|
<br />.-...~..--_...._--_.-- -- ..-- ,~,--'--~~'--"""'-~----.
<br />
<br />eO~I/HT10l'l! OF PERMIT AFFIDAVIT,
<br />A. t:lOT;CE OF DEED ~~S!~~~CTrO~s. '.'
<br />lh. IJ4lrll,.t4 Uft..,.t.nl. t~lt tb\' ,.r.lt ~~y bl sub)lc' tt 'o.~~ r~st,\~tlonl' whl~~ IIY 'I I'" rOJlrlC&lvl 'hiD Cl't
<br />r.,.I,'I'II. tbl ~bdrrsl'fted ".."e "Jpo~Jlbili'Y for ~o.pl1~nc. .ith ,ny .pplic~bl. 4f.. rt.t,lc\i~3S.
<br />
<br />B. UNLICiNSED CCN'T~ACrCI6~ AND COt:lTRA!;U'~ RE~r-()N1I..IJilI"'ITU:a
<br />If thl "Plr h.. hirl' a c,ntrlct.r .r (~n\r'c'lr' t. u~d.r,.ko .ork. '~'Y .ay h. r.,uiro6 ,. .. llc,ftle4 in acc,rd.ftc. with
<br />Stitt aft' liCit r.gulatlon" 'f th,'~.ntr'ct.r 15 not liconttd '1 r.~ulrrd .y I.w. ~o'h 'h. .waet and ~Ift'ractlr ,-y ~I
<br />cited for a Illd'lt.nor vl.l.tlln u"der ".tl llw. l' '~t OKner or l"ten'~d contractor .,t unctrtlln as tl ahat llCI.51ng
<br />rft~lr'llfttl aar 1~,ly f.r t~t Intended u6rk, they If. advls.4 t~ contJ~t the Ci~, ~f Zephjrbilll luildino De,art_eftt, 11131
<br />"8-"11. .
<br />
<br />"
<br />
<br />Fur\h,r..", It th' o""er hAI hir.d I (o"tract., .r cDntr.~t.r5. hI ii Idvis,d to h.~. thl cOltrl,t.tls) sign por~lons ,f th.
<br />'Contnctor $c,Uons' of tbU ,pplicath11 hr .IIlcll kill)' 1I.U1 bt rMPoTlslbll. If ~GU, as tbe Oll1ftt' Ilin II thl "atrlCh,.
<br />~cu Ir. lndlcA\in; lhl' you, ,.th" th.n LII, contra.to" Itt rrsp6nsibl, fvr thl _ort. If lb. Ctntrlcto, _lshe. you to ."n
<br />, .s contr.etor 'hIt IIV~' .0 lndir,tltft th~t ft. 'I not ,r~plrly littnsed lnd Is not tntltl,~ t. p.rlitting prl~ll.,.s In,''''
<br />City .f Ze,hyrhllll,
<br />
<br />c. TRANSPORte!lQN IMPACT ~EES AND UTiLITY CONNECTIO~ F~i9
<br />
<br />~. eQNSTRUCTION LIEN LA~ (CHAPTE~ 713. F~aRIDA STATUTES, AS AMENDED)
<br />I e.rtif, ,..t I. 'h, tppliclnt, hlY' 'ORA provlted wlth a c.,y of 'Florida's ton'lrutt~Dft ~lr. La~ . Mbleo_ncr'. 'tet.ctlon
<br />;y\d.t pr.,art4 by tne Flori.. D.part.lnl of ~9ri(.I\ut. in4 Co~sul~r AFf.ir5. tf thl applicant I, s..tene tlh,t 'haft lh.
<br />'o.ner', I certify thl' 1 h.y. o~t.ln~d . copy of ~h. aboY' d'lcr'b~d do(uaen\ and proils, II ,.od f.ith to drll,., It to the
<br />'o~n.r. prior.t. tD,a,nc..,nt, .
<br />
<br />i. ,QNTRACTOF< II/O~J~E~~_AFF I DAVIr
<br />J t.T.1f, \hI' ell 'hi inf.rl.t!., In '~i. Appllc.tio~ 11 .teural. and th,' .11 .ork .ill ~t dont in tDapll.nC' with .11
<br />aPlllcab!. J... rlvu1it1ftt clftllrackion, loning. tnd I.~ d.v.lop.lnt. .
<br />
<br />_ppltcltloft 11 htrr.y ..d. ,. ob,.ift . p~r.it to do .ork and lns&.llalioa as in4ie.l.d, I clrtif, that no lork or
<br />:::~;~:;:~O:D~::r~~:~::ct~i~rlordto lssu~ncl of a p~rli' and th.t all Mort Mltl be per'.r..d to lilt Itlftdards .fall l~.s
<br />ctrtlf, th., 1 ~nd.rl'I~4 'h:te:~:I:t::~~~o~~~~'::~:;','~ IlndtdrV,I,p'rnl regulations In ,hr J~,I,dj~lio~. ! 'Iso
<br />IY r..ponslbI111r to \'efttify what ItllolK ! lust Ilk. too~:r~:t:o:pl~:~~: "S:~' :~p~.:: ;htli~t'~d:d _ort't~~ :~a~ It i.
