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<br />t 101.)--15- "34 TUE 13: 05 I D :
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<br />TEL lID:
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<br />tl009 P02
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<br />CONDITIONS OF PERMIT AFVIDAVIT
<br />A. NOTICE 0' D&BD RESTRICTIONS
<br />'fbe un4enlgall1 ..taDc1a ~t thle penlt la, be eubject to 'dnd rutrlcUOII8' ,bleb ., be lOre rutrlcth. tbeII City
<br />reguJIUODI. !lie UDCltJ.lpe4 ..... relpollllbllitr fot 1Dp1lilnce 11th an, applicable eeea rutrlctlOlll.
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<br />B. UKLI~.BD CQl(TRACTORS AND CONTRACTqR"RBSPONSIBXJ.ITIES
<br />If till OlDer h.. blred a coatractor or contuctOrl to unc1.rtuI vork, tbIJ uy be nqulrtd to be llceoltlt in ICCOr4anCI with
<br />Itate aD4 loea1 flglllatiODl. If tbI contractor 18 DOt llceneelJ .. rllQllirld by lal, both the 0IIDIf - eontrlCtOJ IIJ be
<br />clte4 for a .il4M1111Or violation under 8tate Ie", If tile OI08r or intemled CGIltractor are uneertalD II to "bat l1ctllling
<br />r~ir.-nta II' appl, for the Intetl4ed work, they lU'e Idvil.a to coatect the City of IepbYlbllll lulldiD9 DepuUeat, (8U)
<br />788-6611.
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<br />PurtberlOre, if tbe owner hae bire4 a contractor or contractorB, be 18 advlled to haft tbe coatrlctor(l) sIgn portlone of the
<br />-COJltl'lctor 8tctiflll' of WI appUcaUan for Ifbieb tbeyvill be rupoftJlble. If JOUr 18 the Oller 'lga as tb8 CCIIIuactor:,
<br />you are IDC11caUIl9 tJIIt JOU, rathllr than the contractor, an fesponalble for tilt .ort. If the eontractor wl_ JOU to aign
<br />iI8 contractor tIlat II' be III in4iCIUon tbat be 11 not properly lic8I181cl and ., not entitled to penltUng prlllleg.. in the
<br />elly of Zepbytbll11.
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<br />C. T.RAH~POR!.~!ON "_~~PACT FEES AND UTILXTY CONNl{~~ION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATU'1'ES, AS AMBHDKD)
<br />I certUy tbat I, t:IrI8 appllcant, bave been prov14e4 with a copy of -Florida'. CCIIatructiOll Lien Law - JIoIeoImIrI. ProtecUon
<br />Guiae" prlpltec1 by" the floIl4. Departlent of Agriculture an4 COllllIIII Atfain. If the appl1eut i. ~ other tIIaD the
<br />'OlDer', J cut1f, that I hive obtained 8 copy o[ tbt above delt!rlbec1 docuIlmt and pr~l.. 111 good faith to dt11Yer it to thl
<br />'OWIIer' prior to ~JletI8nt.
<br />
<br />E. CONTRACTOR'S OWNER'S AFFIDAVIT
<br />I certify t III the inforlltlon In this application is accurate and that all IOrk ifill be 4008 In COIPliaoce with III
<br />IppUeabl, 1... ngul.tllMJ toDIuucUon, looing, an4 llI1ddlvelopnnl.
<br />
<br />Application ia MIIlbJ .. to obtain a petlllt to do work 81IC1 inltallation II indicated. 1 cettifr tbat no lUrk or
<br />installation bu ~eecl pdor to l..uanee of a lltl'lit and tbilt all IIOrk ,Ul be perfone4 to "It atandatda of all 1a-.
<br />regulating COIlItruetlon, City COCleI, soning regulationl, and land deY8IOVHllt regulatlonl ill the jurllC11ctlOll. I allO
<br />certif, tltit I WIOerttancl tlIat tJJe regulation. of other gOY8tDllDtal quellS III apply to the lnt8P4ec1lfOl't, aocl that it lB
<br />Ii relpollllblUty to identity wbat actionl t IUJl take to be in COIplllllC8. Sucll agenda Inel. bat an not Hllted to:
<br />t DePa~t of !IldtoOllllt,l Regulation - Clpreal Bayheadl, VtUan4 AttU and InYitOfllelltally Balti" L8nclI,
<br />VaterlVBBtewater IreatJent
<br />t 80utMIt Florid. Mater MenaQll8l1t Dlltrict . leIla, CypruI Baybe., Wetland !teal, Altering latercour...
