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<br />CUI.ill'fIONS OF PERMIT AFFIDAVIT
<br />A. NOTICE OF DEED RESTR1CTIONS
<br />Ibe underslgaec1 uaderstaads that this peralt lal be subject to -deed restrlctloaa- wbleb lal be IOte t8ltrlctlve than tltl
<br />regulatloal. !be UD4erslgaec1 uaU181 reaponalbllltr for cmpliance with anI applicable deed reatdctlODl.
<br />
<br />B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONS~BILITIES
<br />If the owner bablred a contractor or contractors to uncJertul! worl, ther liar be required to be lIceD8eel In accordance with
<br />state and local regulations. If the contractor Is not HCeD8ell a required br law, both the 0Imef and contractor 1Ia, be
<br />cited for a lisd_lDOr violation under state law. If the ~r or Intended contractor are uncertain as to what Hcenaing
<br />reC)UlreaentJ la' applr for the Intended wort, the, are advised' to contact the tilJ of lepIIJrhlUa BuilcUng .Deparl:lent, (813)
<br />788-6611. ' . , ,. .
<br />
<br />FurtherlOre, If the owner bas birec1 a contractor or contractor" be II advised to have the contractor(s) aiga portions of the
<br />-Contractor SecUODI- of thia appUcaUoo for which tIIeJ will ~ responsible. If JOU, as the owner lign a the contractor,
<br />IOU Ire iadicating that rou, rather than the contractor, are r..ponsible for the worl. If the contractor liahea JOU to aign
<br />U CCIIltrictor that la' be an lD41caUoo tbat he lalOt properlJ llC8Dled ana 18 not enUtled to peWtUng privUeges in the
<br />titl oflepb,rbills. '
<br />
<br />C. TRAHSPORTATION IMPACT FBBS AND UTILITY CONNBCTION FEES
<br />
<br />D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
<br />I certif, that I, the applicant, bave been provided with a copy of -Florida's Conatructloa Lien Law _ BoIeoMner's Protectioa
<br />Guide- prepared by the Florida Departlent of Igriculture and Consuser Iffaira. If the applicant Is SOl8ODl other tbaa the
<br />-OIIJler-, I certify that I have obtained a copr of the above _dbed cJocUl8Dt and prcalae In good faith to deliver It to the
<br />-OIIJler- pdor to COMeDCl!ll!J1t.
<br />
<br />B. CONTRACTOR' S/OWNER' S AFFIDAVIT , "',
<br />I certifr that all the InfOIlltlon In this application I, accurate and that all worl;.ill be done In COIpliance with all
<br />appUcable lawa regulating construction, IOIl.lng, anc1 land developl8llt.
<br />
<br />IpplicatiOn is herebJ aac1e to obtain a perlit to do wort and installation a iadlcated. I certify that DO worl or
<br />iDltallation has ~cecI prior to 188uPce of a penn and that all wort wHl be perfoned to Jeet standards of aU laws
<br />regulating construction, Citl codes, loning regulationa, and land developllDt regulatlODl in the jurlldictlon. I also
<br />certifr that I unc1erstand that the regulatiODl of other gov~tal agencla IIJ applr to the intended wort, and that it is
<br />If rUpoIUIibHitr to ldentifr what actiona I IUIt tab to be II. COIpUance. Such agencies Include but are not Iilitecl to:
<br />· Deparl:.leDt of IDvlrOlll8lltallegulaUon - Cypreai Barlleada, lIetland Area and IDvirODllDtallr SenaiUve Lands,
<br />later /lfastewater rreal:lent
<br />'Southwest Florida later Nanag8l8Dt Diatrict - lIells, Cypress "rbeads, lIetland Area., Ilterlng lfatercours8I
<br />, Irl' Corp. of IDglneera - Seawall., Doda, lavigable Ifatentar~
<br />· ~rtlent of Health i Rehabilitative Services, IDvirODlBDtal Health Unit - lIell., llaate.ater rreataent, Septic lanla
<br />· US IDvirODleDtal Protection &g8DCJ - labeatoa abatl!l8Dt
<br />I alao cartifr that, if fill ..terlal la to be used In Flood lope -.- or -I,etc.-, It la under.tood tbat a drainage plan
<br />addressing a -COIpeD8ating '01_- Ifll1 be aublilied wbieb is Pl'epared br a professional engineer registered in the State of
<br />Florida prior to perlit issuance.
<br />
<br />I peJ'lit iSlued aball be CODltrued to be a I1ceD8e to proceed wjth the wort and not as autbority to violate, cancel alter, or
<br />set aside anI provisioDl of the technical codes, nor &ball 18SUfDce of a perlit prevent the Building Official frOl thereafter
<br />requiring a correction of errora in plana, COD8truction, or ,iolatlona of any code. Ivery peraft isaued &ball beCOle invalid
<br />unless the IIOrt autborhed br such perait .. co.enceel lithin Stl IODtha of lsauance, .or If worl autborilec1 by the peoit Is
<br />suspended or abandoned for a period of ail IODtha after the till. the worl ia couenced. Ckle 90 dar ateD8iOll of tile, lar be
<br />al101led for the perlit with fee charge of '15.00. rbe ut8Dsloa. allall be requested in wdting to the Bulldiog Official. In
<br />approved iDlpection lUat be logged duriog each aillODth period,: or the project wll1 be conaidered abancJoDeel.
<br />1I1R1lllG ro CMIIR: YOUR FIILURI 10 IlC01D .I,IOII.~ P, ~ III DSULr II YOUR PIIIIIG !IIICK POI IHPROVIIIIIII8 ro lOUI
<br />PIOPERIY. IF YOO InDO' 10 OJlrlll FIIUCIIG, dJISOLr IfIIB fOUl ,LIIDa 0I111nOJlDY IIIfOIII IICOIDIIG fOUllOllCl OF
<br />OJIIDCINBII. JOBS DlDD '2,500 II VlLUI 00 IOIIDO 10 IICOID'IID POSI I -IOfICl OF aJIIIDCIIIIIII-.
<br />
<br />SIGUrllll: MIl OIlGIII
<br />
<br />SIGllruu: CORYRICfCI
<br />
<br />SlIII OF FLORIDA
<br />coonl OF
<br />Tbe foregoing instrument was acknowledged
<br />before me this , 19____ by
<br />
<br />srln OF FLORIDA
<br />COOllY OF
<br />The foregoing instruaent was aC~ledged
<br />before me this, 19_ by
<br />
<br />who is personally known to .e or who has
<br />prOduced
<br />8S identification and who did/did not
<br />tate an oath.
<br />
<br />who is personally known to me or whabas
<br />produced
<br />a8 identification and who did/did nbt
<br />t~te an oiJth.
<br />
<br />(Signature)
<br />(If..e Typed, Printed or StUPed)
<br />NOTARY PUBLIC
<br />
<br />(Signature)
<br />
<br />(Maae Typed, Printed or Stamped)
<br />~OTARY PUBLIC
<br />
<br />I I
<br />
<br />~, '.10,"." ......... .' 'I.'............... ,
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<br />.". '., ..JrtI'l.,..,..... _
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