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<br />CONOITIONS OF PERMIT AFFIDAVIT
<br />A. NO'l'LCEOF J)gED ltESTRICTIONS
<br />'fbeundersigned understands that this pertit lay be subject toBdeed resttictiOIl8. .bid!Iil' be'lIOteretttictive than City
<br />regulations.. fbe undersigned assUles responsibility for COIpliance with any applicable deed reatrictions.
<br />
<br />B. ORLICElfSEb ' CONTRA'C*I'OltS, ,AND CONTRACTOR .RESPONSIBILIT1ES.
<br />IftbeOlller bas hired a. contractor or contractors to undertake wort,. they lay. be . required to.be licenaed. inaccordal1cettitb
<br />state aDd loeal regulations. If the contractor.18 notliC8b8ed as l'IlQuirlrllbtlav,bOthtbeOllD8t.iIJ1dconttldm'laYbt
<br />ci ted for a lisdeleaoor violation under state law. If the OlDer at intended cOntrattor are Ulleettainas to .t UC8118!ng
<br />requiruentalayapply for the intended work, they are advised to contact the City afZepbyrbiU8 Building De~, (813)
<br />788-6611.
<br />
<br />Pllttbetlorflt . if tbeiJlftletJias hired acontrmr or COlltractot1, be ill adfi'setftohDe tlIecoatractor(8) sign portiOllS of the
<br />BContractorSe'ctionsB of this application for which they will be reaponsible. If you, astH 0IfJler sign as, tile contractor,
<br />you are indicating that you, rather than the contractor, are responsible for the trOtt. If the conttactor wishes you to sign
<br />as COIltractor that .Iilybe an indication that be is. notpropetly licensed and is not entitled. to petlitting privileges ill the
<br />City of Zepbyrhillt.
<br />
<br />C. TRANSPORTATIONIMPAC'I' . FEES MIl UTILITY ,'. COHNECTIONFEES
<br />
<br />D. CONSTRUCTION . LIEN . LAW (CHAPTER 713, FLORIOASTATtJ'tES,AS AH8RDED)
<br />1 l:ertlfy that I, the applicant, have been.provided witb a copy of B'lorida'sCOIlS'ttUctionLien Law _ lkIIeoIaler's Protection
<br />Guide. prepared by the Florida Departlent of Agricaltureand Cons_Affairs. If the applicantl. '8ClIeone other than the
<br />-owner., 1 certify that I have obtained a copy of the above delcribed ~t and pl'Olise in gOo'dfaith tadelivlr it to the
<br />-owner'prior to COlleDCeHnt.
<br />
<br />E. CON'l'RAC'l'Olt'S/OWNEH 'S .AFIi"tDAVIT
<br />I certify that all. .the infOrltiltion in this application is accurate and tbatillllfOtkwiU bedCmeiJr COIpliance withal1
<br />applicable laws regulatiDgconstructiiJn, JOlJing, ana landdwelopnm.
<br />
<br />APPllciltlon isllerebyJade to Obtaill. it per.it to ao worlandioatallaUOIl as indicated. 1 cettify that tIO 110ft or
<br />installation haa ClMntel1 prior to>iSSuanceof aplrlit and that . allllOl'iliUbepetf(JtlldtollltataJldardaOf aU. 1M
<br />regulating COIl8tructiml, .Cftreodes, ..loningregUl.tions, ..and '. lancl.c1evelopleDt regulatiOll8 In, the.. judsdiction. I also
<br />certifytbat I understamltbat the. regulations ofotbel' gOflmliebtalagencll8aey.pplytotlie intended work, aDd that it ia
<br />If. respOnSibility to idelltify what . actions IlUIt tate to be in COIp1iance. Such_cia include but are not lilitedto:
<br />t Departleb.t.of Envi~talRewlatiOD - typreaaBayIlead8,Mlandlreasandln,irODleJrtllly SeII8tUft Lands,
<br />. . Ifater/lastewater treatleDt
<br />t 'SOUtble&t FloridaWatetHiihlQtfettt.Dilttict.. Vellst CypteBa aaYbea4r,.lfetlaDdAteas,Altering, watercourses
<br />t.ArayCorPs of Engineers.. seawalls,> Docb,'avigilblelatenrQ8 . .. '. . .
