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<br />FEJ-16-'96 FPI 10:53 ID:
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<br />TEL t'-jc!:
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<br />1:t128 F'02
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<br />1"', . "I'~"";..~ if' .! "l'"trt ...' ~~t
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<br />CONDITIONS OF PERMIT AFFICAVIT
<br />A 9 BeTICI OF DBBD RBSTRICTIONS
<br />Ibt unGt.n.lptd *et1ad8 tht till, penlt HY be subject to Ideed restrlctlonl" ,bleb Ii' be lOr! t8ltrlcUYI tbin City
<br />r.ll1t~t1ftJ. De UDClmJpec1 UlU188 reapGlUllbllltr for capllance with Iny applicable c1eB4 1'IItrlet1cm.
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<br />B ~ tJR'LICBNSBD CONTRACTORS AND CONTRACTOR RESPOHSIBILITIBS
<br />If tbe OIII8r bu hit" a oontractor or contractors to undertake work, tIIey "y be" rIQulnd to be UC111114 In ICCO~ .itJl
<br />Iit.te IDlllocal regulaUODI. If tbe contractor 11 not llcenled aa required br In, both the 0Im8r 114 COIltr~ III be,
<br />cited for I .11d...I ,Iolation un4er .tate I.". If tbe OlDer or intended oontractor are UIlCertlil u to _t llCIIIIIng
<br />r&qUir_tll81 appl:r for the intende4 wort, t.bey are Id"iaed to contact the City of zepbJrb1Ua Buil4lDt ~t,(813)
<br />788-6611.
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<br />Purtbenlore, If tbe GIDU he8 bire4 B controc:tor or contractors, he i. advised to bave the CODtr.ctor(l) sip portiOlll of tb.
<br />'CClltr,ctor Slctlllll' of this QPllcation for which the, .ill be rnponslble. If you, as tbe 011181' .igD II till L'GIltrlCtor,
<br />JOIl are lDticaUDg tblt fOIl, rather than the contractor, are respolUlible for the IIOrk. If till COIltnctor vi_ JOU to 11gn
<br />.. CODtractor that II' be an tnGicatlon tlIat lie is not properly licensed and 11 not entitled to petlittiDg prbU8l. Ja the
<br />City of IIpIaJrJlIlll.
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<br />c. ,.RAHSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
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<br />D, CONSTRUCTION LIEN LAW (CIfAPTER 713, FLORIDA STATUTES, AS AMIIiDKD)
<br />I certify t.bat I, tile IpPIIClllt, .,. beeo Pfovlde4 lith B COPlof .Florida's Construction Llen'taI - ........'.'Prot8CtlOll
<br />Guit~!N pr'epare4 ., tU rlori4a Deputlent of Agriculture and COOlIm8r Jfflin. If tbe ap~liCll1t ie .... ok tlIan the
<br />lIMIer", 1 certtfr tJlat I ""1 obtainad B eGpy of the above described dOCUlellt ana pnmae In good faith to atllter It to the
<br />'CMllr' prlnr to oc.IDCII8Ilt.
<br />
<br />E. &2maDCTOR I a/OWNBR I S AFFIDAVIT
<br />I certify tbat .11 tM inforllUon 111 tIli. appllcatlon 18 accurate and tbat aUwotk ,ill be 400. In COIPU.e vitia all
<br />awUtable 1_ ngullUDg ~t1l1ct1OD, 10111119, and land davalopllJlt.
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<br />Ippl1catioo it hereby Iilde to obtain a perltt to do IOrk and installation as indicatec1. I certifr tJaat 110 IOrk or
<br />iutallaUon bu ~wa prIor to luuancI of it pmit and that all work ,ill be perfotIIG to..t Itduda Of all _
<br />mgulatill9' c:oDItruCUOIl, Cit, coda, loning regulations, and lill1d de,eloplellt regulatiOll8 in the iurll4lcUIII. 1 ;1110
<br />certify tblt I Wl4ttltaDd that the regulations of other gOYlIUIIltl1 agl!1lcil. Ill, apply to tbe intlD4eCl worl, BDd. tbat it i.
