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<br />COHb:t""'iON8i(~'O'J.1'''J''',,{AFFIDA VIT
<br />1\. NOT1CE Ot:' DUD JtKnRlct;tO.tfS'J'!:I.,~li1l~f\,:~;"~j' ."" .,
<br />Ihl! ItniJl!rllgnltl tIIIIlerltlftd. blttbl.,.,..t'4....~....!flt,'..!....trlcUon8. whlcb .a1 be IOfe restrictive than city
<br />feguJ.UOllj. tII. WII1tr.I...........' ~~~Ut'toti,_j_:.tltta.y app1Jcable deed restrictions.
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<br />B. UNLICBN8JW ,~8AaoJULAND collitOlt. RESPONSIBILITIES
<br />I f ~ht ~r ... ttll1d . tel ... ort'GIttmto,rato.... .'i ., . tMr .'f"bet'lC)alred to be licensed in accordance with
<br />stllte 1m11ocat _1.U.... if the tcIItr.cW. l'iJlOtU~"it.I"'" . btlo; both the owner.and contnctor laY be
<br />cited tor a .I~r .)oIIUoa unc1tt .tat.lft. if the .-fbr'.nlMc1ed' c:ontudor Ir8 unc!!rtaln 3S to what llcensing
<br />l@9ulrftMtnll 111 appl, fot the Intended Mfr.; thI, are ..'I....lo taatlct the Cltl of lephrrbllls Building Deparlleot, (813)
<br />188-66H. .. .'. .
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<br />rur~herltot~, U lhe otml!r has hired II contractor or conbact~r', hI! I.addsed to hue the contractor(s) sign portion8 of the
<br />"Conltlttlor Sedl..' of UJI ."Hatl... for .hleh the, tlU be tt8JlClllllb1e. If JOU, a8 the owner 8ign a8 the contractor,
<br />you lIri! IJt4Ue8Ung lfl4t fCJII, rdthtlr tfl4n tilt contractor, IIrl f...lble tor the wort If ~he contractor !fishes you Lo sign
<br />88 torllraclor that .J be .n lnalcltlOlt tltat he II not proptrl,Uc:wed end lIoot enUtled to per.ltUng privileges in the
<br />City of lephfrhlll..
<br />
<br />c. TRANSPORTATION IMPACT FEES ANn UT.lLITY CONNECTION FEES
<br />
<br />lJ. ~ONSTRUCTI0N LIEN <LAW' (CItAPTl\R 113~ FLORIDA 8'1'ATUTES, AS AMENDED)
<br />I cl!rtlff that I, the appllcent, ...e been prorJaea with. copy of "lorlaa'. ConstructIon tlen Law - HOIeOlDer's Protection
<br />Guld!!" prepared bt the r~btl" DepilrtIMtof Agriculture ....CoMUItr Affairs. If tile applicant i8 sOIeone other tban the
<br />.ownl!r", I certl'r that I ha'f obtllned . cop, ot the above de.trJbed aocu.ent and prOll81 In good faith to deliver it to the
<br />"owner" prior to toaenct!llNtnt. ' .", 4. l
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<br />E. CONTRACTOR t B/OWNER' S AFFIDAVIT
<br />I cl!rtlfy that .11 the Infotlltion tn t.ll application I. accurate Ind that all work will be done In co.pliance with all
<br />sppllcabll! la.. ri!gdJaUIIf contlnetlCld" lOlIing, anc11ant1 t1m1op1111t.
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<br />""pllcaUon I. hereb, .. tdflbtaha . per.1t to do IOrk .nd .IIIU.'UIUon all lncUcated. I certify that no worl or
<br />In8tallaUon Ita. toMI!IItfM1 'dbrtD'1I....ol.. penU"" ,Ulal..U wr. .111 be perforN to Jeet standards oC all laws
<br />regulating con.trucUon, CU, todIt,. ..lag,tegll.H_. ....l........lopllentregul.UODIln the jurisdiction. I also
<br />cl!rtlfr that I...rel'" t.h8t lJIt tegullUoIitbr bther: .....__l.lagend.. R," appl, to the'lntendl!d worl, and tbat it is
<br />I' reBpohlfbHUr t~ ldtItUf'.t.ct1_t....,t...le;~ ~,ll1~U...ee. Such ageocJell Include but are not li.ited to:
<br />. Depart_t of IIldr..-tat_laUaa .. CJPt""lIthNd.,leU.ltd Ar.as and IndronaentaJ1f Sensitive Lands,
<br />". tlater/1llltlNtlr ftliUtnl
<br />. Southwest Fioddl "atu ~t ulttrlcl .. hll., C,pttt.8a,IIi8t1i1, lIetland Areas, IIlterIng Watercourses
<br />t 1\[11 COlPl of Intl:-' ......U..' Dacb." Ildgabi. Vaten,,.
