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<br />norr-25-'99 Tl.E 1(l:00 ;r':
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<br />T=_ ,,<I: _ .
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<br />tl79-<l P03
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<br />CONOjTIO~s OF PtRHIT AFFIDAVIT
<br />A. "onC! or DEED RSSTJl.ICr;rOHS
<br />"he und.ezajlJfled unde..at.neb th.t thia penlL1t IUY!)e su!lject to -deed reatriction." which
<br />-Y be _r.. ....atr1et1". than City re1J"lation.'" The ,u,d.raiVned ...~. re.panaibility fOr
<br />~llano.. ~th afty .pplieable deed ....t~1ct1~ll..
<br />a. UNW!=DlS!D cmrrAAc:'rDR.5 AIlI) COIfTRAeTOM USPOt;U8ll.ITIES
<br />If ~.. ONDer ha. A1Z9d .. oontractor or COfltractors to undertake work, tbei.., be r.qyired
<br />to be lioanaed in accordanoe with .tate and loCal re9ula~iona. If the contractor i. not
<br />licenaed .. ..equ1recl by l.w. !loth the owner and contrec:to.. _y he ci ted for . al.~DOr
<br />violation WIele.. etate law, If the owner or ;.ntended contractor are \moeZ'tUD .. to "bat
<br />110enaiD, Z'equ1~t8 -y IIpply tor the intendtld work, they are adv.1.ed to aontaClt the
<br />C1ty of Zephyrh111. Building Dep.r~nt, 813-7'8-6611.
<br />rurthe~re, if th.. own..r ha. hired. contractor or coatractora, he i.. advieed to have the
<br />contr.c:tor(.) .ip portion.. of t).e "contuctor SectJ.on.- of thi. app11oeuOII. for WIlJ.ab they
<br />w11l be reaponaible. If you. a. the owner ai9ne aa toh. contractor. you are UMU.OIIt1.hg tha~
<br />you, rather than the contnctor. axe rellpOh!lUlle for the wort, If the conuac:tor Wig..
<br />yoll to Dtn a. CGI1t.tacto.t that may be an ind1c:.uon that he 1. not properl]' Uo.ued aDd 1.
<br />hot uti1:lecl to peDai.tUng privllepa 1.n the City of Zephyrh1lla.
<br />C, TlWfSPORDnCllf IMPACT n:a AND U'l'ILI'J'Y CONKscrJCfi PUS
<br />D. OClNaTJtUCnrlON LID LAW (CHAPTER "B. n.olUM STAT\.."'l'ES, AS ANDlDJ:D)
<br />I ~ufy that I, the applicant, have been provicied vith a copy of ~Floricla' a CohatnactJ.on
<br />lio 1.a.. - ___.r' a Protection Guide" preparecl by the Florida Depa.rt..nt of ~d.ClU1t;u...
<br />aJaCl Con._r ~fair.. If the applicant i. a_. ot.her th.t. t.he .._~, I C*d.fy th&t I'
<br />ha_ obta1J\ed a copy of the abo"e deaedbllCl documellt and prOlll1e.. 111 ,ood faith to _11_r
<br />1t to the .owner- prior to c:aa..n~nt.
<br />B. CXlJl'!'AAC'J'oR' 'fOlINO's AFr'IDAvrT
<br />I certify that .11 the 1nfo~tion in thi. application is accyrat. and that all wor_ will
<br />be doDe in OGaFli.nce with all applioable law& regulating conatruction. Zoning. aDd land
<br />develop.ant.
<br />~l1cati_ 18 hereby..de to o!lt.in a penut to do work .nd lIwtallat1_ .. 1ncl1cated. I
<br />certify th.t no wort or .1netallat1on has co.menced prior to 1..uance of a per.dt &Ad that
<br />all work Will be perfoDllllCl t.o _.t IItandards of all la... r.VU1a1;.1ng OOIlIItruClU.oD, C1ty
<br />cod... &0n1n9 r.gul.tiona. and land development rSVl.llationa in the j1lZi.dict1oJl. I alaD
<br />certify that I undentand that the J:evulation5 c! other ,ove-"-tal .,ftG1... _y apply to
<br />the intended wort, ancl t.hat it ia my reeponaibili ty to identity Nbat: eeuon. r lllUet tan to
<br />.1:1. 111 ~11ance. Such .gallein include but lire not 111l1tecl to: .De~t of
<br />Bavlron.eJltal Regulation-Cypreaa Baybeacla, Wetland Nea. and Bnvi~o~tally hnait.lve
<br />LancIa, -aterlWa.tew.t.r Tr.atment
<br />-Soutb_.t r1oz1da Water Nalla,ement Di.trict-Wella, Cypre.. Bayh..da. Wetland Are..,
<br />Alt.t1ng ..t"~couza"a
<br />-~ Cocp. of cn,1n..r..-aeawallll, DOCk.., H.V19able W.terwa,.
