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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />-- A. NOTICE OF DEED RESTRICTIONS
<br />rile undersigned understands that this penit JaY be subject to 'deedreatrictions' whieb .y be IOrerestrietive tbaDCity
<br />regulatiCllS. Ihe unc1ersigned asSUle& responsibility for COIpliance with any applicable deed restrictiOll8.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSI8ILITIES
<br />If the orner baa hired a contractor or contractors to unc1ertate wort, tber IlaY be required to be lieensed in acc:orc1ance with
<br />state and local regulations. If the contractor is not licensed as required by law, both the orner and contractor .y be
<br />cited for a lisdaeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
<br />requirl!llellts .y apply for the intended wort, they are advised to contact the City of lephyrbills Boilding DepartMnt, (813)
<br />788-6611.
<br />
<br />Furthenore, if the orner has hired a contractor or contractors, he is advised to bave the contractoI(s) sign portiOll8 of the
<br />IContractor Sectionsl of this application for rbieb they will be responsible. If you, as the orner sign as the contractor,
<br />JOu are indicating that JOU, rather than the contractor, are responsible for the wort. If the contractor wiahea fOIl to sign
<br />as contractor that .y be an indication that he is not properly licensed and is not entitled to penitting pri,Uegu in the
<br />City ofZepbyrbills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY. CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES , AS AMBHDED)
<br />I certify that I, the applicant, have been provided with a copy of 'Plorida's Coastruction Lien Law - ~'. Protection
<br />Guide- prepared by the Florida Departlent of Agriculture and ConsUM[ Affairs. If the applicant is IIOI8OD8 other than the
<br />1000er', I certify that I have obtained a copy of the abOve described c10cUIent andprcalse in good faith to deliver it to the
<br />lornerl prior to ~eJeDt.
<br />
<br />E. CONTRACTOR' S/OWNER' S. AFFIDAVIT
<br />I certify that all the infonation in this application is accurate and that all wort will be done in COIpliance with all
<br />applicable 1_ regulating construction, lORing, and land developleDt.
<br />
<br />Application is hereby lade to obtain a petlit toc1o wort and installation as indicated. I certify that no wort or
<br />installation has cmIeI1ced prior to i88uance of a penit and that allllOrt will.be perforJed to _t stanc1arc1s of alllawa
<br />regulating construction, City codea, aoning regulations, and laad d89810(lllDt regulations in the juriac11ction. I also
<br />certify that I unc1erstand that the regulations of other goJerD8tal agencies .y apply to the intendec1worl, and. that it is
<br />If responsibility to. identify what actions I lUSt tate to be in COIpliance. Sueb agencies inelucle but are not IUlted to:
<br />t Departlent of InYll'ODlleDtalRegulation - Cypress Baybeada, WetlancllIeas andlnvirODleDtally Sensitive Lanc1s,
<br />lIater/llastewater !reatlent
<br />t Soutbreat Florida lIater Jlanagelent Di8trict - lIells, Cypress Baybeac1s, Wetland lIeas, Altering llatercoursea
<br />t Any Corps of Inqineers - Seawalls, Docb, lavigable lIaterrays
<br />t DepartJent of Health' Rehabilitative Senicea, IDvilODleDtal Health Unit - lIe118, lIaSt_tet lreatlent, Septic I_
<br />t USlnviIODleDtal Protection Agency - Asbestos abatuent
<br />I also certify that, if fill .terial is to be used in Flood loDe 'A' or lA, etc. I, it i8 lIDc1eratood that a c1raiDage plan
<br />adc1ressing alCQJpeD8ating wlllle' will be sw.itted wbieb i8 prepared by a prof_ional iDgineer registerec11n the State of
<br />Florida prior to perlit issuance.
<br />
<br />A penit issued shall be construed to be a license to proceed witb theworl and not as authority -to violate, canc:el alt~, or
<br />set aside any provisions of the tecbnicalcodes,nor shall i88uance of a penit preveilt the Builc1ing Official fDthereafter
<br />requiring a correction of errors in plans, construction, or YiolatiODl of any coc1e. BV8lJ peniti88ued shall becoIe invalid
<br />unless the wort autboriled by. sueb perlit is COIIeDCed .itbin slllODtbs of i88uanee, or if wort autborilflc1 by the penit is
<br />sl18peDc1ed or abandoned for a period of slllODtbs after the tile the work is ~ced. One 90 clay atensim of 0.., . be
<br />allowed for the penit with fee charge of $15.00. !be atension sball be requested. in writing to the Builcling Official., An
<br />approv~ inspection lUSt be logged during eaebslllODth period, or the project w111 be considered iIbandoned.
<br />IIAH1IIG !O ODIR: YOOR FAILORB !O RBCOBD A JfO!ICE OF CCIIIDCBIIII! lilY RlSULt II YOUR PAYIIG DICE fOR DIPROVBIIIItS !O _
<br />PROPBR'lY. IF YOU ImIID !O OB'IIIJI FIIfUCIIG, COISUL! IIID YOOR LIIIDIR 01.. D ImIDY BIPORI .RICORDIIG YOOI JOIICI OF
<br />CDllBJlCBIIDI. JOBS UlDBR"2,~9IH,~1O! IBID !O RBCORD AID POSt A 'fOrICl~F ctIIIDCIIIBJl!l.
<br />
<br />~) ~/=>
<br />
<br />SIGU. UIl IlbUl : ODRAC!OR
<br />
<br />sIAn OF FLORIDA ~
<br />coum OF '-... f(/ ~ e.D
<br />The foregoing ~trument was aCknowledged
<br />before me this ~e.L.J.7, 19 f? by
<br />
<br />t?~t~~
<br />wbo is ~ersonal.!l known. to ~ or who has
<br />produce
<br />as identification and wbo did/did not
<br />
<br />tat. an ~(Y ~~~ 0
<br />(Signature) . A/J / :A
<br />" t. A7e K /l- 'i:;Z-J....//..{ ()
<br />(Mame Typed, Printed or Stamped)
<br />NOTARY PUBLIC .
<br />
<br />SlAD .0' . FLORIDA /)
<br />coum OF if~ ~
<br />Tbe foregoing inst~t was acknowledged
<br />before me this /fu .)-7, 19~ by .
<br />(]J~ .C~~
<br />wbo is personally known to me or wbo bas
<br />producecf
<br />as identification and who did/did not
<br />take an. o~?t ~ A .~
<br />A- ~a.
<br />(Signature) . /J1~ .,f-Pl!1-I-/S C)
<br />
<br />(N..e Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />........ .,-. ;l
<br />l1,:,:~~.," Mark A. BeI/;so .
<br />~;(~O:;:~Notary Fub!ic" Slate?f Florida !
<br />\:,p~..~:My com m.,..(iXPireS APfl.!?...,;..;,;;;l: ~'
<br />....Q". Comm Ii CC091752
<br />'-:"'-"'?'".~""-'~""lC"""'~.~. .
<br />
<br />r /;,.:.....,::-..- -l';~" ., I .
<br />I.J""..,,~.. . "",r:.. A 8e,luso I
<br />,! ~:' 'j '..', Notary Fublic;, Stala of Florid,l .,
<br />
<br />~l ,:~j;kti:'~~;~~d~;~~~;~~~7.~;.y,;i3~~:JJ
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