|
<br />~ ... lJCT-18~'96 FRI 1D:23 ID:
<br />
<br />TEL 1-,)0:
<br />
<br />...~. .
<br />1tEY?3 P02
<br />
<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />1~. NO'l'ICE OF DEED RESTRICTIONS
<br />'fbe uMeraipeG Wl4erstanda thet thIs pemit aay be subject to "deed rutrictione" ..bleb lai be ~re restricti" thaI1 City
<br />regulatlont. ne unde1'8igned a88aes responsibility lar coq>liance with any applicable deelJ reattlc:t1C1D1.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIB7LITIES
<br />If the QlmU baa hired a contractor or contractora to unGertalte work, they EJ be requited to. l1c:aD88l'1ln ~daDu .ltll
<br />state and local regulatloos. If the contractor 11 not licensed all required by law, both till mmer lUI4 COIltractor 111 .be
<br />cited fot a Iliadeatanor 'fiolatfon under state law. [f tlll! owner or Intend8cl contractor are uncutdD u to Ifbat neeDling
<br />requirl!Mllu &1 apply for the intended worll, they ale advis!d to contact the Citl of IepbythUl. Bu1l4lnv ~t, (Bll)
<br />788-~11.
<br />
<br />fUrtbWlOre, if tlIe owner baa b1tlld a contractor or contractors, be is advised to have the eoDtrICto.r(.) sip portJou of tile
<br />'Contractor Bections- of WI applicaUon for IIbich they will be Ie8po1l8ible. If you, as tile OlDer 819'1 II tile ClQIltrattor,
<br />YO\l Ire in41catlng tll8t you, rather thin the contractor, are responsible for the work. If the contracto:l' "libel IOU to lip.
<br />lUl contractor that IIill' be an indication tlJat he is IIOt properly licensed and is not entitled to perJ1tUng pr1vllegu 1ft tile
<br />titl of Zepbyrhills.
<br />
<br />c. TRANSPORTATION IMPACT FEES AND UTILITY CON.NECTXON FEES
<br />
<br />D. CONSTRUCTZON LZEN LAW (CHAPTER 713, FLORIDA STATUTES, AS >>ISHDSO)
<br />] certif1 that I, the applicant, bllve beel1 provided witll a copy of "florIda's construction LilD Law - RoIeaImer'. Protection
<br />Guide" prepued by the Florida Depaf~ent of Agriculture and Col\8UHr Affair8. If the appliClllt 11 ....... DtJaIr I:IIaIl the
<br />"lJIfIlerM, 1 certify that I have obtaiaed il copy of the above described d~t 8JldproUse In good faltb to dl1iYlr It to the
<br />-owner. prior to ~clllll!nt.
<br />
<br />E. COHTRACTOR'8/0WNER'S AFF:lDAVIT ,
<br />I certify that all the infor.lltion in thiS application 11 accurate and that all worlt will be (IoQe 10 ~liance wltll all
<br />applicable li1V8 regulatiJlg conabuction, lOlling, and land deve1O{lE1t.
<br />
<br />Application is herebp .ade to obtain II perlit to do !fOrk and installation as indicated. I cartiEr fiat fie) IIOd or
<br />instllUation lIil8 CDIeIlc84 prior to iS8n8Jlce of II perIIit Bnd that all 1I01'k will be perfoOlt1 to ..t ,taadatd.I of all 1_
<br />regulating conatruct1on, City oodee, loning regulations, and land developteJlt regulations in tJae jurll4ictlOll. I alIo
<br />c~rtif1 that I under8tand that the regulations of otller gOYellllental agencies Illy apply to tb8 iotlDClll1 IIOl't, and tbat it i.
<br />rt reBl)OlI8ibUUy to identify wbat actiona 1 IlUst take to be in CO-pUllI1ce. Sueb ag8DCiea inclucle but m DOt llaited to:
<br />t DePllrtJlent of BnviroiW'Jlul Requlation - Cypress byh..."., Jfetlami Ar~ and IfnJiroaenta11y Bl!IlIiUvI L8QcJI,
<br />WatQr/Waste.uter Ireatlent
<br />t Southwest Florida Kater Jlanily.-nt Diltrict - Weu" Cypress Bayheada, lfetlSf14 Ireal, Altuillll aratercour..
