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<br />MAR-26-'98 THU 09:01 ID:
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<br />TEL NO:
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<br />1:*552 P04
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<br />CONDITIONS OF PBRMIT AFPIDAVIT
<br />A. lf01'ICK OF DBBD RBSTR:rCTI01fS
<br />rile _nJ", unaentlndl that tIll8 penlt II, be .ub1gc:t to "deed re8trlcUDIII' widell .., be .,re ruuicU" tJIu City
<br />regulltlClll. !lie UDdltlipBC1 UlIlIeI I'88pa111lbllit, for ~Ulnce wlt.11 all, applicable deec1 netrlctlau.
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<br />B. UNLJCBNSBD CONTRACTORS AND CONTRACTOR RESPONSIBILITIRS
<br />If the ... .... Mrld a cantraetor or contrac:ton to llIldertUe IOrk, they .., be tlQalred to M lICt!1111d in lecardanc:e .ltJl
<br />atale IIId lGel1 ngalatlOlll. If the CODtrador t. DOt l1c:en,ec1 a8 reQUired br law, both the ClllDlr aDd IDltnttDr .., be
<br />cited fOt a 11Id-.nor violation under state la.~ If tlJll OWIIef or tnten4ec1 c:ontrletor are UDcertalll .. to _t liCll1lIQ9
<br />nqulr_t. ., appl, for the Intended tIOrll, the, III Idvlsed to contact tbe Citr of lepb,rbUlI Bulldtng Deparbent, (813)
<br />788-6611.
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<br />PurtJIenDra, if tile DWIU .... bind a canulctor or coDtractors, be i. addled to ban the COJItractor(.) 8iga partiona of the
<br />'Caatractor 8ectJOIII. of tbl. IppliceUaa for wbicb the, wiU be reapGlllibll. If JDlI, u tbe _If lip . tile CIIltractat,
<br />JOlI are illdieatlllf that JOU, ratJMtr than tile contractor, are reBpCllllible for the won. If the cootrletor .1..... JOU to .ign
<br />U CDDtrlctor tbat -, be an Indication tllat be 11 not properly liCClHil and II not 8IIt1tled to pen1ttlll9 pr19UIgII in tbe
<br />City of IBpbrrbilll.
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<br />C. TRAN8PORTAT~ON IMPACT FEES AND UTILITY CONNECTION PEES
<br />
<br />O. CONSTRUC1"ION LIEN LAW (CHAPTER 713, FLORIDA STATUTBS, AS AllBllDEP)
<br />I eertUr tblt I, the app)jeant, ha". beeD provided wU:J1a copy of -Florida'. Canltruc:Uon Lien Law _ a.c..r'. ProtactiGn
<br />Guill,- prepared by the 'lurid. DepllbllDt of Agriculture. .-net ConlUllr Iffair.. If the appUclftt 1a .... other tbIft the
<br />-OIJIlr-, I certify tblt I have obtaiDll1 a copy of the abo'e deacribed docuent III1d pram.. 11 goad faIth ttJ dl119.. it to the .
<br />-OWDI!t' prior to ~.....t~
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<br />B. CONTRACTOR I S/OWIfKR' S AFFIDAVIT
<br />I cartlfr tilt 811 tbe ilforlltfan in tbil application i. accuratl and tbat all IOrt will be dane in CQlpliance .Itb all
<br />Ippl1..1e 1_ "plating canatruction, laning, IDd land dtvlloPltDt.
