�9��'1�� 0� ���� ���T�1C°P1�6��: The und�r�igned und�rstands th���his permifi may��subj�ct�o"d��d°r���ri���ns" �
<br /> �r�E�h�y f��r���r,�tr.ic�iv���i��,C�u.n�y reg.�ti��in��. �`ur,r��r.�Cg�t��.uc��r��,�,�ifaiti�;�foe�.rn�G�c�uvi��e��y
<br /> applic�bl�d�r�d r�sfric�ion�. � , _ �
<br /> ���.������� ��t�`�����'�0�� ��� ���i���'��E� ���E����f�i�e�'8��: if �fi� ewn�r h�s hir�d � car��r�c�r ar
<br /> c��Cr��t�r�to und�r��lc� w�r�, th�y may�� r�q�ir�d to he N��n�ed in a��rdance with �4at�and lo��f regu(ati�ns. tf th�
<br /> eantr�c#or i� not fic�n��d a� r�guir�d by,taw, bc��h th� owner and c�ntractor may be cit�d for a mi�dem�anor violatior�
<br /> und�r�t�g� l�w, ir"�h� �wn�r vr i�#�r���d �n�ra�tvr ar� ue����fain �����uvh�� li�en�ing�r�uir�m��i�.m�y �a�ty �or. �h�
<br /> i�►��n��d w�rl:, �Fttay�I'���VI�C�$CX.�QPIf�G�'E�Ie'E���,�Cl��tCt�� �Gi-IC�k�it,� I¢l���C:4dE3F1'�fVtSt�l3--LkCeCtS![��.�'u.eC�l@tt r��7�T-c`�T-
<br /> �0a9. �urfh�rmoro, if fhe ov+m�r ha� hired a contractor or confrac'rors, he is �daised f� h�vo th� confiracfor(5) sign
<br /> �or�on� ���h� "c����r�f�c�c" c���4�i���ppfi�fi�o�►�.ir uxhicil �i't�y�wif4 b� ���p��s��1�. fF yt��, �� �h��u���r�ign a� #{�e
<br /> G�i"c'ei�e.iCie, i.ilcai �„�,y �� ��r i�c;�c��ian ������ 3� ��� �r���riy ii�o���� aii� I�u fi���i'l��d��e.� ��i �vit'i'li�tjl�i�'j jJ#`I`tf'iicv��.� li'i �c�ad:�
<br /> G�Uii$y, � ,
<br /> ���9�P��5���'6�� ii�P�C�'/�`�IL9�i�� l�������iD ����4J����t���l���Y F���: The und�r�ign�d understmnds
<br /> �hat i ransporta�ion lmpac�Fe�s arid Recourse Recovery F�e� ��y apply ta 4he eonstrucfiion o; n�w buildir►g�, change o� i
<br /> u�� ir� �xisfiing btaildin9�, �r�xpansion of.�xi�ting building�, a� �p�cit��tl in P��co �o�m4y �rdin�nc� n�am��r�9�0� 2�nd - '
<br /> �t3��,.�� �3iYt�tl�t�. ��'t�1.I�id��'�igfl����� iA�t��fi����PtC��, ��i�� 5'4�C�1����,:�5'PPt�'y�� �'t�', 1A1i�� b�i��'fi1'���C� �a$�i� i1YYi��i
<br /> �E:P�'II1��1it�. `1$ I$ 1�UP'tf1�P 4li1L�EP�$ABC� ��"I�l' �Pr�Yi���f���iOPI"�i"i1��C't'�Ci�S c'lild �G^�OUf�3 g.B��V@Plf'�@*�� TilL}�$k3� pc'11C� �'!i'i0Y�`9 �
<br /> r���ivin� � "c�r�ifr�to of�ccu��ncy"or fin�l power r�leas�.' t�f fh� pr�j�ci does not inv�lve � cc�rti�c�tc� of occu�a�ncy or
<br /> ��at po�� ��le���, �EZ�fi�� �n,��b����.�a�ec�� �����i�6��;�a.�c.�. F��,s���,���, i�E����u����Ul€������v�r�� �����
<br /> f�es a��d�a�, they mu�f��p�id.pri�����aermif l��uance}n��card�nce wi�h a�pfi�bl��'as���unt�y�rdinan��a.
<br /> ��f��'�'�i�G���i� L���! t�4��f(��i��������, �C��[�� ��2����,�� ��������; 1�v�fuation of�,�orl�is�2�500.Qa or mer�, !