<br />t Ir.IY Corps of lDgi~~r8 ~ Seawall., DockR, .aYig~ble Waterways
<br />t Deparbellt of Health , IlehabUitatiYe Seelices, Invirouental Health unit ~ Vells, Vaatl!ltaUt 1'reablnt, Septic IIdb
<br />t US Bnv1rOlll8Dtal PtotecUOlI A!Jency - Asbestos abateEat i
<br />I also cartJfy that, if fill Ntedal il to be used in Flood Zone. "1\" or MA,etc.", it ia WIder'toad thIIt I drai1lage plan
<br />addressing a .COII*JBlItlng voluetl .ill be sw.itted which i8 preparl!(1 by a llrofusional engineer regiltaW in tile Stlte of
<br />?Iorida prior to per.it. i88uance.
<br />
<br />.! pemit i88ll8d shall be colllltrued to he a Iicl!IIle to proceed with the work ana IIOt as autJaorfty to ,lolate, cace1 lItH, or
<br />,let aaids an, provision. of tha technical codes. nor shall !ssusnce of a perlit prlVellt the Bu1l4iDg Official f~ thereafter
<br />requiring a correctiOll of errora in plana, construction, or violationa of lID, coc1e. BvUJ peraJt illUld Iball .... 11l'fll1l11
<br />;10188B the 1lGrk authodled by 8uch pecaU is couenced 1I1tbln silt IOntbs of iS8U81lee, Ot if lICIt' Illthorbed by tile P8nit 18
<br />,1Uspended or abanOoned for a perioc1 of sll IQIt1la after the till! the work is COIme8ced. ODe 90 c1ar uteaaidll of tOe, Ilaf he
<br />illlOlled for the penit .ith fee charge of $15.00. !be e.tenslon shall be reqneeted in lItitinq to tile Bul141Dt Official. An
<br />approved in.pection ..t be logged during each 811 ~tb perloil, or Ul8 project .ill be CODI1e1ered a.banc1oDtd.
<br />UARJIllfG '0 OOKR; YOUR PAIWRJl 'fO RBCOIll) A ROrlCH OF aJUlgCIDf!!tT HAY RBSUL1' II YOOR paUIG MCS FOR DIP80IIIIIIIrs to YOUR
<br />?RQPm'Y. IF YOO IJl1'ElD 'fO 081'1 " FlllAlCllfG, CONSULf WI1'H YOUR LmmEft OR AI JnORDY BU'DRlllICORDING YOUR .orICI OP
<br />l:(U"IItEIlIIIf. _ llIllIIl 12 n VIURlIlO 101' .... '" BBtOIID un ~ . .~ Ill' ~. .
<br />
<br />c/)~_<~~
<br />SI BI"Jr::- cDll!RlCfOi
<br />
<br />
<br />SUR OF ruIllDA
<br />coom OF ~sco
<br />'Ihe foregOing InstI"Wllel1t was acknowledged
<br />before JPe this /0.-J7 . 19~ by
<br />
<br />J~\L\~D\\ h\l tl\OV(\'
<br />llho is personally'knaam to me or who has
<br />proouced
<br />.tl3 identification and wbo did/did not
<br />
<br />C:~:ath. ,,,. (1 'ndd~!:~
<br />(Sign8tur~ ~_~~~....:...._ ~ .
<br />PATRICIA M. CAMPBELL
<br />( !\{l.UIIe !.
<br />~9'l'ARY PUB - EXPII&: .IInuIiY 24. ll87
<br />..Rt,.,' IIandId 1bnI1IatIry PIMo .........
<br />
<br />STAR OF FLOIllDA
<br />coum OF '~S c 0
<br />The foregoing Inatrument was aCknowledged
<br />before lI!,e this /t).- 1'7 ~ 19..2..k..., by
<br />
<br />~~\~6N~~XI)QlYJ
<br />who i~ ~,!!rAnn..ll}' !m.0'fJl t~ me vi; iiho haii
<br />produced
<br />as identification and .no did/did not
<br />
<br />\~tb. C ^"f~
<br />'-- . .. ~j fn. L 0 ' /
<br />(Signature)
<br />
<br />
<br />in
<br />tI'f
<br />EllPIRES: JIIdlY 24, 1887
<br />IIandId 1bnI NlllIIY PIMo ~
<br />
|