|
<br />NOV-13-'96 WED 11:35 ID:
<br />
<br />TEL NO:
<br />
<br />lH19 P02
<br />
<br />. .
<br />
<br />CONDITIONS OF PBRMIT AFFIDAVIT
<br />A. IIOTICB OF DEaD RBSTRICTIOIfS
<br />'lbe uncfenlpel ua4entaa&s that tb1s penlt NY be lubject to -deed reltrictions- Ibieb II' be .re r..ulctlve thin City
<br />regulltillUl. De IBlderllgnecJ HlIIIII reapaulbility for eGlplilDce 11th anI appJicUle deed r..trlctloaa.
<br />
<br />B~ UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSI8ILITIBS
<br />If tbe OIlIer .... bind I coatraetar or contraetarl to uncJerta~e IIOrt, tb., II' be r8C)llir8l! to 1M! 11C1d111l1a ICClOrdlllce .UJI
<br />8tate IIK1 local regulationl. If the contractor 11 Dot licenled .1 required hf In, both tbe __ IIM1 _tractor .J be
<br />cited for a lilli_mol dolation WIder state lal. If tlJe CMner or intended contractor are UDcutai. u to "'t lielDllag
<br />r~rtll.lltl II' apply for tbe intended "rt, tile, are adviald to contad tile City of z.pa.,rbilll Bu.lldlag DeputllDt, (813)
<br />788-6611.
<br />
<br />PurtJler'IDre, if tile GIIIlIt has bired a contractor or tontrlctOf8, he il a4viHd to bav. tbI contractur(s) lign pOrtia of t.be
<br />-Contractor leet1C1l.- of tilt. application for IIbieb they will be rupontible. If JOU, U tile wner lip II 1:118 aJDtractor,
<br />you are lncucatiDg tbat JOU, rather than the contractor, are respontible for the IIOIt. If the coauactor wi.. yau to sign
<br />III c:antraetor UIIt II, be an Indication tbat be is not properly Been.eel and is not IJltitled to ,.oittog priYil.... iD lb.
<br />Clt, of IepbJrbil18.
<br />
<br />C. TRANSPORTATION IMPACT PEES AND UTILITY CONNBCTION FBBS
<br />
<br />D. CONSTRUCTION LIEM' LAW (CHAPTER 713, FLORlPA STATUTES, AS MEllDED)
<br />I certlfr tblt I, tbe applicant, bave been provided 11th a cop, of -'Iorid,'. CDnltruction Lien LIt - ~IS Protection
<br />Guide' prepatlll br the Florida DepartJent of Agriculture i1I1d COnaIlleI Affair.. If tblappl1c:ant il ..... ol:Jlet I:IlaJJ t.bI
<br />-lIIII1llr-, I certifr that I IIave obtained a COP)' of the above deacribed docUlellt anc1 prolile In gaud filth to l1ellter It to tb8
<br />-owner- prior to ~t.
<br />
<br />E. CONTRACTOR"S/OWNER'S AFFIDAVIT
<br />I certifr tbat all ~ infar..tion In lbi. application 11 accurate and that all IOrt will be 40ne in caaplllDCI wltJI all
<br />.pplJceble J... regulating conltruction, laning, and land developllftt. .
