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<br />CONblf1tON8'~:()t.l/PI.ler"AFFIDA VIT
<br />1\. NOTiCE OF DJW) R8"l~~"tlll\~''lit..i1:;'~i' "n
<br />thl! tmderl...... "rlt.. taat\tfI "pt, .Jl!lllIt _tlt~>.lo)~.,:r..t.rlc:Uon.. whicb.af be lOre restrictive than city
<br />regulaUOIltl. ne ...1.... ................Utrltr _11." tellJa any.IpltHcable deed restrictions.
<br />-.. I -c\: ;" ~ ;~:
<br />
<br />B. UNLICENSE1J ,corrtRACTO AND CON'tltACTOR RESPONSIBILITIES
<br />If the owner hit. It t ...... tortr tGtltrldort to undet Ittot t u..t .., lit reqdlred to be licensed In accordance with
<br />Btite ana loeal t.t.H_~ If. till tCllttlcbtr 18.t Hewed." l'tcJUlrec1 by lal, bolb the OlDer ,and contractor laY be
<br />cited tor It .1tc1....r..ol.Uon UIlC1tt .l.~.ld~' 11 the.., bf Iltl@ltct~c:ontrador afe uncl!rtain liS to wbat licensing
<br />tegulreltntl lit .ppl, rat ~ lnt......ttot.t the, Itt a4vltedlOebntacl the City of Zeph1rbl11s BuIldIng Deparllent, (813)
<br />188-6611. . . ..' . .
<br />
<br />rurtheriot~t It the OID@r ha. hlrea . contractor or conlract~r', he Is ;ld,lsed to bay. the contractor(s) sign portions of the
<br />'conhllC:tor BeeU,,' of W. '1PPIltiU..a for ttilleh ther ,HI bt telpol1s1ble. If you, a8 the owner sign a8 the contractor,
<br />you ar@ tddlcttlng that fbUt tether ~ the eontraclor, are filPoft*lble tor the MOrl. If the contractor wishes you to sign
<br />811 c:onUatlor that II' lit III lnalcaUCIIl tMt be JI not propfrl, Utenlet1 and 11 nol enUtled to per.itting privileges in the
<br />City of leph,rhIIJs.
<br />
<br />c. TRANSPORTA'tl0N iMPACT FEES AND UT1LITY CONNECTION FEES
<br />
<br />D. ~ONSTRUCTI0N LIEN oLAW \ (CUAPTI!;It 113 t FLORIDA S'1'ATUTES, AS AMENDED)
<br />1 certify that It the applicant, bI,. been prOiJdea _Ith a copr uf 'Plorld.'s Construction Lien Law - HOIeownerta Protection
<br />Guida- prepared b, tht rlbtlda Deplt_bof Agriculture anc1 c~r AUalrt. If the applIcant is 801eon. other than the
<br />'owner', 1 cl!rUffltiat 1 'lie,. obtalnet1 . top, of the abovI delc:rlbet1 c1oc:uaent aoo protise In good faith to deliver it to the
<br />"owner' prior to toIItnc:t!lenl. I." ...
<br />
<br />"I ,';'
<br />
<br />E. CONTJtACTont~/oWNER'S AFFIDAVIT
<br />I cprtffl that all thl lnfortltlon In lhl. application II accurate and that all work viii be done in cOlpliance with all
<br />applicable 18.. tegulatlng tonItrlttlGd. lonlng" ana ladd.....loptent.
