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<br />AF-'R-l':;l-' ':35 TUE 10: 1:::: I D:
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<br />TEL tl[':
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<br />tf045 F'02
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<br />CONDITIONS or PERMIT AFPIDAVIT
<br />A. NOTICE~ DIED RJSTRICTIONS
<br />. tIDI1Irilplll1 tub tlaat ~II putlt MY be .ubJect to ~411d rutrlctions" ,bleb ., be lOre r..trleU" tbua Cltr
<br />ngaJ.aUa. D1111G1nlf*1... reapalbl11tJ for lDIPl1l1lCI .ltb IDY applicable aeea reatr1cUOII.
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<br />B. UNLICEHSBD CORTRACTORS AND CONTRACTOR,RBSPONSIBILITIBS
<br />If tlIe IJIIJ8t bu bind . _tractor or contractor. to undertab work, the, II' be regulnd to lle UCtDlIG II actOr41Dc:8 with
<br />ltlte eacJ local ngultUClftI. If thl CODtraetor i. not Hewed 18 rlQUirtd br In, both Ule __ ID4 CGIltrlCtOr ., be
<br />cite4 for a .lad__r ,1ol.UOD ua4er .tate law. If the owner or Intll1c1td contractor are uncertdD u to ....t Ucatlag
<br />rlllir_ta .f IpplJ for tJae iDbmded .or", tber lIa Idvltell to contact tbe City of lapbJrbi1l1ldl41DV nepm..t, (813)
<br />'.1611.
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<br />httbenore, if tb8 OIQU baa bind a contractor or contractors, be i. advised to baY8 tbe coDtractor(.) l1ga portlOll8 of the
<br />"CoDtrKtor BecU.' of WI tpp1icaUoo for Ibicll tbey will be rllpOnllblB. If JOU, .. t.be GlIDer lip.. tile _tractor,
<br />J'IIO ue 1D4lcatlog that JOU, r.tbIr than the contractor, are respooaible for the IIOrk. If the COIltrlctor .1_ JW to lip
<br />. CUDtractor tbat III be III iDticaUOD tllat he 11 Dot pmperlr UctDIll1u4 18 DOt entitled to pmlttlDg ptl,nlpl ill the
<br />cltr of IepbrdUla.
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<br />c. TRANSPORTATION IMPACT FEES AND UTILITY, CONlfBCTIOH FEES
<br />
<br />D. COHSTRUC'1'IOlf LID LAW. (CHAPTER 713, FLORIDA STATUTES, AS AllBHDBD)
<br />I c:ertlfJ tIIIt I, tIIe.eppllClllt, II1Ye beeD provlc11d .iUl a cop, of -Florida'. CODItrucUOft Lien Law . ......r'. ProtecUClIl
<br />Gu.l"- prepare4 br till llorill DeputllDt of Igdc1.l1ture and CoRlUJer Affairs. If tbe appUcut 18 .... ok tbID the
<br />'1MIIl'-, I cetUfy that I 11Ift obtlIDed . CClPJ of the Ibm 4ucdbed c10cIIIent and pflalae iD good faltll to aa1111r it to the
<br />....' prior to ~~t.
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<br />B. OONTRACTOR'SlONNER'S AVFlqAVIT
<br />I Clrtif, thit III tIaI .tnfOl'lltloa in till. application ia accurate and that all IOrl will be done ID _IHCI wlUld1
<br />."Ucable 111II replaUllg IDIItncUGl, ItGIDg, an4 110(1 ae,elopllllt.
<br />
<br />Application i. berebJ .. to obtallll perlit to do work ID4 installation u iD4icated. lemUr tJlit DO IOrk or
<br />iDlta11atioa baa ~ prior to 1l1aaac. of . penlt ID4 that 111lOr1 ,,111 be pufODld to _t ltu41r4t of 11111n
<br />tegulat1D9 CODItrucUCIl, cn, codu, .Oft~ regulations, 11\4 IPC1 de,elOpMDt ngulaUo. In the ,urlldlct1C11. I &110
<br />c:erUfJ tIIIt I UD4entaac1 tbat ...... regulatlODl of other fOyeruenW aglDCill .y appl, to the lDt~ ..1, IDI1 tIIIt It I.