<br />. = of t=I1MIr1 .. a....llt. Dotu, nav1gable waterway.
<br />t De t of ~~"leJIabl~ltatlYl SmICI., IDfirVDI8Dtal Health Unit . WeIll, I.thaler 'frstlent, Septic tanh
<br />t US lD,lraMntll ~0Il AaIDCJ .. l.but08 abatuent
<br />I allO cuUfr tMt,lT1Il1 ..tedal 18 to be use4 In '1004 Iont 'A' or -A.Ilc.', It It un4eretood that I 4t,lnIge plill
<br />atldreulng a .COIPIIlIItiDt vol\i11' will be lubaittlld vbleb it prepl1t4 by a profualoul engineer teg1atsrll11n the State of
<br />PlorMII prior to penlt illUMee. .
<br />
<br />A pe.nit ISlued Bball be c.oottruect to be 8 license to proceed with tbl IfOrk 8114 not 81 authority to ,Iollti, CUClIl alter, or
<br />set Islde any provl,l00J of the technical codeR, nor Rball issuanct Of a peralt preyent tbe Builaing Official ftal tbttoafter
<br />requJrlnq a cornctlOl1 of error:8 in pll118, COllIUuction, or violations of any code. Bvery peralt 118_ ...1 beCOI8 1Jlwa1id
<br />unless the work autJlocbed by IUch petitt 1& COMenced llltblD ... IOOthI of i88ulUlct, or if lfOl'k 8otllorilG4 by till petlit IB
<br />lu,penae4 or ebIn40Dtd for II period of IUlOIIthe after the tile the work Is~, One 90 tal 111:IrIa10ll Df tile, MY be
<br />lI110wfd fot tile penit vitia f.. charge of $15.00. !be utenelOll alIaU be requutea in ,dUnq to tbe Bul141DQ Official. An
<br />approved IDlpecUoo IUIt be logged during Ilch sil IIOOtb period, or the ptoject .ill be CODIlhre4 ~.
<br />"DlIIG ro (NOR: YOOIlAILUII YO RICORP A lOflCl OF C<IICDCBMIlft' MAY RESULT 1M Yova PIYlIO "'ICI ftlR ~8 TO 1001I
<br />PROmTY. IP 100 IIIUIJ YO 0811111 "lwCIlG, COISUL! WItH YOOR LIIDIB OR U AnORDY BI10II RICORDIIG YOOK IOIICl
<br />COIMDCIJIIII'I'. JOBS tz,soo 1. VALUI 00 DID fO RICORJ) AND l'09f A '.OrICK ..
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<br />81
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<br />STIR OF FtOIllDA ..f1
<br />COORYY Of 14-$ eo ... L
<br />Tbe foregoing ~~ent vas 8~~ledgad
<br />before lie tbis o!:l.., 19 q--r by
<br />
<br />---/?,f.:,% ~-
<br />wbo is per. 811y known to me or who has
<br />produr:ed
<br />as identification and who did/didnor:-
<br />
<br />::~~~:t/}1J~r"~
<br />
<br />,_ In~. L,4e,,,,,,,e"i I
<br />(Hue Typed, Pdnted or Stempeoj--
<br />!~MrfJUDLIC
<br />
<br />.....~?ilt\. MAR8ARET J. CRIMEM
<br />l.'f ~ MY CQMMISSlON' CC 342116
<br />~ ElCPIflES: Jluury 13. 1.
<br />"'~ IlCIndlld ltmJ NotIIy NlIIc tkIdIrWIIlIlI
<br />
<br />B
<br />
<br />
<br />STAR OP FtOIllDA LJ
<br />coom OF ,Mev
<br />The foregoIng inB~t Mae Gc&ftOMledged
<br />before 11I9 this ..':1#c/Jf~~ , t9.z.c-by
<br />
<br />who I. ~'tib ~~~ho hao
<br />
<br />produced
<br />as identification and who di~/dld Got
<br />ake an MAReARET J. CRlMENI
<br />
<br />EXPIRES: Janu8IY 13. 19118
<br />lloIIIIDd "I'IlIu NoIIIY NIIIc lJIlllIMIIlIII
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