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<br />I 1.1 I U'-. ~. '.... (, "....' "_'.~.', ~''-- ... ".. _
<br />
<br />CONDITIONS OF PERMIT AFfIDAVIT
<br />A.. Ifl1.JCB QF DEED RBSTBICTIONS
<br />!be under.lgD1d uadlfltaDdt that tbfl pettit lay be subject to 'de~ re9trictions" whieb lal be tore restrlctiy. than City
<br />regulation.. Ihe DDderlfgnld 811018' responsibility for cOIplflnce with any appliclhle deed :clt~ietiODl.
<br />
<br />B. UNLICBNS8D CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
<br />If till -.t lIu Idrecfa-contnctor or contrBctars - to undertake wOrt, they .iy be required to be lIcenaea fa Iccordallce 11th
<br />atat. and local regulaUona. If the contractor is not licensed a.ll lllQuirfld by In, both tbe owner and contractor ., be
<br />cUed for a 111d8lHJlor violation undet state 18.. If the owner or intended contractor are UDcertafD II to IfIMt IlclDtinq
<br />requirlllDt, la' apply fOf the intended work, they are advised to contact the City of lepbprbil18 Building DlplrtleDt, (813)
<br />788.6611.
<br />
<br />ru(lber~re, if tbl OWRer bas blred 8 contractor or contractors, be fA Advised to have tbe conttlctor(.) liQn portloaa of tbt
<br />'Contractor hctiDDl' of tbiB application [or whicb tbey Ifill be responsible. If JOU, II the OlDer a1gu II the COIItllctor,
<br />JOU If. indicating that )'OU, r~tb'r than tblJ contractor, are responsible for tlIe wor~. If the contractor .1.... fOIl to lign
<br />U l.'OIltractor tbat .y bt an indlclIUon U1al be 18 not properly licensed and Is not entitled to penittlD9 prbUegu iD the
<br />City of Iepbrrbl111.
<br />
<br />c. TRANSPORTATION IHPAC~.f~EE!_~D U~~LIT~_.CO.NNECTION FEES
<br />
<br />D. CONS1'RUCTION LlkN LAW (CHAPTER 113, FtOlUDA STATUTES, AS AMBHDED)
<br />I cutU, tIIIt I, tile appUcant, bave baen proy!"M .itlJ a copy of "Florida's Construction Lien LlII .. s.o.mer'. Protection
<br />Guide' prepared by tht Florida Dtlpartlent of Agriculture and Conlluler AffaIre. If the appUClIlIt 1t IMOne otller than tile
<br />'eMIlr', I certlf, that I baVII obtained II copy Of tbe above described docUMnt and prOliae in good flith to dl1lJer it to the
<br />'owner' prior to COMlttlcaent.
<br />
<br />E. COlfTRACTOR I 8 L1>~BR I~ )lFF IJ)A V IT.
<br />J certir, talt III the infOrlltion in tbi! application i. accurate and tbllt all wor~ ,ill be done in COIpl1IDce Mitb ,II
<br />applicablt 111I regulating construction, loning, and land developlent.
<br />
<br />App!iclUoa la bertbr Jade to obtain a perlit to do work and in8tallatlon as indicated. I eerUlr that no IOr1 Ot
<br />illltaUaUoa baa u.enced prior to issuance of a perlit and that a11lOr" "UI be perforwed to .et ltandarda of .111DB
<br />regulatiDg COftItruction, Cit, codBl, loning regulations, and land daveloptent regulationa in the jurl84ictlon. I lIto
<br />cerUf, that I undlr.tand that the regulations of other go'etnle.nt81 llgenct.. H, apply to the illtded 101'1, and tMt It il
<br />If rupoulbiUtf to identify wbat IIctlonl 1 lUst tate to be in co.pHance. Such ageneta incluc1e but 11'1 not Haited to:
<br />I IlINrment 9f rnYirOflleJltal Revulation - CypruB Barheads, lIetllUld Area8 and In,irol1lMtally 8t11Blthe Laade,
<br />. Weter/Wastewater rrelltJp~t
<br />t Bouthlelt 'loridi Water Jlanag.ent Diltrict - We1)l, Cypress 8l1ybeada, Wetland Arlta., Altering IIaterCOUI'HI
<br />I ~ of IIDetn - SeawaUs, Dods, NavIgable Waterway.