<br />I! r.paiblUt, to 14IDtifJ wllat tOUODl I IUIt tab to be ill COIpllancl. Buell ageDclll lnclucla but art DOt 1111t14 to:
<br />tf!llrtl-eDt of IIlflnMltnta1l~at''!! - Cypr... Barhuda, W.UIU1c1lttu and lawlrOlll8lltallJ I_lUte LaD4s,
<br />Watu/Wlltnlter fr.._t
<br />t IoutJltelt Flori.. lltar lIiIDIa_t Di.trlct - "IUI, CJprua Barb.ads, Wetland II..., lltering later~
<br />t - of liiIrI .. 181II111, Docb, la,lgable ..tInsfI
<br />t t of lItlUle 8micu IDdtoDllDtal Realtb Unit - lIe118, IIutlllter Ir...t, Septic I.
<br />a 1I1DY1r.-tIl ... ,IQtlICJ .. llbutoe IbIt_t I
<br />I a1Io certlfJ that, if flll llterl,lll to be \I8ec11n Plood IoDI -.- or 'I,ate.', it il uD4eratood that . drllDage pllD
<br />"'119 . .~t1Dg toJ_, will hi ..Itttel which is prepared by . profeaaioul eaglul. fl9l1tertd ID till State of
<br />Floda prior to ptII1 t 11IIIIlCe.
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<br />I penit i..~ Iball be cautrue4 to be a license to procled with the IIOr1 and not 88 authority to dolata, CIIICIl liter, or
<br />lit aside DJ prod.lou of till tdDlcal COlla, DOl' lball iS8uance of a penit pr"lnt tb8 Bul1d1Dg Offlclll frcll tllenaftu
<br />~ naur1ng I cometiCl1 of errorl in pIa, CODIUuCtioa, or YlolatlODf of aD, coc1e. .YII'J penlt l..ueG ..1 ... walld .
<br />111I1.. the .or. autllorllll1 br auch pmlt 11 ~ t11tbin .flatu of llll1aDce, or If IOrk autbodle4 br tba palt I.
<br />IUpI!ll1Id or IbInl1aDtl1 fot . peri04 of Iii IDIlthl .(tar tile till the wrt 1. ~cea. ODe '0 &if ataSaa Of u., ., be
<br />allORd for the pemt ,itb '" charve of '15.00. file eat_Ion shall be rlQUllted in .IUng to tile 8u11411lg Offlclll. In
<br />, IPPI00ed lD8pect.iCII at be loggect clUing ucb IlIlODtII perloc1, or the project will he cou14erec1 ......
<br />_J.G fO (MJJI: _ rur.ua ro IICOID AIOI'ICI 0' alllDCIIlBtff JIlY DIUL' III lOOR PIIlIIG BleB fOR ~8 to YCIJI
<br />ram,. I' 100 IIIIID to (11m 'IUlCIIS, COII8DLr VIlli _ _II OR IJIlft(IDY 11M RICORDllfG IOUIIOfIQ 01
<br />cmat'DIIIrI'. Jt18 tIDIItZ,5GO U 'ILUI DO JOt IUD to RICORD lID POSt I lJOrIC! or ~'.
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<br />11&11I_: MIl II ~ 81;0_: CCIDICrOI '
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<br />IIItI 01 PLCIlDl
<br />caam or
<br />!be foregoing ID.t~t .ae acknowledged
<br />before .. tbi. , 19_ by
<br />
<br />S'IH 0' MlOA
<br />COUIrY or Hi 11 sborouqh
<br />The foregoiDg iDat.t'Ull8llt ... aClUlowleclge4
<br />before .. this Aorj 1 12 , 19 95 by
<br />Louis R. Colangione
<br />who i8 per.onally mOlll1 to _ )ti*,Oiiti~~
<br />-~
<br />as identificatiOD and .bo :am/did not "" T
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<br />t.k~ ~ "-
<br />(Signat .) -J v ';1 ~
<br />Mary T. Hugbes
<br />(Nue TJped, Printed Lor 'StMPed)
<br />ROTARY PUBLIC
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<br />~~r;::.,,,
<br />1~1:""~"
<br />i:.€ ~:i
<br />~'... .t1j
<br />-..~~
<br />
<br />MARY T. HUGHES
<br />MY COMMISSION. CC 401834
<br />EXPiRES: January 27, 19ta
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