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<br />T F:L Ilfl:
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<br />1:IlJO'3 P02
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<br />CONDITIONS OF PERMIT AYFIDAVIT
<br />1\. NOTICE 0.. DEBD RESTRICTIONS
<br />The unO.rtlllll84 \me.rnanc1l ~t thb Penlt 131 be iubject: to 'deed [sltrlctl0l181 wblc.h 118' be lOre rutrlcthe tbln City
<br />regulation.. Ybe onderl1gDeG a8eu.eJ relponttbllity for co.pllanc@ 11th lRJ appllClble Ilea r..ttletIODl.
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<br />B. UNLl~.SJUl_~RACTORS AND CONTRACT,Q!LMSPONSIIULITIES
<br />If tbI\ (M)er bee bind 8 oontr8ctor or conttllcton to undertake !IOrl, tbey ..y be rlqulclC1 to be HeeQed In accordance with
<br />state an4 loed regullltiOOl. 11 the contractor lR not Hcen.ell 81 requir.~ bJ 11., both the OIIIW' 1184 contractor Ill' be
<br />clte4 lor a .iedlllllllOOr violation llI1der Btat.e lilll. If tb. owner or Intended contrll:tor are \lDctrtaln u to tibet UCM8inv
<br />r~ir_otll 113' IIpply (or the lote1lded lfOr~, they lUll IldviBeo h couteet: the City of IBpbyrbUlI Bulldll19 Deparblent, (813)
<br />70A-~611.
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<br />FurtberlOre. If the owner ha. hir.d II contractor nr contract>>rB, he In ad~llIP.d to ha'. tbt cootractor(a) 91qo portlone of th~
<br />"Contractor 9~ttmJ" of thb applicaUon for wbleb tbey .ill ~ rnpontlbl.. If you, iI8 the ovner '190 atl tb8 tontrllctor,
<br />you 8re indiCAting thAt JOU. r.tbRf th8n the contr8ctor, are responsible foc tbe work. If th, contr.ctor wlahe. Jou to li~
<br />ae coot18clor tbat la, b@ an iudlCltlon that hp. II not properly lic9n1.a end 19 nnt IDtltled to parllttlng prlYlleg.. In the
<br />city or '~bJrbll1',
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<br />c _T~.~POR1-'~T~.9!L):~r!\,c;r___FBES AND UTILln cOmn~<;T;1:.Qlf.J.EEG
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<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STA'l'UTJS, AS AMENDKD)
<br />I C,(t{~tbAt I, the eppllcant, blv~ been prowldea .ttb a coPY of 'Florioa'R cOOItructlon Lien Law - ~B(l. ProtectIon
<br />Guld@" prepued bythll Florid, Depart..nt of Agriculture Mil COQBlJIII!r Affaiu. If the eppllcant i. IQIlIGOt\e other than th(l
<br />"owner', J Clrtlrr that I ~v8 obt,lntO 8 copy of the &boy! described docu~nt and pr~II' In good f31th to dell'er It to the
<br />"owner' prior to COII@nc~nt.
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<br />E. CONTRACTOR'S OWNER'S AFFIDAVIT
<br />I certify t all the Inforlltlon in thl8 application is accurate Bnd thnt all fOrk will be ~on8 in COIPliaoct wJth all
<br />8ppllrnbJ~ 1..- regul.tlng conIlructlon, .onino, an~ land d9f.lopl9Dt.
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<br />~pplication 18 ~r.8bJ lade to obtaIn a ~rllt to do work an4 installation a8 Indicat~. 1 certify that DO work or
<br />inBtallatlon ~ ~ce6 prior to loou,nce of a ptrlit and that all work wIll be perforttd to ...t 8tandardJ of all lawe
<br />r~gul~tlng con.tructloo, City coOeA, loning [!gUlationR, and land duyolopeent rogulatlonA in the jurltdlctlon. I allo
<br />c~rttfy that I un41l.tanD tbat ~ rRgulatlon. or otbor gOJetDItDtal IV8ncl8B II' apply to the Intt04e4 work, aod that it IB
<br />-v reBponIlblllty to 14entlty what actionA I .ust takl to be in co.pllannR. Such agonelo. Inelu4a but art not Illlttd tOI
<br />. Depar:~t.j)t1ndI.QQI9Ilt~lJ'-9Jl.1~!!!J.!I - (yprllAR Boyhe8dl, Votlanc1 Are81 anl'l llRJitorwentAlly Rendthe ~i).00A,
<br />Vllter {VaRtevitter Trellt"l9nt
<br />t ~utbvelt Florid' Water Hanagll8Dt Dlat(lct . lell., Cypr881 Bayb.~dl, Vetl8nd ftreaRr Alterlnv Watercour891
<br />. ~ Co~ of ~1DIIr. ~ 8",,11'1 DoCke, "8vlgable Watettlay.
