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<br />CONDITIONS,~f.~~RMI1 AFFIDAVIT .
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<br />A . Non ,"IE !;If O.EEO RE.llTll I ~T' ONS ;.., 1:" >" ' . "" .'
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<br />The underslgned understands that thlS plr.lt "Y bl subilct to 'dlld rl,trictiona' .bich .ay b. lor. r.st~ictiv - ity
<br />regulatiDns. Thl und.rsigned 111QII1~1~~..~it~~~~'!PI}IftC. .itb &JY tPplic~~~.'.~~r!ctionl.
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<br />B . UNL I CENSED CONTRACTPR~ qND CQtlIljl'IJ;I~ ~~SPONS I Pl~ J T '~S
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<br />KATHY C. MONTIETH
<br />"'olaV i:ltlbllc. State of FlorIda
<br />M'( Comm. Exp. Jon. 3. 1999
<br />No.CC431231
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<br />If the owntr has hired I contrletor or contr.,\,rs " undtrtl_' work, .thlY .ay be flquir" to bl licl...d i. Ie
<br />,tat. and local regulations. If thl contrlctof il not 11c..... II rlquirld by 1'1, bo~ ....., ..-,tIt
<br />cited for I Iildelunor violltion UNltr It.\.I....:.1f ", ...r or intend.d contractor .n u"'lrhin is tn.
<br />requirtl.n" .ay apply for the int.Ddtd IfOrk, thlY .r. Idvi..... toc..'.cttbt City.,f _yrltUlt ...U4.
<br />19S-6611. " ";i. '. ."
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<br />Further.ore, 1f the owner h.s hirld I contrlCtor or contrlCtorl, be il Idvised to havl the contr.ctor(s) siel
<br />'Contr.ctor Sections' of this application for which they will bl responsible. If you, al thtDwne, 5igl IS
<br />you are indicating that you, rlthtr thin the contflctor, Irt r,.,oJlibl. for the work. If the contractor wilh
<br />as contractor that ~ay be an indicltion thlt he is not proplrly licensed Ind 15 not entitled to perlitti~.pri.
<br />City of 2ephyrhills.
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<br />
<br />,of the
<br />W,
<br />11gn
<br />" the
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<br />C. TRANSPORTATION IMPACT FEESA"IP UTILITY CONNECTIQtJ F~ES
<br />.. .. ,t:',., i
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<br />~. ~STRUCTION LIEN LAW (CHAPlER 71a. fLORID~ STAT~TES, AS
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<br />I certify that I, the applicant, bave been pfOvidltlli\ll I elM " 'n.rida'. Con.ltuditJI q,n Llw - H.... .. .
<br />6uide' prepared by the Floridl DepartHnt of Agriculture I'" Ctuu.... Affairs. If'tb. ..,unnt is 51111..~. .
<br />'owner', I certify thlt I hlvt obt111td1,'COPY of'tbt '''V!~!1b.~<dOtu.ent Ind pro.~ l~ Qood flith to
<br />"owner' prior to cOI.enceaent. ' .'~~'~ - .~"",
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<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
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<br />I certify thlt III the infor'ltion in tbil Ipplicltion il ICc.r.t. Ind that III ~r~ ,~. _e done in c..,li
<br />appliclble IIw5 regulating construction, lon1"9, Ulll_,.iMHN. .'
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<br />Application is hereby lade to obtain I perlit to'do work aad iftltJll~lion as indicated.. I ~ertify t~at no
<br />instlllltion hiS cOllenced prior to issulnee of I plrlit .nd tblt all work will be perftrled to I.etstlnd
<br />regulating construction, City codes, zoning regulltiDII, and. land developlent r~9ullt~~s in the jurisdicti,~~...
<br />certify thlt I understand that tbe regulltionl of other gov"Menhl agencies .ay Ipply')o the intended _ork,'.
<br />.IY responsibility to identify wbl~ IcUonsI IUlt take to be in CDIP!iance. Such agencies include but .Ie no .
<br />._' ,_,_,-,-' ._,_ _,~... .__~._" .,._. __...._.... .......___w. _ __ .....__......._. ....~.,.~
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<br />...
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<br />I DeDlrhe~t of Envir~nltnia1 Reaulltton - Cy,r"1 B.yb..~'IIIUJDd.Ar'~li and EnvirtllftallysensHiYI L.
<br />Ulter/lllltmter TreltHnt" ..
<br />. Southwest Florida wlter "anlDllent Diltrict - IItll.; CypJ.' ..,'-<<Ii, Wet1lndAr~u,..in9 ~lt.r~QY.r
<br />. Arty CorDS of EnQineers - Sea.llls, Dockl, IIiviglble UltlflliYI .' ~'C.' ....,.
<br />I Dellartaent of Hellth L Rehabilitl~~ve StrYi~ll. ~nvir~_ ~.l.'h Unit - lItJ,.,' r if,
<br />I US Environlental Protection ADeney .. AibeJ~ol Ib.\etI8t'C!,;. ·
<br />. . . . '. ''''r,.."",~"..*_*..!,..... ',"
<br />I also .certify thlt, if fi 11 lateriil 11 to be uled iftF1~!1oDt 1.A'or 'A,etc,., i f11 ullllerstood tl,at
<br />Iddressing I 'co.pensating volwae',.ill be Jub""td wbich"i..rlplred by j pro.!,~,i~llf e,,!ineer regist
<br />Floridl prior to penit issulnce. I ....- . ,: ." .
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<br />A perlit issued shall be construed to be I license to protttd .itnthe work and not ~?authority to violl
<br />set Iside any provisions of the technical COd'l, nor Ih.ll illUlnc. of I perlit prevIPl the Building Off\c.
<br />requiring. correction of erron in plian5i con5tructiDJ.Or~.lIt'Dns of inv ntllt!j.lllry penit iS5uud
<br />unless the 1I0rk authorized by such peraitl5 CDHIIIICItI .i~"',h .."ths of inulnn,"'., if ..ork luthorU'
<br />suspended or ablndoned for. period ofsil IOllth5,.n,r "~tPl the. work ii c~ ." Q~. 90 dlY e:ct' '
<br />. III owed for the per.it with fee chlrge of $15.00. lhl ellQlII... 1IM1l be requm' i ijng to the
<br />Ipproved inspection .ust be logged during each 5h 'oltb ",1", Dr the projectwU t~.,idered ~
<br />_ ~nv~."., , " : 0 ~'~~~,~~H'%T ,
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<br />WARN I NG TO OWNER s VOUR FA I L~RE'" TO~$lt;CORD A NOT I c~:1bF;' CO/,
<br />RESULT IN YOUR PAVING TWICE-FOR ~EMiNTS TO ~~:.fROP~~
<br />INTEND TO OBTAIN FINANCING, CONSLll:..\iITfr VOUR t.,e "'" ..OR A"f'7A
<br />BEFORE RECORDING YOUR NOTICE OF ~OMMiNCEMENT. JOII UNDER $2,
<br />DO NOT NEED TO RECORD AND POST Ah~CE OF C~ T".
<br />r [,DO '1 ~~m~ g~ 0
<br />SIGNATURE_ ~I A~. ~,,_~G)~-------~2~ SIGNATURE__
<br />~!.~_ OR. AGENlItI
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<br />DATE__l_..::._~Q-.::.-B-0_--~-~---_...-~., DATE_________~~......~ -----....-
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<br />__C~. ~~c~(~ ~_C:
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<br />MY COMMISSION EXPIRES_ __________-_________ KV CDMMIS$1 ~~~-----
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<br />NOTARY AS TO
<br />OWNER OR AGENT_
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