<br />f D'~lrtl'.t .1 (~vlron.~ftIJl Rtaul~ti~~ . Cypre,' B.yheads, VelJ~nd ArtlS'lnd tnvir:n.~nt.l~ ~~~si~iv:r~'::1 · ~t' t.,
<br />, W.t.rJVast,"al,r TrOII_pnt I,
<br />t Southnt FIIT1" llater l'hnl3tltllt District. 11,115 C . II
<br />t Ar,y C.,.. ,f [ftol""~1 ~ S'~.~11', ~'~kl, ~.v19~bl~ U:~;~::y,IT cads. W~ti.nd ArI.S, All'rin, W&t.rc&ur$"
<br />t hllUtUllt If Hum ~ RtDt~lhh~la!i''''Jlet!j hvlnl!""I~1 HuH . , ..
<br />t US I.vtr.".t~lll-Prtlr(t;." A~tncY . A~b'ltol lb....." - h UnIt Yells, W'S'f~lt,r Troal.FRt, Septic T.nis
<br />r .110 certify th.I, If fill .at.rlil 11 10 b. ijs.d in flood Zon " , .',. I
<br />addr.sslDf a 'cOlptn,.tlng y~ll1lt' .il1 ~. sub.ill.d ~~j ~. t A or A,tit. , ~t II und.rslood th.t ~ dralft.,. pl~n
<br />florid. ,rlar \. ."Ii' i,suanCI. C 15 prep,re_ ~y · prOr'SSIDnil .n~lnl.r r.qllttrrd I- the St.t. or
<br />
<br />i per.H lul.Ied Iball bt c:o"s~rul!d to lie I liern, I. ' ,
<br />Sit iAld. ~y ,'Ivillonl .r lh. t.,hrtlcil codal ~or ,::r~trd .Iib t~: N~rk .~d not 's luthority tD ylolat'f c,nc.l ,Ittr .r
<br />rrqu rlag , c.rr.ttioD .r .rrars in pl.n,. coostrvttlon or ssu.n[~ 0 · p.r'll pr.v.nt th. I~lldin~ Officill frol thl,I.}'lr
<br />:~~:;:d::'o:O~:,:;;bO~i:td oy luck prr,ll i. ,0IAtn,.d ~ltht:l:::t~:~:h:'O~nr'~::~;f ~vtrr,per.;t ilsu,d sh.ll .,C'.' lavalid
<br />Illowtd f6r the ftr;~t "~~hlf::r:::/: :~\'onths ~H,r lh. 't~.. th. ltork is co..eIlC;d~~ On"~ d:~I::;:~:t.:r 'lI ,tr." "
<br />
<br />:::::;:I,i';:~: :",::: t r :rl~II;: :;;~,~ ::~:i~ ~:,~::;;:: ::' :i. ';r: ;:::' ::: Ii:. ~:~:l.::1 t::.~:~:: A, 'ir~ ::r:1 ~'Il:'
<br />~::i:;E~IF Yl~.l HIEHI TO OITAIH /1 HAII':IIlG, COllSll.' :n/::~r~:H~: ::S:;' A ~:o:: 'All NIl'~lcr fOR IliPAoiEIlEUIl 10 IPUt
<br />. UW~ER f~ 0 IN VM.UI~ DO NOT NltD TO RecQA~ AND POST A Y mORE ~COADJH& YOUR ~OTlCf 01
<br />'NOTICE DF COMHENCEKEHr.,
<br />~
<br />
<br />
<br />
<br />$IATI OF 'LORIOA
<br />COUICTY If
<br />Th. fgrV9Qin; instrumont
<br />bwfon 1\. thi.
<br />
<br />STAlE OF FLORIDA
<br />ClJUtHY DF
<br />TIoI -
<br />. f~r.o~inQ in.t~u~~nt
<br />b.fDn m.. thh
<br />
<br />W~. .cknowltdg~d
<br />_ 21'_ by
<br />
<br />w.. acknowl.diod
<br />_, 1'~ by
<br />
<br />:_:~:: & _ _____ , , w_
<br />produ.c-.rd..-~~~...'. ~~o..,.,-, L
<br />wO inCi ~.... who h...
<br />1I,.ldonUflcIUc.n .nd I'jho dhJ/d id no"
<br />Une l!'\ o.tk. ~
<br />(SlQn.ture)
<br />
<br />'0.1...._ i
<br />;~;d~;51:vi-."n.; ~., l.;i ,,,''" tv I"" ~i ..hili hili.
<br />
<br />:11 identificlltion Il'\d who did/cPd "0.
<br />~&kv ~n Q~th. .. ,. i
<br />
<br /><Signature>. ~
<br />(~~T~e Typed. Printed or Stlmped'
<br />_._~,.."( 'P'U!lL I'C' I
<br />
<br />. eName Typ.d, Printed ~r St.~'I=d)
<br />MQTMV PUElL.IQ ..
<br />
|