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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTRIC'l'IONB
<br />The undersigned understands that tbis petllt laV be 8ubject to Rdeed restrictiou8H wbieb aay be lOre restrictive than City
<br />regulations. !be undersigned as8Ul8s res~'sibilit, for COIplianca wIth any applicable deed re~triction6.
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<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If tba 1leIlIet' bafI hired a contractor or contracturs to lUldertate work, tlley lilY be required to be Ucensed in acc:ordance with
<br />state and local regulations, If the cODtraetor 11 not licIll&ed iJS required lIylav, botJI tile ClImer and contractor laY be
<br />cited for a lia4U81l1lOr violation under stat. law. If tIle Olflllr Ot intended contractor are ullClrtain as to Qat licensing
<br />requlrllllnts la' apply for tie intended work, they are add.." to contact the City of lep.byrhiUs BuilOlnq Iltpatt:lent, (au)
<br />788-6611.
<br />
<br />Purtberaore,. if the ~4'r his hired a contractor or contractor., he is advised to hev. the contractor(s} sign portions of the
<br />.Contractor Sections' Df t111s application for lfllidl they wHI be re.sporisible. If you, as the OIlIler aign as the contractor,
<br />vou are indicating that fOu, rather. than tile contractor, are responsible for the tIOd:. If the contractor IIfsllea 1011 to aign
<br />as coutuctor tIlat la' be iIJl indication that be is not propatly Hcensed and is not entitled to penlitting privilege; in the
<br />City of Zepllyrbilll.
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<br />C. TRANSPORTATION IMPACT FEES AND UTIl..ITY CONNECTION FEES ,
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<br />D. CONSTRUCTION LIEN <LAW (CHAPTER 713, FLORIDA STATUTES, AS AMBNDED)
<br />I cartify t)aat I, tlIe aPlll~cilnt, have been provided with a copy at RFlorida's Clmstruction LitJl La. _ 1J00000oeerll Protection
<br />Guide' prepared by tile Florida llepartIent of Agriculture aad Consu.er Allain. If tha appliclDt i. 8Oftone oller than tile
<br />-OMner', I certifJ tb~t I have obtained a copp of tba above described dDcal!nt and prOlise in good faith to 4eliver it to the
<br />'owner' prior to COIIeDceaent.
<br />
<br />E. CONTRACTOR 'S/OWNER'S AFFIDAVIT
<br />I cert!f, that all tbB inforaatioD iB this application is accurate and that all vort viII be done in OOIPliance with all
<br />applicable 1_ l1!!JI1iiUng conStruOUOIl, loning, and land developaent,
<br />
<br />Application 18 flereby aade to obtain Cl pertit to do wort. and installation as indicated. I certify that DO work Ot
<br />iJllltallatim. baa ~8d prior to issuance of a petlit IIIId that all work -111 be pextol'lBd to leet stancludJ of aU 1_
<br />regulatlBg construction, City codes, 10Ilill9 r.gulatioas, alld lead develoPIMt regulatiOllS in tile judRiction. [illso
<br />certify tbt I understand that the regulations of other gO'lCU1lllentalagenciea lily apply to the "intended 1IDIl, iln4 tbat it is
<br />If responslhlllty to Id811tifr what actions I lUat tate to fie in coapUance, Sacb agiJICiell include but are IlOt Hated to:
<br />t flgpartJent of Roviroo.ental lequlaUOII - Cyprel. Baylieeds, Wetland lrells and BnvirouentaUy Sensitive Lands,
<br />Vater/llastewater 'I'l1liltJent
<br />It Southwest Florida later laaaglHnt Di8tri~ - Vella, Cyprellll Bayheads, Wetland Areill, Altering watercourses
<br />t AtlI Con>>I of JMineers - SealalIs, noets, llavlgabJe Waterways
<br />· ~rtJ8Dt of Health' lUahilitdive Senices, InvJr01ll8ntol lIeaJtb Unit - Wells, Wastewater lreatlent, Septic 1'iIJlU
<br />t OS lnvilOllltDtal Protection Aqency - Atbeaws abatetlellt
<br />I also certify that, if UU ~teria] Is to lie ueecJ ill Flood be 11)11 or "A, etc. ", it II> un4erata04 that a drainage plan
<br />addru..tll9 a ucOIpellsating ,01ueU "Hl be su!llJtte" wbicb is prepared by a professional engineer registered Intba State of
<br />Florida prior to par'lt, Issuance.
<br />
<br />. A per.it i88ll.d 6hall be construed to be 0 license to proceed with the work and Dot as authority to violate, cancel alter, or
<br />set aside llIIy provlslOJUj ot tbe tecbn1cal codes, nor shall iSSU8IIC8 of a peclit prevent t:!Ia Building Official ffOl thereafter
<br />requiring a correction of enors in plans, CDIlIuuctlon, or \'lolations of any colle, Ivery pemit Issued HaU beeou invalid
<br />unIu. tile worl autboriled by sucb perot is COlIIDced within alllOntha of isslJaIlce, or if work authorized by tlie petitt it;
<br />SlI8peDded or MdoDed tor a pariOd of sir atha eftsr the tile the worl Is COIUnclld. one 90 day eztenliOll of tite, .y be
<br />allowed for the penH: with f88 chargs of 115.00. rbe extension sball be rlllJDssted ill Irlting to tle Building Official. AD
<br />approved inspectigo IIU8t be lOgged andng laeb libatb period, or the project will he COII8idered all_OUR.
<br />IfWIJIG 1'0 0IiIIllIl: YOOR PAlLOR! ro HBCORD A 1000ICI or COJIMDCiJIIHT KAY Rlsutr II TOUII PlYII(; MCE FOR DIP1lOVIIIIilII TO YOUIi
<br />PBOfiBIm. IP roo JNrlIUJ ro OBl'AII FIIIAJlCIMG, CONSULt VIIK YOUR LDDIR OR AI lrlOIDY BllORllIBCOIDIIIG YOUll HOfICB 0'
<br />cmllIEIICHNr. JOBS UNDER U,500 IN VALU! DO NOT IRED fa RECORD lJR) Poof A '''MICE OF COIOIIJrClOfDIJI.
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<br />SIGlfUORIl:: OIfIIBR OR AGKIIT
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<br />G' '1OBI: C~B
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<br />BfAfl OF ..WllDA
<br />COO1Ift' OF
<br />The foregoing instrument was acknowledged
<br />before me this , 19~ by
<br />
<br />who is porsanal1y known to me or who has
<br />p.toduced
<br />as identification and who aid/did not
<br />toe an oath.
<br />
<br />(Signatura)
<br />
<br />(H~ Typed, Printed Or St~ped)
<br />NOT~RY PUBLIC
<br />
<br />SUrE OF nolll~" ~ _ "":'\
<br />coum or ~
<br />The foregOing instrument wac aCkRowledged
<br />before Ille this / - /6. 19fZ.- by
<br />
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<br />who ~~ to me 0< who has
<br />prod.. "d t
<br />as identification and 1dlo did/dl n01
<br />take en OOtb...YI cut 1':1 m~
<br />
<br />(Signaturo) d&fl c~ A 11>>",j ..
<br />(Naae Typedt Pdnted/or Stampen) *
<br />NOTARY PUBLIC
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