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<br />CONOITIONS OF P~RM1T AFFIDAVIT
<br />A.. t{QT I !;:~T~I?' Qi~}2...s.U.:t.B.Ut~.w!:
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<br />Tht und.tsivn~d undRTI\'nd.~hat this per.i' .~y be subject to "dlod rl.trlctjon,' which ~ay bo 80T' r,.trlctlv. th.n City
<br />rP9u1atio"I. Thl UndOTJignud alsu~e. r,spDn.ibltl'r for c~.plia"ce with any applicable d~,d 'o~trlctlonl.
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<br />B.
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<br />~~ICe~~~D ~~~T~eCrOBS.AN~ C~taact9R~E~PONSIB~L~
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<br />If the owner hel hired. contractDr Dr CQntrac\~r. t~ undortako work, thay .~y b. roqulrod ~~ b. Ilc.nl~d In .ccord.nc~ ~It
<br />,t,t. and local reQula\lon.. 11 thl contrlctor 11 n~t llc'n,~d II roqulrDd by la", both thl ownor and contractor Ity b.
<br />clt.d for I .llde.~!nDr Ylolatlon under Itat. I;H. If th, ownor or lntondod contractor art ~nt.rtlln al \0 whit Ilc'"lln9
<br />requlre,onts .ay apply for th. Intandtd work, they 'tD sdvlsed to contact the City of Z.~hyrhlllc 9ulldln9 D,partllnt, 191'
<br />789*6'11.
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<br />Further.or'j 1f 'hi own;r hi' hlr.d a contractor Dr c~ntr.ctorl, ho Is advls.d to hay' th. contractor II) '19n portions 01 \
<br />'Contractor Sectlon'~ 01 thlt eppllcatlon for which 'h~y will bt r'lp~n.lbl~. If you, II t~. o"n~r 119" '1 th~ con~r4ctor,
<br />y~u Ir. lndlcltlng thlt you, rlther \hin thl contrlctor, ar. r.nponslbl~ for 'hi work. If !hl c~ntrlctor Wllhp'1 you to Ilr
<br />8S contrl~tor that .ay b. .n indication that h. II not properly llct"uod and I, no~ .ntltl'd to porelttlnQ prtvll10ts In t,
<br />City 01 Zephythllll.
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<br />C. re.ANSPOBTA!I~MPACT Fi~S ANp UTtLlj,Y CO~N~CTI~~.FE~
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<br />D. POt-l~TRU~iIQ~ LIEN LAl-J CCHAPTEA 713, FL.ORIDA S'fATlJTES, AS AMENOEO)
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<br />I certify that I, th~ appli(ant, hevl b~'n provided with. copy or 'Florida', tonltr~r.'lon Lltn LaN . K~"O"n.rll Protectl
<br />Guidi' prlpared by th. Florida Deplrt.,nt ~1 Agrieulturt and Conl"..r Affaltt. If \hv arpllcant II IOIQ~n' o\h.t then the
<br />'~"ner~, t clrtlfy that t havD obtllnad a CDPY Df the Ib~y. doscrlb.d dot\'~.n~ and promll~ In good '11th to d.llv.r It t~
<br />'DHn,r. pr'or to cOlmente~e"t.
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<br />E. ~RACTOR'S~NER.S ~EFIDAVIT
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<br />1 cort1fy that all thi 'nforaation In th15 ~ppl'catl~n II accurat, and thlt all wDrk "111 h' doni In co~pllancl wllh all
<br />Ippllcobll laHs r.gulatlng construction, zoning, and tand develDpMent. .
