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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />!be undersignec1 understands that tbis petlit lilY be subject to Ideed restrictions I Ibieb lilY be lOre restrictive tban City
<br />regulations. !he undersignec1 assUIeB responsibility for capliance litb any applicable deec1 restrictiOll8.
<br />
<br />B. UNLICENSEP CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If tbe OlDer bas birec1 a contractor or contractors to undertake wort, tbey lilY be required to be licensed in accordance litb
<br />state and local regulatiOll8. If tbe contractor is not licensed as required by lal, botb the OlDer and contractor lilY be
<br />citec1 for a lisdl!leanor violation under state lal. If tbe owner or intendec1 contractor are uncertain as to lhat licensing
<br />requireJenu lilY apply for tbe intended IOrt, they are advised to contact tbe City of Zepbyrbills Building Departlent, (813)
<br />788-6611.
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<br />FurtberlOre, if tbe OlDer has birec1 a contractor or contractors, be is advisec1 to bave the contractor(s) sign portiOll8 of the
<br />IContractor Secti0ll81 of this application for Ibieb tbey lill be responsible. If JOU, as tbe owner sign as tbe contractor,
<br />you are indicating that you, ratber than tbe contractor, are responsible for the IOrt. If tbe contractor liabes you to sign
<br />as contractor tbat lilY be an indication tbat be is not properly licensed and is not entitled to perlit.ting privileges in tbe
<br />City of Zepbyrhi11s. --
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<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
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<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, tbe applicant, bave been providec1litb a copy of IFlorida's COnstruction Lien Law - &.olDer's Protection
<br />Guidel preparec1 by tbe Florida Departlent of Agriculture and ConsUler Affairs. If tbe applicant is 8OI8OIl1l otber than tbe
<br />lownerl, I certify tbat I bave obtained a copy of the above described docUlent and pl'Cllise in good faitb to deliver it to tbe
<br />Rownerl prior to cOll8Jlcelent.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the infoIJation in tbis application is accurate and tbat all work lill be done in cOlpliance litb all
<br />applicable lals regulating construction, loning, and land developlent.
<br />
<br />Application is bereby lade to obtain a perlit to do IOrk and installation as indicatec1. I certify that no IOrk or
<br />installation bas ~cec1 prior to issuance of a penit and that all IOrk lill be perfoll8l1 to leet staDc1ards of all laws
<br />regulating construction, City cocles, loning regulations, and land develoPleDt regulations in tbe juriSdiction. I also
<br />certify that I understand tbat tbe regulations of otber goverDII8Iltal agenCies lilY apply to the intended wort, and that it is
<br />If responsibility to identify ,hat actions I lust tate to be in COIpliance. Sueb agencies include but are not lilitec1 to:
<br />t Depart:lent of Envirolll8Dtal Regulation - Cypress &aybeada, Wetland Areas and Envirolll8Dtally Sensitive Lauds,
<br />Water/Wastewater !reatlent
<br />t Soutbwest Florida Water Managel8Dt District - Wells, Cypress Baybeads, Wetland Areas, Altering watercourses
<br />t ArQ Corps of Engineers - Sealalls, Docks, lavigable Waterways
<br />t Departlent of Healtb i Rebabilitative Senices, InvirODlBDtal Healtb Unit - Wells, Wastelater !reatlent, septic !ants
<br />t US EnvirODlBDtal Protection Agency - Asbestos abatl!lll!Jlt
<br />I also certify that, if fill Iilterial is to be used in Flood Zone IAI or IA,etc.l, it is understood that a drainage plan
<br />addressing a ICOJpenBating voluel lill be sublitted lbieb is preparec1 by a professional engineer registered in tbe State of
<br />Florida prior to peIlit issuance.
<br />
<br />A perlit issuec1 shall be construec1 to be a license to proceec1litb the IOrt and not as authority to violate, cancel alter, or
<br />set aside any provisions of tbe technical codes, nor shall issuance of a perlit prevent the Building Official fl'Cll thereafter
<br />requiring a correction of errors in plans, construction, or violations of any coele. Ivery perlit issued shall beCOll! invalid
<br />unless tbe IOrt authorized by sueb peIlit is ~ced litbin sillODtbs of issuance, or if IOrk authoriled by tile peIlit is
<br />suspended or abandoned for a period of sillODtbs after the tile the IOrk is co.encec1. One 90 day atensiell of tile, lilY be
<br />allowed for tbe penit litb fee charge of $15.00. !be atension &ball be requested in writing to the Building Official. An
<br />approved inspection lUSt be logged during eaeb sil IOI1tb period, or the project lill be considered abandoned.
<br />WARRING !O OVXD: YOOR FAILURE !O RlCORD A IO!ICK OF C<IIIIDCIIIIMl' MAY RESUL! II YOUR PAYlIG DICK FOR IIIPROVIIIIIIS !O YOUR
<br />PROPIR'lY. IF YOU IIDIID !O OB!IDJ FIIUCIIG, COISUL! WI!B YOOR LDDIR OR II AnoRDY BIFORI RICORDIHG YOUR HOlICK OF
<br />COMMIICIIDr. JOBS URDU $2,500 II VALUE DO IO! IIDD !O RECORD AHD POS! A 'IO!ICK OF COMMIICllDrI.
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<br />
<br />~JVVI ~~
<br />
<br />c~ '~_I
<br />SIGIIA'lURI: 0IfIIR OR AGm Cb.-Fe I /lr[;L~ I,
<br />
<br />SlAtE OF FLOWJA
<br />COmy OF ~Ct :'5 (-D
<br />The foregoing instrument was acknpwledged
<br />before lie this / ;2 /; .s.- , 19 ~ by
<br />
<br />, I
<br />La flJ i fj ('[xu I)
<br />who is personally kJ)own to lie or who has
<br />produced r: L /) / ~
<br />as identification and who did/did not
<br />
<br />tak~7 ~ oath. I. /,'7 /
<br />li/]q.-u')7/v7<:ja11.~,.\.
<br />(S!9nature) .'
<br />,~Y1ay-c"J) /.-- ' l~b'E' r-
<br />(NUt!. Typed, Printed or Stamped)
<br />NOTARY PUBLIC Notol'Y fiji/ii" Stlltc fA Florida
<br />M; C~mmb$ion Elt!l;m Feb. 22, 199$
<br />
<br />Itonded Thl"\J Troy Fain -lnsuran,eJllc..
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