<br /> cerfii�jr Yha� !, �he applic�rrt, �h�,v� fa�en hrodid�d with a co�y �� thQ "Florida Con�tr�c�on Li�n Law Fl�sm�o�vn�r'�
<br /> �rafection Guid�" prepar�d by�h� Fiorid� ��par�men���f R�griculturc and Con�u��r��air�. -I�fha apptic�r�t i� �omco��
<br /> o�her�k����k�e"ov�n�r", !�r�ify fi��� ���v�.��Yair��d.�a c,�py a��h�.�b�ve d����ib�d.d�c�amenY�nd pr�mi��in goc�d.§'�ith.f�-
<br /> d�Gv�r F��o�h�"��.�n�r"�rioc���em��n��t�x��. _. , _
<br /> ��i�`��e��i�P�'�I�@fi9�9��'� s�c��'��Ab6`�: 1 c��tify tha#at!fhe inrorma�ion iri�his�p�lic�tion r�acctarafe anti fhat aA yvoric
<br /> ��il� f�e•�o�� in �'�ipli�t�ce��+i�h�I!��pliC��l€� �,vv� r�t��aktrt j�4�st�t:����r�, ��ning a�d land��v�1��amen�. Ap�li��ian i�'
<br /> ��i��311 ��ta� �d ��i�l� ea �i�i�f'� �� �ti itii's'3Yii cli5t� Ii�iS[��ic'l�l�t�Yl ca� i�i�il`�,'�i�i�� i t�GPiily` r�i��i�il`e� lR{`�in `a�i {it�E�3l�3u�71 ii'c'��
<br /> eomsr��nc�d prior fia i�su�nce o5e � permi� a�d 4P��� ail worke vuifl i�� p�rro�rn�d 'f.O t7iG@�t �7c^tYtfi��PiIS �� �II I�V'V� P�,�l��r'1.�id1�
<br /> cons4ruction, CounYy and Clfy codcas, zoning r�gulat)ons, �nd I�nd ��v�lopm�nfi r�gula4ion� in the juris�iction. 1 al�o
<br /> cerYify fiP�a� I undersiand thaf th� r�gul�tions of o4h�r gov�rnm�nt�gen�i� m�y apply b th� int�nd�d worl;, and �h�� i� is ,
<br /> my rc�s�on�ibility to iden#ify v�rha��c4ion� I mu�t t�ke 4o be in�om�Olianca. Such a��nci�s incluc�� �ut ar� not limi4s�d t�:
<br /> - I��p�r'�nr+�r�� �if��►virranm�snt�1�r���c�ionr���x�s=��yh��d�, �tV��nd.�1r�����n�! .���iro�rra�ni�Jly S��iiiv�
<br /> L�ndS, W�t�rli�ll���ew���r Tr��fime��it. � -
<br /> - Southw��t Fl�rida W�t�r Man�gementi Dis�ric�W�IIs, Cypr�s� B�yl�eads, Wstfand Areas, A{tering
<br /> tN�i�rcour��s.
<br /> - Army Cor���f�ngine�r�-�sa+�alls, Dock�, N�vigabl�W�f�rur�y�,
<br /> � D�p�rirrvs�nf oi t�ealYH � Reh�bilit�fiive S�rvic��lEnvir.onm�rr�al h9e�fth Unit-W�lls, Was����vater �'reatmen$,
<br /> �e�fic Tank�.
<br /> . � U5�n�rironmee�4�l Prc�tection A�gency-Asbe�fos�ba��menf. __ -
<br /> - E�c��r�t_A�fiafian.A�atihvrity�f�unway�. -
<br /> f ur►ders�a►�d ti��fi:�h��f�(fowing re�firic�i�n��pply�s.�h�u�e of fiiff,.- - ,
<br /> - U��of�11 i� nc�F�Itovved In Flobd Zorra"V"u►iles�expressfy pe�mi��t�.
<br /> � - I� #he �I! �rt�f��ial i� 2fl be �a� -i� Fdood .��� "A�� i� is �nder�t�od .tiaaE�a c�.r2+is�ag� pla� �ddr���i�� �.
<br /> "i:cditZ��i1���1i1� ;,'��LTi�'t��' VJ'li��� 5ii�i3?i�'c�� �i Yt3'Yl'�' �'� p:;1'ii'117�;Pi�V�,1{'ll�ii)9 p�7io}v,�d��y� ra �3'9�tSSi�:?c'1'� c.^-;t�li"tL�i
<br /> }ic�n��d�y th��t��e�r Fl�rid�.- � -
<br /> - f� fihe fiill mat�rial 1s fo be used in Fload Zone "A" in co�ne�Pion with a p�rmittod building using st�m wall
<br /> con�truc#ion, 1 cer�ify tha4�tll wi11 b�,u��d only to fill th�ar��wi#hin th�s#em uv�lt.