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<br />ApplicatIon 15 hereby .ade to obtain I per.it to do Mork Ind Installation II indicated. J c.rtify that no work Dr
<br />In'tlll.tl~n hiS C~~M~ncod prior to Issulnc, of . por.lt and thet all ~ork w\ll bQ pfrfor~~d to ~~ot ,t.n~ar~' of .11 I'"'
<br />tequlatlng construction, City codes, 20nln9 rI9ullti~ns, and land d.ve]op~ent reQuletlon, In the luriSdlctlon. 1 .110
<br />certify that 1 understand that thu regulatlon; 01 other goyernmentel age~cl~1 ~~y apply to the Int&nd~d ~tlrk, and that It
<br />flY responslbHlty to tdenHfy "hat actions IIlIUB\ hkll to Ill! In c6l1plhnco. Such IgrHrcles Il'\clud, but ~ln lIo11lttit,d ttl
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<br />I De~o\t.t.llPnt o1"...Envl,onll!!1l<eaLJ.t!l!!..1lu .. CypreSll Bayh~adi, ~~t1lnd Al'hs and !nv,lronunhlly Sef\,j t-l ve Lj~.dlfl,
<br />Uat!r/Wastewatlr Treat~'nt
<br />, S~utbw~5t~lorida Water_H~Q!9tlrnt D),tric~ . ~el1J, Cypr~is &ayhtods, W,tlend Areas, Alttrinq Uatttcour5rl
<br />. aJ:!Y. CorDI of Entl'n~;r!l . hit/ails, DflCks, Navigable Waterways
<br />t DI1P~r.tr.ent of...IlnHb L Ihh~.!tiJttatl,YR Sl!rvSetW~vlronml1nt~l fieAill..YtJ.U. .. Wv:lh, W~!ltl\l1ahr lrl!lh'!!\t I hpt\c. Tanh
<br />I ~~nvlronp~ptll Pro~!ct~ - A~bl!,to' abatemont
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<br />I allo c.rtlfy that, If fill lattrial \5 to bt used in Flood 201\& .~. Dr "A,ltC.., It II Yndtrlt~tld lll.t . draln~ql plan
<br />addr055in9 I 'colptnsatlng volumal "\11 bt lub.lttod which Is pr~par.d by a profOIII~"al .n91~~.r t&~I'~O(od In thl 9ta~'
<br />Florida prior to pl1rltU luu,ance.' .
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<br />A per~lt 155U~d Ihall b! co~&~ruod to be ~ llcQn5e to prDc.ed Hlth th~ H~r\ and n~t SJ ~uth~fily to ytol~to, canrol .l~~"
<br />,ot esldo any prov151~ns Df \bn tethnical COdIS, nor shalJ i05UBnc. ~f 0 PQr~l~ pr~v~nt thv ~ulldln9 Of(lcl.1 fro~ Ihere
<br />r,quirlng a torT,cllon 01 arrors in pl.ns, cbn5trU(t'~n, or violation, D1 any cod~. Ev~ry p'fnlt iSlllUd I~all bpco" In
<br />unlo55 thll Nork i1uthorin6 by such per.it Is cor"~encpd w1thin Illl month! 01 1&9Ilenc., or If H(.,k .ulhc.'lzf:d by th. p,rtl
<br />&uspt'nded or abandoned 1Dr I plrlod of six IDnth!l after tho till th~ lmk If cDftlIll~nctd. On~ qO day ~~t'MI~1I or \lIP, J
<br />al1~wed for the ptr~it with fee charge of $1'.00. The IxtDns50n shall be reqUp.5te~ In writing 10 tho BUlldln; Offlelal.
<br />Ipprc1ved Inspl1ctlon Illult be It,gg.d during nth six GlDnth plried, ",. the proJoct .,,111 bl! r:or,sldl?rtd IIblllldoMd.
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<br />WARNING TO OWNSR, VOU~ FAILURE TO ~iCO~O A NOTICE OF COMMENCEMENT MAY
<br />R~gULT IN YOUR PAVING TWICE FO~ IMFROV~MENTS TO VOU~ PROP;ATV. IF YOU
<br />INTEND TO OBTAIN FINANCINm, CONSULT WlTH.VOUR ~~NO~P O~ AN ATTO~NEV
<br />BEFORE RECOROING YOUR NOTICE OF COMMENCEMENT. JOSS UNOE~ '2,'00 IN VA'
<br />CO NOT N TO RECORD AND POST A '.1 NOT I Cr:: OF COMMENC:e:MEN'r II ·
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<br />ER ~~~ SIGNA'fURE~ TOR J_~
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<br />.~. _" _... ~ CONTRACTOR __' ______ ~__ ___________
<br />MY COMMISSION EXF'lR~S..._,..._.._.._...:...-.....---.._--- MY COMMI N E:(PIRES__..~;lf:..:?_S::__.
<br />.tOT /to.P.V tu!l":' "Jr!.n r.;; ~~~A
<br />N\I CC"""'~S'1'~ r.)',o ....!...'O. :~. ,...lit.
<br />,n '.'.,. . ' <Ill'" .~".,
<br />IIJI)EO n-IW ~PJill,. ,0<1.1,;,."'.
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<br />SS3~dX3 a~1 O~OHd 9~:~~
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<br />~ 6-9~-~n'
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