<br />
<br />Ippl1cttian 11 berlb, lide to obtlln a perlit to do IIOrk and inatallltion aa lndicatec1. I certify that lID IOrl or
<br />iutaUIUOIl .. ~ prior to illUince of a pemit and that all IOrt ,ill he perfotMJ to _.t II:IDdirdI af 111 1_
<br />rl!Qlllatlll9 conatl'1lctlDll, Clt, cod.l, loning requlltions, and land dIYelO(lllllt regulatiane In tlle Jurildlctllll. lallO
<br />e8ltU, tltat I W'ldIratancJ that the regulationl of other gol8IUe1ltal Igendes _, apply to tile lntenOlll1 lIDrt, IIIIl1 tut it it
<br />If rQJllll1libilit, to identify .bat action. I IUlt tate to be in COIPliance. Sucb agenela include bat are DOt IUlitec1 to:
<br />t DQart8t of InYlrDlllelltal Regulation - Cyprell BaJbeadl, Wetland AIIo and Invirolllllltally 8wiU'1 LIDda,
<br />Vater/Vtatwater tnal:lent
<br />· Soutblut ,10ricJa rater IIInIa8ent Diltrict - Weill, Cyprll' "yheal!J, Vet11114 Area., Iltering hterGOlll'IeI
<br />· AnY Com Df IlaGlnetrl - SeaRll., Dock., litigable Waterways
<br />· DI~ of IIIllIth , leHbllltathe SeniCQ, JnyJrcmental Health ~jt - lfeUI, VutMter fnat.lnt, _tic: fads
<br />t lIB lDyu-ul protlttian Anm:Y - Albntoa llbatl!llellt
<br />[ allo certlfr that, 'If flll_t.rtill is to be UHd In Flood Zone itA- or "I, etc. ., it i. lIJIdar.toad that a clraJqge plan
<br />addreuiD, a -CDlpeDs.ting yol_" "Ill be 'uRitted wbieb i. prepared by a profeuianlll eDglnHr registered In tbI Stlt. of
<br />Florida prior to plrlit, illUaftce.
<br />
<br />. I penllt iaued &ball be eon_trUed to be a Hcenel to proceed witb the IfOrt and not U Iutbodtf to dolste, euceJ illter, or
<br />set asIde IUlJ provl8lon. of l:ha tecbnlcal c:odel, nor shall Is~ui1Dee of a penU prevent tbe 1Iu114JDg OfUd.1 tEal tJleteafter
<br />requlrll1f I eorrection of errorl In plan., CGIIstructlon, or wlolltlOlll of an, COlli. Ivell paJt 11111II1 aba11 .... 1Dvalil1
<br />unleu tile .t IlItborbe4 by IUch penit .. ~ncec1 "Ithin Ib IDIltu of ial\lallCl, Dr if work autboriHII bJ tile penit is
<br />luapended or UIndoaId for . perlOlJ of 111 IDIlUII Ifter tbe U. tJle IOrk 11 COMIIlCll1. Ob. 90 c1aJ ateodoo of t., IIJ be
<br />allawed for I:JIe penU .ith f81 cbIl'1e of '15.00. rbe utenllon lIIaII be requested In .,ltiJIg to the Bulldlag Dfflala1. An
<br />approved iDlplCtioa .st be ICJgIJed during elch Iii 8th period, or tbe project 11111 be COQlc1ull1 abIndaaId.
<br />IIIRIIIC to 0lIIIIR: YCIJR FAILURI ro nCORD A rorra OF Ct1IIDCIIIDr IlAY DSULT II YOOII PAn" ma PIlI IJdIIlOnIurs to YOUI
<br />PROPIm. IF YOO IftDD to DBlIII 'JUICING, COI8ULT 1111" IlIJR LDDIJI OR U AIfORDY BD'OII RltlllDIIG YOOII IfUIla 0'
<br />CIIIIIDCIIIDf. JOBS UIDII $2,500 II VALUI DO IfOI IIID to RItORD AND POSt A -ala OF CtIDDCIIIIIt..
<br />
<br />IIClllIUII: MIll .. AGIIIT
<br />
<br />SICIIAtUU: COIIfIIACTOR
<br />
<br />niB or FUlIIDA
<br />coum OF
<br />The toregoing iDBt~ent ..8 acknOWledged
<br />before .. thill ( 19_ by
<br />
<br />STAR op FliOlrDl
<br />COUIItY or
<br />The foregOing iD8tru8eDt ... IlclmOllledged
<br />before me this , 19 by
<br />
<br />who ia personally knOlln to lie or .ho has
<br />producecl
<br />liS identif1catian and who did/did not
<br />take BII oath.
<br />
<br />who 18 personally Mown to _ or who blla
<br />produced
<br />.s identification and who did/did not
<br />take an ollth.
<br />
<br />(Siga.tare)
<br />
<br />(Mbe TJped, Printed or Staaped)
<br />NOTARY PUBLIC
<br />
<br />(Signature)
<br />
<br />(N... Typed, Printed or St-.p8d)
<br />1f0000ARY PUBLIC
<br />
|