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<br />COND1'1'IONS OF PERMI'!' A"~FIDJ\Vl'r
<br />~OTICE OF DB~P R~SrnICTIONS
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<br />~ re8tlictl~. which tal be ~C8 r&Dtr!ctJ.. tbIo City
<br />witb any applicable deed r..trlctiont.
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<br />)U R a OliSIBILITIB8
<br />I, they IIIIY b~ required to UCIDlI8! 1lI acariI.a.ca with
<br />required by law, l10th the 0IfIl8r ILICI coat.nc:tar .., be
<br />intended contraetOt ate ~Clrtaln II to Ikat 11C1D11ng
<br />Inlact the City or IepbJrbjlla luildlog ~tIIIt, (113)
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<br />Furtbenore, .if the Olfne.r haB hired a cuntracloc or C(lntracto:~&/ be is advised to bave the =ol:ractGr(.) lign portiGAl of tbe
<br />'Coatra~tor SectJons' of thh ilppUcaUon for uh1ch t~e1lfll1 be reaponslble. Ifrou, as till MU_lgn IS th. c:GIIU~tot,
<br />JOU are illdlcaUna that fOU, rather than the CtJ1\trac:Lor, an l~espQD.8ible ror the work. If the contractor .1_ JW to 11p
<br />as mntractot that laY .be an indication that hll Is no~ propedy Ucmed iind Is not entitled to ptIra1t~og prJvUag. 10 the
<br />Citr Of &epayrbil11.
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<br />c. TRANSI'ORTATION 1M PAC '1' FBES AND U'rILI'rY CONNECTION FEES it
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<br />D. CONSTRUCTION LIEN LnW f CIIAP'l'Elt713, FLOR!UA STA'rtJ'I'ES,I AS .AH.8N'DBD)
<br />I certH, tlut 1, tb, appU~t, bare bel!/\ pro~:lded .ith a COllY of 'Florida's CtmstrUCtiDll LJe.o Law . 1IaIIoGet'. PtotacUOl1
<br />GuJae- prepared by tha rlorldA Deparuent of /lgriculturo and ('oncWler ACCaire. It t.ha lIppHcant Is ..-one ok t.bu t.be
<br />lawner-, 1 certify that I ha.,. obtaJned a copy of the aoove dl:llcribcd dI>Cuaent and pro-bB in good falt.b to c1a1.her it to the
<br />IOMner- prior to COIIBncetent.
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<br />x. CONTRACTOJt IS/OWNER'S AFFIOAVI'l'
<br />I certIfy that 111 tbe InforIGtlon 10 thIs aPPlication I, accurate and that all wort will be done In toIp11aDce Mlth all
<br />applIcable 1... regulatlng construction, Joning, and land deve~npaBnt.
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<br />Application 18 Wilby Jade to obtain a plHIH Lo do work lI1Id installaUon all illdlcate4. I c:erUf.r thit QO IOtk Ol
<br />Installation baa COIIancea prior to isBuance or a per.it aDd that all No(k will be pttforled to I9Rt I~ or all law.
<br />regulating conltructlon, City cuUea, loning regJlalions, Bnd land devaloplent regulatIons in tbt Jutiad1atJoa. 1 l1Io
<br />certify that I undetStand tbBt the regulatluns )( albor go,etn.8ola} agencios lay apply to tbe intended IOrt, 8Q4 ~t it JI
<br />., re,ponsibilJty to identify what ~ction8 I lUll taka to be in co.pllance. Such agencies include but Ita not liIltld to:
<br />t Deparllent of Intlrol\lentll RBQUlation - Cypusa Blrheads, ~etland ArMR and Hn9ironaentally BalUn Lana.,
<br />WatetlNs.teliler Treatlent
<br />· Bouthweet rl~rlda "tIt Kaftfg~nt DI8trict . Wella, Crpf888 Bafbeads, Wetland Areas, Altering MatArCOUC881
<br />· it., carpi of ~ini.rl . Seavalls, Docks, NaYigable Waterways
<br />I ~r~t of HllJib , Rebabllitetl_e Servicei, Env!IDnlentBI Health Unit - Walls, Wastewater !reatleDt, Septic tanka
<br />· US IDYi~tal Prottction AglneJ - ASbe8tOl abatuent I
<br />1 allo certUr that, If rlU ..tarid 11 to " 'l.eel In flOOd Eone IA. or -A,etc. ~, At Ja W\dlrltooG tllat a llr.lIlIQlI pIen
<br />~tIIBlng a 'eDIpIn..t1ng volUle- ~il1 b~ lublitted which la prepared by a profesaionaJ engJnaar teglatared Sa the 8bktl of
<br />Florida prior to perlit, 118uance.
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<br />who is' personally known to lIe-0Tt1ho has
<br />produced
<br />81 identification and who did/did Qut ,-.
<br />take on oath.
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<br />(S1gnature)
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<br />rNaae Typed, Printed or Stamped)
<br />OTARY PUBLIC
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