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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />Tbe undersigned understands that this peIlit laY be subject to "deed restrictions" .bich laY be lOre restrictive than City
<br />regulations. ~be undersigned.assDleS responsibility for COIpliance .ith any applicable deed restrictions.
<br />
<br />B. UNLICE:NSED COlfTRACTORS AND CONTRACTOR RESPONSliuLITIES
<br />If the CMler bilil bired a contractor or contractors to Undertake IIOrt, they lay be required to be licetised in accordance .ith
<br />state and local regulations. If tJle contractor is not licensed as required by la., both the owner and contractor laY be
<br />cited for a lisdeJeanor violation under state la.. If the mmer or intended contractor are uncertain as to wbat licensing
<br />requirelellts laY apply for the i~tended work, they are advised to contact the City of Zepbyrbills- Building 1lepartlent, (813)
<br />. 788-6611. .
<br />
<br />Furtheriore, if the Oiner bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
<br />"Contractor Sections' of this application for .bich they .ill be responsible. If you, as the OIIIler sign as the contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the wort. If the contractor wisbes you to sign
<br />as contractor that laY be an indication that be is not properly licensed and is not entitled to perlitting privileges in the
<br />City of Zepbyrbills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, the applicant, bave been provided with a copy of 'Florida's Construction Lien Law - HOIeOIIJler's Protection
<br />Guide' prepared by the Florida DepartJent of Agriculture and COnsUIeI Affairs. If the applicant is sOlH!One other than the
<br />'ownerR, I certify that I bave obtained a copy of the above described docuJent and prOlise in good faith to deliver it to the
<br />Rowner" prior to COlleDCeleDt.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the inforaation in this application is accurate and that all IIOrk will be done in cQlPliance with all
<br />applicable laws regulating construction, loning, and land developllent.
<br />
<br />Application is hereby lade to obtain a peIlit to do work and installation as indicated. I certify that no IIOrt or
<br />installation bas C31enced prior to issuance of a perlit and that all wort .ill be perfoIled to leet standards of all laws
<br />regulating construction, City codes, loning regulations, and land developlellt regulations in the jurisdiction. I also
<br />certify that I understand that the rkgulations of other goverIlllental agencies laY apply to the intended wort, and that it is
<br />IY responsibility to identify what actions I lUst tate to be in COIpliance. Such agencies include but are not luited to:
<br />t Departlent of EnvirolllleDtal Regulation - Cypress Bayheads, Wetland Areas and Envirolllelltally Sensitive Lands,
<br />Water/Wastewater Treatlent . '.'
<br />t Southwest Florida Vater Hanagelent District - VeIls, Cypress Baybeads, Wetland Areas, Altering Watercourses
<br />t AIIY Corps of Engineers - Seawalls, Docks, Navigable Waterways
<br />t DepartJent of Health i Rebabilitative Services, EnvirOllll!Jltal Health Unit - Wells, Wastewater Treatlent, Septic Tanks
<br />t US Envirouental Protection Agency - Asbestos abatl!lellt
<br />I also certify that, if fill laterial is to be used in Flood Zone "AI or "A, etc. I, it is understood that a drainage plan
<br />addressing a RCD.IpeJlSating volUle" will be sublitted which is prepared by a professional engineer registered in the State of
<br />Florida prior to peIlit issuance.
<br />
<br />A perlit issued sball be construed to be a license to proceed with the IIOrt and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical codes, nor sball issuance of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued sball becme invalid
<br />unless the IIOrt authoriled by such peIlit is cOllllllced within sillOnths of issuance, or if IIOrk authoriled by the perlit is
<br />suspended or abandoned for a period of sillODtbs after the tile the work is ~ced. One 90 day utension of tile, laY be
<br />allowed for the perlit with fee charge of $15.00. !he utension sball be requested in writing to the Building Official. An
<br />approved inspection lUSt be logged during each sil IODth period, or the project will be considered abandoned.
<br />~ARMING TO omR: YOUR FAl~,URB TO RECORD A NOtICE DF-coMHDCEHm HAY RESUL! IN YOUR PAYING filCE FOR IHPROVEMDIS TO YOUR
<br />PROPERTY. IF YOUIII!IIID TO OBtAIN FIIIDCING, CONSULT WITH YOUR LBJIDER OR All AnomY BEFORE RECORDING YOUR DICE OF
<br />
<br />
<br />~;:~]L~nnmm~~~',
<br />
<br />S : OIlIER SI : RAC!OR
<br />
<br />1:)I~1l/~1:f F. ~e6t+~T
<br />who is personally known to me or who has
<br />produced Ft-.~ I.-tC,.-Ft g f~3- lfdp-~- &-0
<br />as identification and who didjdid not
<br />take an oath~~
<br />
<br />(Signature) ~ 7'
<br />, I I 0/ -d - /-h::r-JJ S-oJ-J
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUB
<br />
<br />STATE OF FLORIDA /J
<br />coum OF r~.v
<br />The foregoing instrument was acknowledged
<br />before me this~us-r /'7, 19 ~<:;; by
<br />
<br />'O,e-r-tetCbf 'F. e ~(
<br />who is personally known to me or who has
<br />produced I="L "bl<.. LL e..:#;.(.1 LIP 1- ~--H.:,- 45ZJ-o
<br />as identification and who did/did not
<br />take an oa~~$-B--
<br />
<br />(Signature)
<br />~~ :r. ~~U
<br />(Name.Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />STATE OF FLORIDA P
<br />coum OF ~
<br />The foregoing instrument was acknowledged
<br />before me this~ 17 , 19~ by
<br />
<br />:o.',t\UU", S N
<br />$~~l:.'!.Y ~~~t. BEITY J. RAN 0
<br />g.; :*~ MY COMMISSION II CC15393S
<br />~~" ..'jj EXPIRES: October21,1995
<br />~"Z,~r:t~~~"~ Bonded Thru NoI8ry Pubk UnderwdIIn
<br />
<br />f$.~~!"~~~\ BElTY J. RANSON
<br />;;i '..= MY COMMISSlON II CC 153935
<br />~;;:. EXPIRES: October 21 1995
<br />~,t, ,,'to BondedThniNotaryPubk~
<br />
<br />
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