<br />· ~t DO,,.l" . 'RebllblUtaU,e Senicls, lrI,irOlllental Heelth Unit - We118, Vllstewater ItUtlent, 8eptic lanb
<br />· US Iml~tll1'rotectlOD Aoenq - Aabestos abate.nt
<br />1 .180 certU, that, It ftll IiJtefial is to be uSlId in Flood ZoM "A' 01 "/\, etc. ", It 1. understood that 8 drainage plan
<br />addreaetD9 a 'COIpID8.tjng voluae. will be 8ubtJtted whicb is prepared by a profes8ional engineer registered in the Statt of
<br />Plorida prior to pertit jlluance.
<br />
<br />A JIIl'Itt IIlUed lha11 be CUDltrued to be a Ucense to proceed lflth the wort and not II autboritf to 'lolate, canc:elalter, or
<br />let aBide anr prowllioal of the technical codes, not shall ilsuance of 8 pertit prevent tbe Building Offici.l frol tbetllfter
<br />f.1ri19 a correction of error. in plan., construction, or Yiolations of IIDY code. Iveq ptl'lit inued paU becoIe lhali4
<br />anle.. tlJe work lutborbed by .lIm pertit ia C<*enced lithin SillODthl Qf i88uance, or if IOrt lutllorb84 bl tbI JIIfIlt ia
<br />luapellde4 or lIbimdouea for I period of 8i1lOnt.b8 after the tile tile IOrt is ~cea. 0ft8 90 aar ntlDllOll of tile, .r be
<br />allowed for th penlJt .ith fee cJtarge of '15.00. tbe atenlio. .hall be requeated in writing to tilt IuU41Dg Offle1.1. AD
<br />apprOYId iDaPICtJon lUst be lDogtd during each Ilil IOItb period, or th. project "!II be conaittered UIndonId.
<br />_IR to 0IfIID; YOl'JR PAlLURltO RECORD A mICE 0' mtNKlfClJfBHI MAY MSULt IN fOUR PAYIIG rlflCB POll IIIPIIOVIm1'S to IOOR
<br />PJIOIIIftr. IF 100 JI7DD ro OBfAllI FIUHCIJfG, COlfSULY IIIrK YDI1R LODER OR U lnOJlQJ BBFORI HlCORDIIG fOUJIalCl 0'
<br />~. UIDIR .2,500 II VALU! DO lOT NIID 1'0 RECORD UO POS! A "lonCE OF aJIIIlICIIIIJtf'.
<br />
<br />
<br />?;A~~~~
<br />~ CONTRACTOR
<br />
<br />
<br />81lfl 0' rral~
<br />rQJm 0' _ ~...A ~ ..
<br />The foregoing iDstruaeut was acknowledged
<br />before lie this ~L, 19.!l.1. by
<br />
<br />~ I> r- d.l\ ^ e.. (a. (' l'\..i-A..___._______
<br />w 0 18 Rar80nally known to mA or who has
<br />produced , _____ '__
<br />a. identification and who did/did not
<br />
<br />~~~-~-
<br />(Halle ~ Wi~a~J:~s'tupedj'-'---
<br />NOTARY PU8L~ '.~~,
<br />
<br />
<br />"~.~
<br />
<br />StAfl OP noRlDA
<br />coom OF f? ~
<br />The foregoing instrument wa. acknOWledged
<br />before me this --~-ll, 19q7 _ by
<br />
<br />---.. ;r () e C\ '( .e...~~
<br />who 1s .R.ersonallv known to .. or who bas
<br />produced
<br />fts identification and Who did/did not
<br />to~:~~
<br />~'e
<br />__..k I-=\. \-t\.... ~ I'"' \' t- to h
<br />(Name Typed, P~inted or Sta8ped)
<br />!!Q!!.RY PUB
<br />
<br />
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