<br /> - If �i11 m�t��i�l is t� b� us�d in any ar��, ! c�rti�y fih�t u�� o� �uch �ill �nnll not adv�r��ly �ff��t �dj��nt
<br /> - p��pe�iies. I��as� o��!i is,oun� �o adv�r��ly��i�c���jac�nt pr�perti��,-�I�e owner may b� ci#�d for�i�l��e�g
<br /> �h� cc��di�ions afi fih� builciing p�r�ni4 issu�d und�e fh� �'t�chcd ��rrr�it ap�li���ion, �o� lo�� I��� xhan e�n� (9)
<br /> �cr�which ar�el�vat�d by fill, an engtne�red drainage pl�n is r�qt�ired.
<br /> 6f 1�ov�6ho A���`� ���g����4�f�,.�pua����r��,ca�d.:fi���k���i,���sr�v�k�ar��e�a��:tiku����it�i��+,��d3ti.c�r�s sef��a�h ir� '
<br /> fhi� a�'ida�oit prior� cemm�nci�g eonstructic�r�. I under�gar�d 'eha� a se��r��� p��rni�-rriay b�requir�d ior etec��ic�t woe{:,
<br /> pf�rr�bi�tg, sign�, w�lf�, pool�, air conditioning, g��, or oth�r in�taUa�ions no� �peci�ic�fly i�ciud�d in tih� ��Spli�atiEon. 1�
<br /> ��rmit issu�d �half b� constru�d to be a licen�� to pr�c�ed with th�wori:end not a� �uthorify fio viot�t�, cancel, alt�r, or
<br /> set��ide any provi�ion�of the��chnical cod�s, n�r shal!issuanc�of a permit pr�vQnf fh� �uilding O�ciaf from th�r���t�r
<br /> e�q�ai�'irtg�cgcr.cc�i�n �f�cror�in pl�n�, e�n�fr�ctlon�r vi�i��ion�oF�ny c�des. �v�ry.p�rmiY is�u�d�h�il b�eom�inv�fid
<br /> unle� �he.�vark ��fk�ari��d �Sy s►��h pQrmig �s ca�me�ce� v���k�F�t �Ex ��r�ths��p�t�r►�� ���u����, er ig�urarle ���k�oFt��ei.�ay,
<br /> ��1���f°IY7iY IS 9Ua��hu'@d OP���Yi�O(�@CI YOC e� �i@PIOC�t1�&IX(�}YY10i1fh�u 2�2�'P$�i�fPtYl@ i{'tA 112IOP�C iS COf'Cii'i'1@f1C@�. �1l7 @X�@i�810P1
<br /> may°�e r�qu����d, i�a r�riti��, �r��i_#he ��ildi�-.U�i�i�J.Far� per��d n�f @��xc��d nir���y (90� days �nd vuiA d�mo���r�f�
<br /> 3�;:�'ti��`�'�;.�us�ir���vn�r��ior. ���,���;:cQ��ES i0f�i7r�y��J)c��se�a�iv��3�yis, b�e jo�is c�r�����r����an��rr€�. -
<br /> 4!�!l��i�91�9G �0 �@�P���: ��1�� ��1�.11�� �'� ������ � �l��'I�� �� ���t#d6tf���9����i�� i�Jd�Y ���UB.� �6� �'���
<br /> �Al������� ��� S�',fdF��������i�`���'�1���6�������3Y. I� `��d� f�4 i��d�a����'�Ho"� �9��',6��9Gz9�,���9��9L c
<br /> 4�f6�'8�Y����,�6�I��R��Ai�'�°�`��� �Y� ���� ���0�9�16��Yf�l�R 4i��`�9����� �����i�C�6�13�1�`�.
<br /> FlURI£3A dUfZAT(F.S. ' .03) �
<br /> ��PBE�d�PsG�61�� . GC895'��ii�C"i�' /�,�� �
<br /> $ubscribed and swom ta(oca` ed� � re me this� ._ : Su6scribed and swom to(or a�irm_1 _foCe me th���� -
<br /> �y � g�— - •
<br /> tilho is/ar�peronally}mown to me or has/have produced, Who is/are personally known to me or haslhave produc�d
<br /> as identifiication. as identification.
<br /> Notary Public f�of�ry Public
<br /> Gamsni��ion Na. Cas�miss�on t�a. �
<br /> Name of Notary 4yped,prinfed or�tamped Name of No#ary typed,printed or s4amped
<br />
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