<br />If relpclIIIibilit, to Idllltifr .hat actions I .uat take to be In coapliance.. Such agencies incl_ but are DOt Halted to:
<br />t DeIJIr_t of IIltlr~tal legulaUon - Cypress Baybeada, Wetland lreM and Invltolllelltallf 8eD8lthe LiuIda,
<br />Iater/VUthatll' IreaUeDt
<br />t SoatlMat Florida If.ter lI~t Di~ - If.ll., Cypreal Bayheads, Wetland lreas, Altering lfaterc:ourUl
<br />* of lbee&1 - 8ulalll, Daca, ledgab1. latenrara
<br />t lleH1'f4Dt tJI II Rlllahilltatlve Senlcu BnfirDDllel1ul Health unit - Willi, Watt_tar 11'tI_t, septic'.
<br />t US ..Jl!YJ!BI~1 PIotectlCll IGIIDCf - bbe8tOl abat8llnt I
<br />I ,110 oartlfy tbat, If fill laterl.! 18 to be used In Flood lone 'A' or -1,etc.l, it is underltoad thlt a dr.laag8 plIO
<br />ecldtuuinrr it 'lXI/IPIIl8Ilting vol_" will be BubDltted wbich 18 prepared by a profesBionll engineer regiltarec1 .ID tile State of
<br />Fl(ldc1ll pdor to penit illlllllc:e. .
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<br />~ r,.~lnU. lSl\uad ahall be COJl8ttuec1 to be a license to proceed with tbe wori and not II authority to dolate, CIDC81alt&r, or
<br />Sl~I: aaid; lJI!f ~rOV'lclOlll of the t.eclmlcal coo.., nor sball 188uanc8 of a p&IIlt prevent the Bulldlftt Official fIQI ~tIr
<br />feqn!rint a correctioo of errorl iD pllDl, construction, or violations of anp code. aVIrJ pmJt t_ll1lball beCGIIlDvalld
<br />UDl~.a1 t.b8 aQrk IUtIJorJaed by suCh penllt 18 ~ce4 _itbln 811 Bltbl of issuuce, or if wort autlloriud bJ the pealt 11 '
<br />8~ or ibia1oIle4 for I pe.ri04 of alllOllthe after the tile tbe IOrk is ~cel1. (Me 90 U, utauioo of UII~ III be
<br />~lloel for the pIIIlt Iltb f.. cbarge of '15.00. fbe eJtwion sball be requuted In Elting to the lui141Dg Official.' AD.
<br />apprOl14 iDlpec.Uoa at bllovvad lluIing each ail 8th period, or the project ,ill be C01IIi.. 1baDdaDId.
<br />UllIIG to 011II: YO:JI PllLURI ro RICORD A ROIICB OF CCIIHDCBllBIIT MAY RlSULI 11 YOUR PAUICS !VICB POI lIIPIJnIII1'8 to YOOR
<br />PIIOPIm. I' YOO IIDID 10 OBrAII PIlIIIClIG, CONSUL' II11H YOUR LIIIDIR OR 1Jf IftORIIY BItORI RlalDlIG YOOI DICB or
<br />aJIII Jill ED tZ,500 lit V&LOB DO lOt 1(110 10 RECORD IRD POSt A -NotICH OF CCIIBJI '.
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<br />~:...~~r~!o~!lg, i!.I!S1:t~ F'::! ..a~..,aclu1owlecSged
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<br />llIb~ is per ally kncnm to lie or who has
<br />pn'ldr.Ac:ud
<br />eM 1duntlfi~.t1oa and who 'did/did Dot
<br />~e.~j)Wgd-
<br />(Sign 8)
<br />'~r-: ,SHYLOCK
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<br />8fA'1 OF FWRIDA f1:J r; 0
<br />coumOF uC '\
<br />'the foregoinry i!!!!!~~ was aC~9wl~ged
<br />before IDe this ,;IJ1::L , 19 ?b by.
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<br />&;IY r--f .L f;ff / erf?-
<br />who 1. personally 1m to ae or who has
<br />produced
<br />a. ideutific tiOD and who did/4
<br />take an Olf. .
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