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<br />COND!'!'IONS OF PERM!'!' AFFIDAVIT
<br />A.' NO'I'ICE OF DEED RESTRICTIONS
<br />!be UDd(lJ'.8igned .understands that this pmit laY be subject to ldeed nstriCti0ll81 ,hieb laY be lOre nstrictbe than City .
<br />regu!atiOll8. !be UDderaigDed __ responsibility for Clllpliaace litla IDJ applicable deed restrictiOll8.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If the OlDer bas hired a contractor or contracton to UDdertaU IOrt, they ., be required to be liceD8ed in accordaDce ,ith
<br />state aDd local regulatiOll8. If the contractor il DOt liClll8eC1. required bJ law, both the 0IIDeI aDd COIltractor laY be
<br />cited for a li8deleanor flotation UDder ltate law. If the OIIIIIJ: or inteDded coatractor are uncertain as to ,bat licasing
<br />requirBellta laY apply for the inteDdec1lOrt, tiler are adYillld to COIltact the City of IepllJrbilll Building DepartBt, (813)
<br />788-6611.
<br />
<br />Purtberlore, If the owner baa hired a contractor or coatracton, he II .11ed to ban the COIltractor(l) liga port!C1118 of the
<br />lCoDtractor Secti0ll81 of thil application for wieb tiler .111 be responsible. If JOU, . the OlDer liga II the COIltractor,
<br />you are inc1lcating that you, rather tbaD the COIltractor, are responsible for the IOrt. If the COIltractor .1..... you to lign
<br />18 COIltractor that laY be an iDdicatioa that be il DOt properl, liClDllll and II DOt atitled to .pmitting priYilega ill the
<br />City of IepbyrIIIlll. ..
<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, have been provided .itha copy of IPlorida', Construction Lien Law - &.olDer', Protection
<br />Guide' prepared by the Florida DepartleDt of Agriculture and eons.er Iffain. If the applicant il 8CIIeOIl8 other than the
<br />'OlDer', I certify that I bave obtained a copy of the aIlOIe dac:ribed docmeDt anel prolise ill good faith todeliter it to the
<br />'OIDerl prior to a.enc:eleDt.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify that all the infOIliltion in thil application il accurate anel that all IOrt ,ill be clone in COIpliance with all
<br />applicable 1_ regulating COIlIUuctioo, IOOlag, anel lanel dnel~t.
<br />
<br />Application il hereby lilde to obtain a pmit to do IOrk and ID8WlattOll . iDdicated. I certify that DO work or
<br />inatallattOll bas ~ prior to i8l1JaDce of a penit and that all IOrt .i11 be perfcned to _t ltandard8 of all 1M
<br />regulating COIlItnction, City codes, lCIling regu!atiOll8, and land dmlos-at regulatiOll8 in the jurisdictilll. I allO
<br />certify that I understand that the regulatiOll8 of other ~tal agencies la' apply to the intended work, and that it il
<br />., responsibility to identify ....t actions I lUSt tate to be in Clllpliance. Sueb agencies include but are DOt liaited to:
<br />t Departlent of In,iroDlelltal Regulation - Cypress Baybeads, Wetland 1reaI1IIl11n,iIOllllllWlr Sensitive LandI,
<br />Mater/lfllteRter InatleDt
<br />t Soutblfest Florida Water IlanagMellt Diltrlct - Velll, Cypreu 8aybeal1I, Wetlanellreu, I1tering MaterCOU1'88l
<br />t Any Corps of Inqineera - Seawalll, DocU, lavlgable Materlayl
<br />t DepartleDt of Health' Rehabilitative Senices, lnYifODllllul Health lJDit - Velll, IfIIt_ter lreat.-.t, Septic ,ants
<br />t US lD,iraDll!Dtal Protection Agency - labestoe abatBeDt
<br />I allO certify that, if fill .terlal 11 to be used iD Flood lODe 1.1 or '1,ltC.', It il undentood that a drainage plan
<br />ldc1reuing . 'COlp!D8ating tOl..' _ill be aDittel1lbic:ll II prepared bJ a prof.iooal engiDeer regiltered iD the State of
<br />Florida prior to pemlt illlllllCl.
<br />
<br />. pemit luuee) abaII be construed to be a liceDII to proceed wl~ tile IOrt anel DOt II authority to violate, caace1 alter, or
<br />set alide anr proviliona of the technical coelea, DOr shall illUlDCl of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of erron in pl., COIlItrucUOO, or ,101atlOll8 of an, coele. bery penit luued shall becme iDYalid
<br />unlesl the IOrl authoriled br luch pemit il ~ within IU _tba of illllilllce, or if IIOrt authoriled by the pemit il
<br />suspenclec1 or abandoned for a period of Iii _tbs after the tUe the work II cc.enced. ODe 90 day stenaion of tUe, ., be
<br />allCM!d for the pmit with fee charge of $15.00. !be a_iOll shall be requested in lIitinq to the Building Official. In
<br />approved inapectioo lUSt be logged during eaeb IU 81th period, or the project .ill be COII8idered abandoned.
<br />WADIIG fO OOER: YOUR FAILURI fO RlCORD A elCK OF aJllDClllllllIIY RESULt III YOOR PAYlIfG !IIICK POR IMPROVIIIDIS fO YOOR
<br />PROPIJlIY. IF YOU IIImD fO 0B!11I FIUIIG, COISULt MUll YOOR IIIIDIR ~ "AnomY BIFORI RICORDIIG YOUR IOrICK OF
<br />aJIIDCIIIIII" . JlIIIl - 12,500 U UIlIl 00 lOr - 10 I~-- lID m I :W!lClII' '. " .
<br />
<br />
<br />~111.. ~ ~~_-~
<br />SICillIURI: CIIJIR CIIIGIII IGII: j
<br />
<br />
<br />IIln OF PLOIIDI r;)
<br />coum 01 ~ UG
<br />The foregoing i7lrulleDt was acknowledged
<br />before _ this ~7. 23 , 19.t:c. by
<br />
<br />,0/A/J}/'f 171, .. S -r€IV/lA!. T
<br />who is personally known to _ or who bas
<br />produced
<br />as identification
<br />tate an oath.
<br />
<br />mn or rrAmDI ~
<br />aan 01 dLK.
<br />The foregoing inst~t was acknowledged
<br />before _ thisOe:r. 23" t 19 9S' by
<br />~ .,-- -
<br />
<br />CbIlM~L L. ~lE~
<br />who is per80llally known 0 _ or who has
<br />produced
<br />88 identifica
<br />take an 04
<br />
<br />
<br />(Signature)
<br />
<br />+-":.-~~
<br />
<br />. -..
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