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<br />n: ' Lj(~LU;J.:,_()T DEl::!) PEBTR I CT .lJJ!::IS!_
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<br />lh~ IIndrrsignrd underslands lhal lhls pl!r.1t lII~y bl! 511bjrcl l~ "drl?d rrslricli(,nr,' IIhirh roa)' llf' nr'lr rrdlic\ivr Ih~n Cily
<br />rrgulall~ns. lhr undrrslgnl!d aSSUlIIl!S rl!sponslbllll~':'for compllallcl' Hilh any appliraldr, dre,1 rrslrirlion's.
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<br />IJ. LJ!"L~J~~~NSED CONTRACTORS At~LU C.Q~~LU:l.[\r::nll LJU~~SE~r)f\ISJIII~I_IT I E~;_
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<br />If lhl! ('lInH h~s hired a clonlraclor or conlractors to IIlldrr!akl' Imrl:, \llI'y r>ay hl' rl'~Hill.'d Ir, bp licl.'nsrd in acc~rdance Hith
<br />statl! and I~ol rrgulatlons. If lhl! contrador Is Il(ll IlcenHd as rr~Hirrd by 1,,11, h(dl, Ihl~ r..,ner and r(,nlr~cl~r nay bl!
<br />ciled fH a nisdrneanlor vlolall(ln under slale lall., If lhl! (,Hner ('r inlrndrd c~nlrac'r'r all' IIner'llair, as 10 !fhal licrnsing
<br />rr~uilr.rnI5 lIay aprrly ffor the inl!?l1ded lIl'rk, lhl'Y are advisrd l~ [(,nlad \I,I! [ill' (,f f'rpl,('rhillr, Puilding IlrpHI~rnl, (HI])
<br />700~I,bll.
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<br />rurlhl'ra~rr, if Ihe l'Hn!?r has hired a c(lntractor or conlrac!c,rs, hI! Is advlSl!rllr, h""r lhp ((,nll"cIH(5) sign p~rlil'n5 of Ihl!
<br />'Conlractor Sedions' (If lhls appllcalion for "hlch lhl!Y "II] he rl!sp(,nslhle. If Y('II, as Ihl' [,Hn[-r sign as Ihr cl,nlraclor,
<br />Y~u ar~ indicaling Ihal you, ralher lhan lhl! conlracl~r, arr rl'sp(,nsihlr fllr lI,l' IIr,rl:. If \I,r ((,nlr;;cl(.r Hishrs Yl'U t(, sign
<br />as ({onl,aclfor Ihal lIay be an indicallc,n lhal hI! Is nol prr,pl'r]y licl'nsrd ar,d is l,r'! rnlilll'r\ 1(, prH,i\lir'f) privilrf)rs in lI,e
<br />Cj ly (.f Zcphyrhi lIs.
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<br />c. TflANspornAT I ON I MPACT FEES ANl?.-J)":'LU=-Ll..L~ONt-lr~(~_IJJ11\1 lETS
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<br />D.
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<br />~!-JNSTflUCTI ON L I EN LAW
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<br /><CI-IAPTEfl 713~ FUJflII)(l ~~l()TUJT~), (l~; At'll~NIJE[))
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<br />I ccrtify lhat 11 lI,c applicant, havl! b!?l!n provi~l!d "ilh iI copy of "Florida's Cr,"r,lrllcli(,n Lirn L,'H - Ilr,nroHnrr's Prolrclion
<br />Gllldc' prcparl'd by Ihl! nrorida Dl!parhl!nl of ngrlcullllre and CllnSlll\H /\ff~irs. If 11,1' ~r,['ljr.-,nl is s(,er6rrl' ~Ihrr Ih~n lhe
<br />'r'lIner', I crrtify that I ha'll! e,btain!?d B, copy of th!? ahovl! IIcscrihcr\ Ift.rtlrr,l:n\ ,,',11 ['rl,n,j,r' jh q[,otl f.-Ii II, 10 t1rl ivrr it 10 Ihc
<br />'trHPH' pr itrr 10 ctrUl!ncl!lIl!nl.
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<br />: 1 '~ .:,', " , ; .
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<br />E .'.;,..~J\NTfl.0.~TO!1 -' S IO.\rINER '..S .(;)FF lOA\! IT
<br />,"\.. ..... i \. W ," ,",~ .;
<br />I certify lhal all lh_f"r,"~\i~~ thlspprJlca\ic'n ir, accllr~le and Ihal all 'H,d; Hill "I' dr, Ii!' HI c('~plianct' Hilh all
<br />applic~blt' Jails rt'IJulaling c~~t""'.n,.1tn\f), ilnd lallll dcvl'l~f1/.1r.nl.
