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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRICTIONS
<br />fbe undersigned understaDds that tbis perlit laY be subject to Ideed restrictionsl wbich lilY be lOre restrictive tban City
<br />regulations. !be undersigned BSSUJe8 responsibility for COIpliance witb any applicable deed restrictions.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If tbe OImer bas hired a contractor or contractors to undertake wrt, tbey lilY be required to be licensed in accordance witb
<br />state and local regulations. If tbe contractor is not licensed as required by law, botb tbe 0IIDer and contractor lilY be
<br />cited for a lisdell!aDor violation under state law. If tbe mmer or intended contractor are uncertain as to wbat licensing
<br />reguireJellts laY apply for tbe intended wrt, tbey are advised to contact tbe City of Zepbyrbills Building DepartJent, (813)
<br />788-6611.
<br />
<br />Furtbel'lOre, if the OImer bas hired a contractor or contractors, he is advised to have the contractor(s) sign portions of tbe
<br />lContractor Sectionsl of tbis application for which tbey ,ill be responsible. If you, as tbe OIfJ1er sign as the contractor,
<br />you are indicating that you, ratber tban tbe contractor, are responsible for tbe wrt. If tbe contractor wishes you to sign
<br />as contractor that laY be an indication that be is not properly licensed and is not entitled to peraitting priVileges in the
<br />City of Zepbyrbills.
<br />
<br />C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certify that I, tbe applicant, have been provided witb a copy of IFlorida's Construction Lien Law - lDeoImer's Protection
<br />Guidel prepared by the Florida DepartJent of Agriculture and COnsUIeI Affairs. If the applicant is SOJeODe otber than the
<br />100000eru, I certify tbat I have obtained a copy of tbe above described dOCUJeDt and prolise in good faitb to deliver it to the
<br />"OImer" prior to co.enCeJellt.
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certify tbat all tbe inforJation in tbis application is accurate and that all wrt ,ill be done in COIpliance witb all
<br />applicable laws regulating construction, loning, and land developleDt.
<br />
<br />Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no wort or
<br />installation bas ~ced prior to issuance of a perlit and that all IOrk ,ill be perfoIled to leet standards of all laws
<br />regulating construction, City codes, loning regulations, and land develOpJeDt regulations in tbe jurisdiction. I also
<br />certify tbat I understand tbat tbe regulations of otber goveruental agencies laY apply to the intended wort, and that it is
<br />IY responsibility to identify what actions I lUst take to be in COIpliance. Such agencies include but are not liJited to:
<br />I DepartJent of EnvirOl1leDtal Regulation - Cypress Baybeads, Wetland Areas and EnvirolllH!lltally Sensitive Lands,
<br />Water /Wastewater freat:lent
<br />I Soutbwest Florida lIater Jlanagell!llt District - Wells, Cypress Bayheads, lIetland Areas, Altering Watercourses
<br />I ArJy Corps of Engineers - Seawalls, Docks, Navigable lIatenays
<br />I DepartJent of Healtb i Rehabilitative Senices, EnvirOJlll!lltal Healtb Unit - Wells, Wastewater freatlent, Septic fants
<br />I US EnviIODleDtal Protection Agency - Asbestos abateJellt
<br />I also certify that, if fllllaterial is to be used in Flood ZOne IAI or uA,etc. u, it is understood tbat a drainage plan
<br />addressing a lCOIpeD8ating volUleu will be subJitted wbich is prepared by a professional engineer registered in the State of
<br />Florida prior to petlit issuance.
<br />
<br />A perlit issued shall be construed to be a license to proceed witb tbe work and not as authority to violate, cancel alter, or
<br />set aside any provisions of the technical codes, nor sball issuance of a perlit prevent the Building Official fIOl thereafter
<br />requiring a correction of mors in plans, construction, or violations of any code. Every perait issued aball beco.e invalid
<br />unless tbe IOrk authoriled by such petlit is COIIllIlced witbin sillOntbs of issuance, or if work autboriJed by the petlit is
<br />suspended or abandoned for a period of sil IODtbs after the tile tbe work is COIIllIlced. One 90 day atension of tile, laY be
<br />allowed for tbe perlit witb fee charge of $15.00. !he atension shall be requested in writing to the Building Official. An
<br />approved inspection lUSt be logged during each sillOl1tb period, or tbe profect will be considered abandoned.
<br />WWIlfG to (IlfII: YOUR FAILURE to RECORD A lorICI OF COtMBICEIIIRl' MAY RESULr II YOUR PAYIIG ftlICI FOR DIPROVIIIDIS fO YOOI
<br />PROPBI'fY. IF YOU IIft'IND to OBIlll FIJIAICIIG, COKSULf wlm YOUR LINDIB OR AN AftOIIBY BlFOIlE IICOIDIIG YOOIIIOfICI OF
<br />COMMDC!MElff. JOBS OlDER '2,500 II VALUE DO lor mn ro RECORD AND POsr A -MorICI OF <XJIIDCBIID!..
<br />Joe DelataHe, C.E.-o... CoJleel\ Cuff( Ct=O John L. Wallace, Executive V.P./C.O.O.
<br />
<br />(1~~:o~~~r, (;Fn ' 9sV~JffiL"
<br />
<br />FLORIDA MEDICAL CLINIC ;HINSON BUILDING CORPORATION
<br />
<br />SrAR OF FLOR~
<br />coum OF a...d.C..O
<br />The foregoing instrument was acknowledged
<br />before me this /1 - 02 6- , 19..!l..b. "by
<br />
<br />srArE OF FLORI~
<br />COU1IfY OF cw--LtJ
<br />The foregoing instrument was acknowledged
<br />before me this /1- ~S , 19~ by
<br />
<br />~ is personally known to ..~r who has
<br />produced
<br />as identification and who did~~
<br />
<br />~th4~~
<br />( Wgnaturer
<br />(l/)R2(/~Fl ;:J Si-/jJpE"/2.i
<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
<br />
<br />(~s ~~~~Dal~!m kI10wn to~r who has
<br />pr uceu
<br />as identification and who did/did not
<br />ta~~~hy v& l1'LJP~Y
<br />
<br />~ignature) ./ /'
<br />{1/'l~2~G'n fJ. S-l/fLJE,e-l-
<br />(Name Typed, Printe ~r Stamped)
<br />NOTARY PUBLIC
<br />
<br />
<br />CARLEEN A. STlPPERT
<br />Notary Public, State of Aorida
<br />My Comm. Exp. Sept. 6, 1999
<br />Comm. No. CC 493590
<br />
<br />
<br />CARLEEN A. STlPPERT
<br />Notary Pulllic, State of Aoricla
<br />My Comm. Exp. Sept. 6. 1999
<br />Comm. No. CC 493590
<br />
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