<br />-l)epartment ot lleaJ.tb , Rehabilitative Service., EIlvironJlleJ)taJ. H..lth Un1t.....lla,
<br />W..t....t.z ~....t.eDt, Septic ~Aftka
<br />.U.I. ltftV1t_tal Prot..eUon Ageacy-Asbe.t:o. &bat._at
<br />I alao certify that, if fill _teri.l ia to be uaed in Flood %one .A" OJ: .A..to.... it 1.
<br />underetood that a drainaoe pl.n addressing a -caqpenaat1ng VOlum8" w111 be ~tted which
<br />ia prepared by a profe.aional enoiaeer registered in the State of Florida pr.1or to pe~t
<br />ia.lUUlce.
<br />A peZlll1t .i..Uld ahall be construed to be a license to proceed wit.b t:ba wort anc:I alot &8
<br />aUt)aor.ity to V1olate, cancel, altar, or ..t .aide any provi.1-. of the teclmical codea.
<br />Dor ahall i.suance of . pem1t prevent the 8u1lc11n9 Official frca thereafter hQU1zoUlG e
<br />cOJ:rect1on of errore in plans. l;:lmatrur:tloA, or v10latlona ot any oode, Ewizy P.DI1t
<br />i.a1led .hall be_ invalid =le.. the work authorized by al.lch pe~t 1. ~c:ed with1:a
<br />IlU -.on1:ha of 1..1IancI, or if work lluthorized by the pendt ia euapelKled or ab~ecl fer.
<br />period ef ..1x Montha .fter t.he time the work ill =--need, One 90 clay enenaion of t.s...
<br />may be allowed for tbe permt with fee charge cf $15.00. '1'h. axteuioc .hall be r.qu..ateet
<br />in "ritin, 'to the BUildinv Offidal. An approved inspection llIUat be l09~ duriJlO e.ch au
<br />_ft~h periocl. or the P"j.~ will be cDna1dered abanciODed.
<br />DJlHI)fl: 'J'O OIINER, YOUR DJl.URE TO RECOJU> A HOTIe!: OF ~ KIU" JlUDL'l III YOUR
<br />PAYING TWICE rDR IMPROII!:HD."'l'S TO YOUR PJIOPz:RTY. 1 F YOU IH'1'EIfD '1'0 08'J'AIN FIKMCDlG, CONSULT
<br />10TH YOUlt l.oDnlBR 0;;' AN A:r70flNE~ B&P'OR!: RECOJlD!)lG rOt:Jl NOTICE or CC*MDICDIBrfT. Jems WEIER
<br />".>DO ,. v..."" DO ... .... "" """DHl> AN. "'OT ^ ..". Dr ~'.
<br />
<br />~f/J1c;-cJyt
<br />
<br />S:CONATURE: OlQIIER OR AGDlT llI:oAATURE: cotI'1'JUt.CToR
<br />
<br />STArE OF f'LOIUDl'.
<br />CouNTY or
<br />The fo~egolft' .in.trwMent well ackhowl~dged
<br />Before me th1e_ day of " lL.,
<br />!ly
<br />(name of par.on .~knowla4;.d)
<br />[:] who .h per.oDall)' known to me, or
<br />
<br />a whQ hea proC:hac.cS
<br />(type ot identification)
<br />and wboO did Oaic! not take al>. oath.
<br />
<br />S!ATf; OF nORI~
<br />CotrnTY or
<br />The for~oin9 11>.8trUDeftt va. aekftewledfed .
<br />Before.. thie --Slay of . 19...:....
<br />hy
<br />'name of penon ackD_le4gecll
<br />c,ho ia peraonally known to _, Dr
<br />
<br />Cl who baa pzoclucad
<br />(type of Ldemtificat10nl
<br />.Old who Odid O:lid aot take an oa~
<br />
<br />S1qnatllte of per.on tekin9 acknowledgement
<br />
<br />S;gnature of peraon tak1n, acknowled,..nt
<br />
<br />)1--. typed, printed or at-.ped
<br />
<br />M~e typed. pr1ctad or .taaped
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