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<br />. CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />!be undersigned understands that tbis pmit lily be subject to Ideed restricti0l81 tdJiclllilY he lOre restrictlYe tbaa Cit;
<br />regulatiOllS. !lie undersigued aasUIeB responsibility for Clllpliance 11th aDy applicable deed rutrlctiOllS. .,.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPOKSIBILITIES
<br />If the OlDer lias hired a contractor or contractors to undertake IOrt, tiler .y he ngu!red to lie licenaed ia ac:cordaace lith
<br />state and local regulatiOllS. If tbe contractor is not liceD8ed as required by In, both the 0IIIIer aod contractor .., he
<br />cited for a .i~r violation under state lal. If the OlDer or inteaded contractor ve uncertain as to lllat llClD&Iag
<br />requlrllellts ., apply for the intended IOrt, they are advised to coatact the City of Ie1iarrIaUls BuilcUDg IlepartBt, (813)
<br />788-6611.
<br />
<br />Furtberlore, if the OlDer lias Jaired a contractor or contractors, lie is advised to ltave the COIItractor(s) sign portiOlll of the
<br />ICOIItractor Secti0ll81 of this application for lhicll they lill he responsible. If JOU, as the .. sign u the CIIltnctor,
<br />you are iDlUcatillg tbat fOU, rather titan the contractor, are responsible for the IOn. If the contractor wiJlla JOU to sign
<br />as CIIltractor tbat lily he aD iDc1ication tbat Iae is not properly licensed and Is not eatiUed to penittiDg privU.... ia tM
<br />City of lepbyrJailla.
<br />
<br />C. TRAKSPORTATION IMPACT FEES AND UTILITY COJINBCTION FDS
<br />
<br />D. COKSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AIIB19DED)
<br />I certif, tbat I, the applicant, ltave been provided ,itb a copy of I,lorlda's COastructlon Liea Law _ .......r'. ProtIctlon
<br />Guidel prepared by the Florida DepartleDt of Agriculture and COas.-r Iffairs. If the applicant is .... other tbaD the
<br />10IID8l'1, I certify that I ltave obtained a copy of the above described c10cuIeDt and prGIiae in good faith to dellVII' it to the
<br />lOImerl prior to ~t.
<br />
<br />E. CONTRACTOR' S/OWNER' S AFFIDAVIT
<br />I certify that all the infODliltiOll in tbis application i. accurate and tbat all IOrt ,ill he doae in Clllpllance ,itb all
<br />applicable 1_ regulating construction, loniDg, and land deve1.....t.
<br />
<br />Application. is laerellr Iilde to obtain a pmit to do wort and installation as indicated. I certify that no 10ft or
<br />installation lias ~ced prior to issuauce of a pmit and tbat all wort ,ill be perfOllld to _t .tIDduda of all _
<br />regulating construction, City codes, lOlling regulatiODS, and I_ devel..t regulatiOll8 ia tile jurildicUlII. I also
<br />certify that I under.tand that tbe regu1atiOll8 of otber PlIDBtal agenciu lilY apply to the inteDl1ed at, and tbat it is
<br />If responsibility to identify ,ltat actiOll8 I lUSt tate to be in allpliance. Such agencies Include bat are not lUlted to:
<br />t DeparUent of IDYil'OllleJltal Regulation - Cypress "yheads, IIeUand lIeu and IDvilOllllDtally 8eDsitive LaDds,
<br />IIater/lfas_ter lnatBt
<br />t Southleat Florida Water ~t DI.trict - llells, Cyprus ..,.., IleUaod lIeas, Iltering lfaterc:oursea
<br />t IrIy CorDI of lDgineers - Senall., Docb, lavigable Watenars
<br />t ~t of Bea1tb , Relaabilitative Services, Invi~tal B8a1tb lJDit - ileUs, IIIstelater !reItBt, Septic laob. '
<br />t US InYIlOIIIII1tal Protection Agency - .l8bestoa abat_t
<br />I also certify tbat, if filllilterial is to he _ in Fload lODe III or II, etc. I, it i. lIIdentood tbat a drainage plaD
<br />addressing a l~satiDg vol..1 ,Ill he soblitted lhich Is prepared by a prof.iODal engiDeer registered in the State of
<br />Florida prior to penit lasuauce.
<br />
<br />I penit issued shall he construed to be a liCeDSe to proceed ,itb the IOrt and DOt as autboritr to violate, ~ alter, or
<br />set aide aDy provi.iOll8 of the technical codes, DOr sJaall i88U1DC1 of a pmit prevent tile lIuUdiDg OfflcW fa tlllnafter
<br />requiring a correct1oa of errors in pl., CCIII8tructiCll, or vlolaUIIII of aDl code. Iverr pea1t 1'" IMll .... IBalld
<br />unl. the _t autboriled by such pmit is ,.,..ed ,itbin .il _the of 181UaDC8, or If IOrt autIIoriaed Jar tile pea1t 1.
<br />IIIIp8Dded or ahlJ_ed for a perioc1 of sUlODtba after tile tile tile at Is -=--ed. b 90 dar atallll of tile, .., be
<br />allCMld for the pe.nit ,itb fee claarge of '15.00. !be at_lOll aball be rlQUlted in lritiDg to the BuiWDg Offic1l1. In
<br />approved iDlpectiCll at he logged during each sil _th perioc1, or tile project ,Ill be ...iderld ....... '
<br />UllIIG !O (lID: YOOI mLIJII !O RICOID llO!ICI 0' ~ MY aLl U YOOI PIYIICi !ltlCK . ~ !O YOOI
<br />PlOPlIft'. IF YCXJ IIIIID !O OIIDU. 'IIIICIIG, awsm.I UD mil.'" ClllIlftCBIY .. BalDIIG YOOI alCl 01
<br />~. JOBS UIDIII'2,SOO U VlLUI 00 IIO! 1aD!O IIDID _ f08! I IDlCE OF ~I.
<br />
<br />81.!IJII: CIIIR CIIlGIJI'I
<br />
<br />81.!IJII: CCII!IICmI
<br />
<br />SliD 0' MIDI
<br />coom 01
<br />The foregoing instI'WleJlt was acknowledged
<br />before _ this , 19_ by
<br />
<br />SliD 01 PLCIIIIM
<br />coum OF
<br />The foregoing instI'UMDt was acknowledged
<br />before _ this , 19 by
<br />
<br />who is personally known to _ or who has
<br />produced
<br />as identification and who did/did Dot
<br />take an oath.
<br />
<br />who is personally known to .. or who has
<br />produced
<br />as identification and who did/did not
<br />take an oeth.
<br />
<br />(Signature)
<br />(Hue. '1'yped, Printed or Stuped)
<br />HO'1'ARY PUBLIC
<br />
<br />(Signature)
<br />(M_ 'lyped, Printed or StMped)
<br />McnARY PUBLIC
<br />
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