknowledged
<br />before me this , 19_____ by
<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 />who is personally known to me or who has
<br />produced
<br />as identification and who did/did not
<br />take an o~th.
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY.PUBLIC
<br />
<br />(Signature)
<br />
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
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