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<br />ApplicaUCII 1. IIerUr IIIIe to ,*tain if Plnlt to 40 work IIId ID1tallation .. Indicated. 1 cartlfr that DO IOd or
<br />illltlll.tlon .. ~cecJ prior to luuilllee of a penU ana thit aU IOrl wUI be perfoned to ..t .taaaard. of 111 1_
<br />regul1tlll9 eaaatructJOIl, en, coda, lonIng regullUOIII, and land dltelDpleftt tlglllltlOlll in tbe jUrl,cUcUGn. I allO
<br />eutU, tllat I Wldtrftanc1 tlaat tile regulatlOll8 of other goveruentllagenclea ., IIpPIJ to the int_ell .t, IIId that It il
<br />If rapaIIIillilltr to {dutifr what actions I IUIt take to be in COIplilOce. Such agenda Include but are not IiIUec1 to:
<br />t Duarllat of IIld~talllllllat1on - CfPnu Be,llnda, Wetland Ateu and InvirOlllll1t:ell, 8enIiUte Landi,
<br />llter/VlltlWater freat.lent
<br />t BoIltllM8t Florida "tit lIIDIa_t Dlltrict - 11111, CJpl'tll BaflJeat.l., IIetliIIIIJ Areal, Ilterlng latercourses
<br />· InJ an. of 1:t1ll~ - 8...11., ODeb, latigable Ifatlnar'
<br />t IlIJu'tBt of tIa , leIlibilitaUv. Senlcu, IDdrauental Health IJDjt - !feU8, lfutnatlt 'r'IUent, Septic rWI
<br />I OS "'J~tll Protectlaa Ig~ - A8be.t~ Ibetl!lll!Jlt
<br />I alII c:ertifp that, If fill laterlal i. to be Uled in Flood long ".- or WA,ete.", it i. undlrataad that i drl~ plan
<br />a&1reuiag a '~..UII9 val.' IfUI be ..ittecJ wbich 11 prepared by 1 profeuiGllal engl_ rlgi.tered ill till state af
<br />Florida prlar to pemt illUaJlce.
<br />
<br />A perIIit IIIlIId lball be COIIItrued to be a lic8DJe to prOCUd with the IIOrt IDi not II lutborltr to violate, ClllC81 liter, or
<br />eet alicJe lA' provlllOlll of tbe tldlnlcal code., nor .hall iuuanc. of a penlt prevent the BuU4int Offlcill ffCII tbereafter
<br />reguiring · cornc:tlon of errore In plus, CCII18truc:Uon, or viollUDIIS of au, code~ Iverl ptIait l..oed ...11 .... IlIvl114
<br />unl.., the IIOd luthorbed br IUcb penlt 11 ~nced wltbin Ib .,ntbl of beuance, or if IIOrt autlaorblll bf tbe pemit is
<br />I~ or 1budoaBC1 for a perlocl of .11 _till after tbe tile tJllt IOrt J. ~ced. ODI 10 'If at_illl Df till, .J be
<br />a1l_ for the pemit with fee cbir,e af '15.00. !be uten810n Hall be requllt:ed ill wrlUng to tbe IulldJIIf Official. An
<br />Ippmred Il11p1ttiaa ...t be loned elurlng uch Ib IDI'ltb period, or the project wIll be COIIIiierld 1IbIDdaD1d.
<br />UIIIIIe to CIIIIIII: YOUR PIILURI to RBCOID I IOIICB OF COIlIIIIClllIII JIIy IllSULr II 1001 PAY" ma FOI lIIPIIWIIlumJ to _
<br />PIIOPIIIfY. IF" ImID to OIIIAII PIIIlICIIIC, CON8UL! WItH YOUR LlIDIR 01 II 111'ORIIIY IIPOIIIIICDIDIIIQ YOUR IDfla OF
<br />CQIIIIIQIIIIJ. JOI8 DIDO '2,500 II VALUlIIO lor NOD ro RICOID MD POSr A lI.orlel OF aJIIIDQuwrrl.
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<br />r -~~
<br />-\eu-. ' \_ -.
<br />81_1UII: OMIt 01 KIIr r
<br />
<br />~,,2:DJ J~
<br />SIl;lArDIII: COIIfRlClOll ~ v
<br />
<br />liAR 01 UIDA
<br />aam OP
<br />'l'be foregOing in8tJ:U8BDt vas acllnowledged
<br />before.. this , 19_ by
<br />
<br />STAR OP FLORIDA
<br />coum 0'
<br />The foregoing iD8truaent
<br />before De tbis
<br />
<br />..8 acJmow1edged
<br />, 1'____ by
<br />
<br />who is personally Mown to .e or who baa
<br />produced
<br />as identification and wbo did/did not
<br />take an oath.
<br />
<br />who 1s per80nally kDOIID to _ or who bas
<br />produced
<br />al identificatioD and who did/did Dot
<br />take an o,tb.
<br />
<br />(Sipalure)
<br />(.... TJped, Printed or Stamped)
<br />JlOTARY PUBLIC
<br />
<br />(Signature)
<br />(Name Typed, Printed or Sta-.ped)
<br />IfOTAaY PUBLIC
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