<br />t ~t.leDt Of trrB~UU'~~!tlenlC88, IDvixWIeJ1tlll Beeltb \h!U . W,UI, Vattft1fllhr TrMtIeIlt, 61ptlc tiUlh
<br />t us Indrcaentll prot!JHr' IVIfICI ~ A8btato9 abatgent
<br />( iito certify that, If IItlrlal Is to be used 1n flood lone MAM or 'A,ltC.', It I, unaer.tood that l draInage plin
<br />a~rel,l"9 a -COIP8fta,ting voluae' .ill be RI~ltt@d which Ip prop,red by a professional '~gln.et tegletor8d In the Stale or
<br />FJort~3 prior to perllt iIIUane@. .
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<br />~ pf!rln lDRUM 8MB be conJtrued to b@ II liteM! to procp.ed lllth lbll work tlOd not 88 autborlty to ,lolatll, canool alter, or
<br />8et SRlde Inr provl.lon. or the technical cod~n, nor 8hnll In,uBDce or 3 per.,t pCQy@nt tb& Bull~lD9 Officill f[Ol tb't9lftlt
<br />requiring I corr,ctJon ot errore In plane, con.lruction, or viol~tlone of any code. SV.fJ pttllt IIBUed shall becoII 1>>.8116
<br />unJp-RI the work .uthorlltd by Ruch per.lt i8 c~nced llltbln ,I. IOntbt of i8.u8nc~, or If work lutborlaod by tb8 "tltt 18
<br />IJU'p".nd~ or lIbamld for 8 perii'd of sh JO.lltM aHer tbo tlM the work 18 ~Dced. Ooe 90 aay utlMlon of t1Je, IIY be
<br />3Jlow@d for t.lt~ Pfnlt vltJI fll clI8f9' of U5.00. !bl! ule.n9lon ,ball 00 tequt8tOO in "dUny to the 8uUdlno Offlelal. An
<br />3WrovP/1 11l8~cUOll I\Ilt tit 1099~ ~uriOi BlICh sh IOnlb period, or tb, ptoj.ct IfUI be ooDJIl4ere4 abanOOntd.
<br />"ftR'H~G TO lNDJI~ TOOl rAlLU1l1 TO RlCORO A "OTICE OF C{JIKnCllMm IOIY RE9ULT IN YOOR PUIKG !VICl fOR IMPRC.YnJtDT8 TO YOOR
<br />PllQrltm. 11 TOO JJlIID TO OB'fIIJI ,rWCll((l, COIISUL! WitH YOOR LPUB OR All AnORm BIFORI RICOIUlING YOOR MOT1Cl OF
<br />r1JDWltWJn'. J0B6 ""DIR t2,500 1M VALUI 00 Il(1f IIlID TO ~KCOIID lND p09f A "MOUCll Of WVlDCIKQJ'.
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<br />STATll 0' Fl.OJlIOA /)
<br />crom OF t"a..J..1!.A.')
<br />Tbe foregoing in,trUllent MiiJ-lic7~ledged
<br />bdoro mp thh t!.tfI. 21--, 19 . by
<br />
<br />- ~ r.'iit Hfa.h.sck- -
<br />who 19 persona knOMn to ~a or who hoa
<br />produced
<br />89 i~entif1~lion aDd who dI~/did not
<br />take "" !!h~; 1/J..t.d; ~
<br />TIilVDa'.tUreJ~~L . i. ~ . .
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<br />(N~.eTyped, Printed or Bt~ped)
<br />lillTI\8Y PUB~IC
<br />
<br />IITAJIi OF Ft.otlIDA /J __
<br />('1MIJY or ~
<br />111.. (of9901iiij ~p-atruWtm'8CkilOlfludged
<br />hAfore Jn~ tbi~' c.::lq r 19.!1f:- by
<br />
<br />
<br />.b.;li~ellfe.~..-or who-h..
<br />pro(lut:'~6
<br />a8 idAI.lU7.IoaHon and who did/J.Ta"nor--
<br />tek~ -
<br />~:~gn:_::m~-' .1 J'~l~'
<br />(",.e ,Typed, Printed o~.,~.~~..peO)
<br />1fO!M!_,!UD~~c>> ~. "~'f'~ ';:~:~i'~=1&
<br />- . ; ; El<P1~: Jt\t'tUllf'/. '3,111II
<br />, Ilandti\ n:~,: Noll', ?l,;1Il1l \iIldIlWIIIII
<br />--- ......
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<br />,oIJ....'!J....r.o.. MARGARET J. CRlMENI
<br />~QJ:r ,~ MY COMM~SSION' CC 342115
<br /><..~ "i EXPIAES. Janumy 18. i.
<br />"'I. ,,~ JIllnded 11Hu NoIIIy NIIIc lbtItVlIlIIII
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