<br />tDeP8I'tlentofHealth. iRl!habilltatiJe~ Senu.,lnYirODll8Du,I,llealth .Ullit ... ileUs, IUtllatetfreatlellt, Septic tants
<br />.. us InvitoDlentalProtection Agency-.Asbestos abateaent
<br />I also certify that, H fill aaterial,fsto be t1sedinPlOOd%One"A., or Bl,ete.B'iitia Ulfder&tood that<a4taiDageplu
<br />addressing a B~till9 VOl.- lill be 'BUbiittet1wbich i8 preparedbyaprofesaional engineer registetecl in the State of
<br />Floridapdor tOperlit iIIS1Il1lce.
<br />
<br />Apenit issuedshlUbe CODstruedtobe a license to,proceecl,ith the wort and Ilot as autlbdttto 'iolate" cance1alter, or
<br />set aside any provilions of the teclmical codes, nor shall issuanceofapertlt preventthe Buildill90ffieialfrOlthereafter
<br />reqttiringa correctional errors. in. plans, construction, Or .violations of any COde.. Every perait issued aIla11 betGIe.. invalid
<br />unless the wortauthodzeclby sUehperait is ~ed withih all IODths..of issuance, or if IOtt.authoriJed bftbe.petlit is
<br />sl1spemleclor abandoned fora .periodofsiiGtha after the tile. the 1IOI't Is~. .0J1e 90 day utenaiouof tiae,Ia, be
<br />allOled for the pertit with fee chatgeof,15.00. tbe eltensi.OD allan ,berequl8tedin.writing to .tD... Bui1dillg Official. All
<br />approveditllpettiOil at be logg~duringeachsil 81th pedod,<or the project wiUbe. considered abandoned.
<br />WIfUIIKG to .(MfBR : YOUR. FIlLURE YO RECORDA. KOfICE.' OF CCIIuClllDf MlY RlSULt II YOOR P1YIIfG. twICE POl .DIPROVIIIDrsro YOUR
<br />PROPIRfY. .. .IFloo IIfDD 'YO()8'fl1H FIIIMCIHC, COJfSlJtr ."IDYooR..... OR 111 .JftORDYBlPOJIIlICOfU)llIG.YOUR ..leBOF
<br />~. DllIIIDBR IZ.~~~~IO IlI.lIlD JID Rm I 'IlllIl'Il~~~~
<br />. . ..-"-~~~::~:;~~.,.~?// .,J3f[~~-~-
<br />SIGJlAfURE~iaMi'; '. . sHimmr:~bR
<br />
<br />
<br />StAft; dPPOORl:OI. . . ,?)
<br />coum o~ /45"( a
<br />The.foregOing .instl'UDlent .was ackoowledtted
<br />befOre me this _11 Ir-;).- .. ,19~ by
<br />,
<br />
<br />sYAflOFF'OOIttOl ,.' ~.
<br />COUNIY OF ...' .. .... 4-$>C2> ,
<br />Tbe, foregoing. in. s. tZ2i..... ..t.was aC~ledged
<br />before me this . II. ~)..-.... j 19 9~, by
<br />
<br />wbo is personally known to me or who has
<br />prOdUced,
<br />as identi,ficationand who did/did. not
<br />
<br />We.aI1 ....th. 'Jft2ff.. ..~~
<br />
<br />(Signature)
<br />
<br />who is personally known to .eor wbo bas
<br />produCed
<br />as identification and who did/did not
<br />tilkean O.tb~X:A-( ~~
<br />
<br />(Signature)
<br />
<br />
<br />(Name.Typed, pr
<br />tfOt'ARY' PUBLIc
<br />
<br />......- Ji;i'F'IA _
<br />:~'~. "~:<MY C.,OMMISSIOt.; " '.;t45....r...1418
<br />~. f i EXPiRES: M,,";,. .99 .
<br />~~.wn~\\~;r.Bon~ T~~e:;,_ ._".':~?!:-m~rs
<br />
<br />..
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