<br />. De ilrt.lent of t1e11 . ......UU.U,. 8enlcu . .lldr......Ul Bu1th Doll - Vl!ll., lIastewater 1'reallent, Septic Tanks
<br />t US IDdrOJllellt.1 " , ".'....tOl' IbIt..t ... .
<br />I a180 certlf, t, liter .1 I. t~ be uled'ln 'loodldne"A' ~t 'A,@tc.', it i8 understood that a drainage plan
<br />ltlldrl!s81ng II 'toIp@n.aUI9,,,t.'tUI be ..JUea'blell,1I prepared by a prOfessional engineer registered in the state of
<br />Florida prior to per.it. 11.lIdef.
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<br />. II perin b8ued .hlill bt conslruM1 to be . HceDle lo ~toctec1 ttllh the trorl and not as authority to vIolate, cancel alter, or
<br />Bl!t aBide an, pmlll_ uf Ult,~Idutl~l.~, nor .~!1 iI_tllnee of a petlit prevent the Building Orr~clal lrot tbereafter
<br />(equldng . corttetiOll 01 .trot. i. pl.... ttiDlltbttllJll, ot 'Jolatlons of any code.l,err ~tl'llt issued sbal1becon Invalid
<br />unleslI the tfOrl aUllKtrbt4br<ludtptWl.,Jj:ea-."ttt .,__IW..J.lOIIthl of bsuanee, or If worl authorbed by the per.it Is
<br />~u!lpencJed or lbanc10ned tot. IlIrJod of .....UItI'.rbr' {he Uit'tIIt IIOrl 18 conericl!a. One 90 day eltensJon of U.e, .ay be
<br />alloltl!d tor tht 'l!nllIJtJl 1M .-rve.Uf..tl'., (MteM~~~l1 ~ requested in wrlUng to the BuUding Official. An
<br />lIppro,edln'ptlCUblt lUll be loggtlt1'tttlngtd'\ ..'. P..l'8t the project wHl be con8iiJered abanc1onl!d.
<br />""RWIIIC to 0IIlII1t! toUI 'AI'" 10'_"'" A .Ittar. . Mt RRBm,! III YOUR PAn"e; nllCIt FOR IMPROVIHKRYS TO YOUR
<br />PROPIRtf. I' toU Imdra .AI.~!"lllC;,;,"'A OR U AnOR.lt B8ronl RICORDING YOUR 1I0001Cl OF
<br />mlllillClllln. .1oItI IIIUd, .JlllI; '''110 IMJIJ' .. r. rosf A ".OflCK OF aJlMDCIJIKKT".
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<br />-SiG"AtURR: OIIR
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<br />SIATIl OF FLORIDA . " : I1AI' Ut. rtoRlDA
<br />(OURtJ or f' As ffi . coom or PA Sc (",
<br />The tort!going n8ttull8llt tell 8~knCJWledged 'A)'htt fort!going instrument was acknr:>wledged
<br />before Rle thil ALL& 17 , 19.1.L .by" ' .,;1', ,before ..0 this ,. w:.r /7, 19q'55 by
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<br />'... ." ".". . .'"
<br />_IJ L~2-R-1 ,5 I MS A L- .Bc:::lRT .s I M-S
<br />who is personally known to .e or whe has ". .,who is personally known to me or ..he bftB
<br />proddgetl II"' lJt'edur;ed '
<br />M idl!JtUlleati8lt end tfho .4UdIdld .tlut · ~.' at. ideNUfiGaU9A and who did/did not
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<br />;::~~UJ&'J~o,~ ... :"~:~:&~Pi-~8 6;,,~~~
<br />(N.... ':':1:' p;t;te~ ~T8tf.::or tJ :: "~"_ TJ~~?'t~~i.fe~J 0; It~f.tl" U.l
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<br />NOTARY rUBLIC to\>.1 PI/a " WN " ~ :~o,~AJ.lY. PUBLIC .,o."to~~/8(.-t' KATHLEENJBROWN
<br />..0." ~ t.-" KATHLEEN J BRO . 1jL-'r., My COn'lmlsslon cC449029
<br />ii* My CommlS. 5.lOnCC449029 * * A 02 1""'''
<br />Expir.. "pr. .....
<br />* Expirn Apr. 02.1999 "',.. ~.,
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<br />'E OF f\.\)
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