<br />
<br />IIppllcatlon II herebf.... .1d........ t........ ...penl. ...,.l~.. t.a. '..dotlOd..: .ancJ..ll11.. ti.'uauon IS. 1. nc1. lc.at.ed... I. c. e.rtUY. .that no. work. or
<br />!nlltallaUon hltt t......ftlbrto'.......ot~. pldlt.:" .UIat,.'ll'ltOrl tdll.beptrforaec1to l8et ItandardaoCilll laws
<br />regulating conthlJcUon; . Clt,,_,~''''i!,.pl.tl.rllll1. JIi4' ~1Clf11Rt,r.~.UODl'~n;th8jur1.dlcUOll. 'I also
<br />terUf,lhat t ttndtdllllC1lh3l tIII.t.I.U_br;6lhtr9ott.~.r._ll"'",:,ppl(lolh.~lntendedlOd;, andlbat it is
<br />
<br />:' =r~~l::.=:=;.-n~o=l='~~u.::' ":-='=IJJ:~l:'~:.:"La:::, U.lle4 to:
<br />
<br />. , ..... \"tIr/1ftlt...lttlttlU8nt
<br />. Southwest Flodda ..tu t JJIttrlct ';'IIItIt./.~n*M. r.,taeac1it Wetland Area., Altering Watercourses
<br />
<br />: : .r:at :f I "i-;,*fi~rs:tit.~;t:aur Health Unit - 1Ie118, lIallewater Treatlent, Septic Tanks
<br />. US IDtlrootelll ,. .. f . ll~' ... .tOl" t..t.. .' '
<br />I aho C!rtlfr t ,llItlil' .l:"I. tok ult!d:l..",laocl Idnl' 'A' or 'A,@tC.', It II understood that a drainage plan
<br />addressing.. 'coIpt!DIIlUl9tOl.l,ttlU bII lablltttc1lhlch,l. prepared by a proCessional engineer registered in the State of
<br />Flodda prior to perllt. IdttMtt.
<br />
<br />. A perlltl88ued Ih.ll be tontttMea'to be . llclna. to pr~ ttIth the work and not as authorIty to ,Iolate, cancel alter, or
<br />8et asldl! anr protll'.' .ftMi,.., ,. ..1. ,.Iis ....~...',..' .'.'\.~. '..; .,.... ",I.;:btU.' ....ce of a per.1t preventth.. e Bulldlng Off~clal frOl t. bereafter
<br />r@guldng . tot~tI..a 0' trtOhl. ,~"~.tMtllitli;Y1ul.Uon. of 11I1 eoc1e.lvery Ilftllt"111UI!4+8haU"beCOlllntalld
<br />unless thA Iforl luthctrb.. br,._.....t..:~,;jf'.r~.IWa.ll..t.hI ofluuance, or,if IOrk autlJodled by the petlit is
<br />IIUBpemlet1 or IIbllnl1on!4 fot . petllJC1.bfll.lII,lt...nti.lheUIt\'th. worl!1I tI*Incet1. Ono 90 day eltenBlon oC ti.e, laY be
<br />allowed for tht fetllt tllUa'.....l1I or ...1..'_.. .~'........"'........!1cJ..,... ...~.1..11 ~ reque8ted In Irltln.9 to tho Building Official. An
<br />lIppro,ed Inipedlbd lUll'" lagglK1 M1ft9"tIIJ' .. ~~~fllh' project 1111 be conBiaered abamloned.
<br />""RlnIlG 10 OlIIIIa! root rau..1tti~A"1Of: "IIAY IIIButt III YOUR '.'IIIGTIIICE FOR'IRPROVIHKIITS to YOUR
<br />PROI'IRtf. IF dt . . . . " ... . ... 01 All . INGtOUR lIOT1CK OF
<br />mill 'fOIl ICE F
<br />
<br />
<br />~///'
<br />CONtRACtOR
<br />
<br />. . ..:. .
<br />
<br />STftTK OF r~_ __ . . .. MAtI 0' ~DA ~ 1\ /'~
<br />count OF ~C' n coom OF ~ L ~
<br />The toregoi~ in8"I'UII8D~a8 ~o"ledg8~ '~':'1'hlt foregoin inst ent Mas a~ledged
<br />before lie thin C\ \ ;:::; n ~ 1~ by lie ' 19~ by
<br />.. \ t , .
<br />
<br />
<br />3r~~\:~"bo bai,:,....~D eraD al~Y knowp_~~e r who baa
<br />produce ---------- __ ~ _ ~toduced
<br />dB IdenHfica ion end tf 1 d }it)t .. I','... identification and wl1 d not
<br />. .. ,.." t . ta
<br />t 08.. ......
<br />
<br />
<br />
<br />(8ignatul.e)
<br />r".c t.'"
<br />
<br />. .' (NBIIe Typed, pri\EE~R~ped)
<br />, . 'IIUTARY, PUB Notary publiC, State of Florida
<br />., . ,., . .. ,iI\ My comm. E.XP' March 8, 2002
<br />Comm. No CC 723061
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