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<br />npfllicalion is hereby lIj1de h. c,blain a perlll'l I~ 110 lIork ilnd inslall~lic.n ,lS illlliudl'd. I [[I lift' thai f1{, H[,rk or
<br />Inslallalit.n has cI.ucntt!~ prior 10 Issuant!? of a PHlllil and Ihal all IIr.r~ lIill hr' I'rrfr"I:lI.t1 \1' ~rct standards e,f all laHs
<br />rt'gulaling conslrucllr,n, City t(.dl!s, zoning nglllatic.ns, am! I~nd dl'vclr,pml'nl rI'IJ"I.1tir'n~ in 11.1' jl1risdiclic,n. I als(\
<br />cl!rtify lI,al I undl:rslarod lhal lhl? ngulations l'f olhcr lJ~vr.rnlll'nlal itrll!Jll:il>5 ""i al'l'l)' \[, thl' irolu,drd IfC.rk, and lhal il is
<br />"y re5por,sil,jlily Ie. idenllfy IIhat actions I musllal:e 10 bl' In cllmpllancl'. r;llcl, alJProcipr, i"clllilr l'lIl ~Ir 1\(.1 linilt'd 1!l1
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<br />. ,
<br />I !1.fQarlmrrol e,f (nvirl'nlll?nlal ReQtllatil.1n - Cypress Bayhrads, lIl'lIand flrras ~lId [Il'lir('flHIlli.lly Srl1sjlj,.~ LHlds,
<br />lIater/Hasll!lIall!r Trealml'nl
<br />f ~e,ulb~!'_~! Florida Ilall'r'lIanaQI?Ill'nt Distric\ ~ Hells,' CYPI!?SS l1aylll!ads, IIdland IIrl','s, f.llr'rirlg Halrru,ursrs
<br />, O!..!'LS~p's[\f EnQinel!ts - Seal/ails, Dods, /lavlgablr Ualerllays
<br />p.!:~~ler,! c,f Ifeallh I. Rehabilitativl! Servic!?s. El1virol1rrl(,~11il.!Ji~UlL!Lrl.il- Ih.lls, lIasll'\I"lrr lrr."I~':n~, Srplic Tanks
<br />~S Enti~e'nal!ntal Prtrlec\\[.n OQl?ncy - Osbl!stos aba!rm!?1I1
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<br />also cl!rtify lhal, if fill lIa!l'rial is 10 bl! used in Flc.od Zconl? "0" C.f "11,1'1(.', il is undr.rsle'l,d lI,~1 ,j drairoagl? plan
<br />addressing a 'collp~nsaling volume" lIill be submitl!?d Hhich is prrparl!d hy a prof"'s5i~hal vnginrrr r('~i51~il'd ill lhl? Slale of
<br />Florida prior ltr pHlIlit issuanc/!.
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<br />n pl?rlil issul'd shall be construl'd to bl! a Iicensl! to procel'd tlilh lhl' He,rk ,oIlIln(,1 as auII,r'lil)' Ie' vilol"lr, caner! al1rr, or
<br />HI aside any pre.vlsie'hs trf thl? lechnlcal ndes, nor shall issuallce ~r;, I'I'rmill'rr-vl'nl Ihl' l'lrildil'!] l1fficj~1 flCol\ Ihereartn
<br />lequiring a ctorrl:ditrll (,f !?rrtlrs In plans; ([,"s1ruelic.n, Cor vi~I;,li~ns (,f .111Y C['lh" hl'IY rl'l~il i5511,',1 ol,all brce'lI! in'/alid
<br />unless lhc tj(,rk aull;c.rlzl?d by such permit is cC'/11llenced Hilhin six I'l~nlh'l I.f iS~U.lliCC', ['I' ifll('I\; ;;ull,(" lOrd bi lhl? per.il is
<br />stJsflelldl'd or al,ar,dr,nrd fe,l' a pl!riOII {.f six lonlhs after lhe liJl' thl' \lorl; i~ C['Ml'flU,r1. [1,,1' '1(1 dar c-~le,.5i~1I llf list', lIay bl?
<br />allt'Nl'd f~r lhe per/llit Hilh fl!l! chargl! of $15.00. The I'xlel1sle'l1 ~hall bl' Jvqlll'slvrJ in '/Jilin!J Ie' lht' r,loildil1g Official. nn
<br />aftpl~."cd insflccllc,n l!Iusl be !c,gged during !?ach si~ lI10nlh pl'rilld, c,r Ihl' prl.j\'cl "ill hl' u",sidrrr:d al'dl,rJ(.r,r-d.
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<br />\..JARN I NG TO D("JNER: ' YOUR FA I LUIlE TO RECORD () I\/( IT 1 CI: UI: l:UI'II'Ir=.r-1l :El'lENT t'IAY
<br />,RESULT I f\I YOUr1 PAY ING TW 1 CE FOR I MPROVEI1EI"T~; TU YUlJH I'IWPEIHV. I F yOU
<br />II'lTEND TO 0I1TAIN FINANCING, CONSULT \.-oJITI.! YClUn LENI)[::I~ (lI~ ('IN f11TORNEY
<br />8EFm~E IlECOrW I NG YOUn NOT I CE UF CUr'II'II':NCEI'IENT. :J Ul1~; (J[\IIJEn '1;2, :)00 I N VALUE
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<br />~~GN:~~H:'EEO TO RE;i Z;;T A "NOTI::G:;O'Il::'lI~"'n". . zJ
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<br />----n-~~AGENT---- --/1;.iiii.' iii\cluii- - n_
<br />DA TE _ _ __ ____ __ _1-~_2_~f?:::_~---_c-._------- VA TE - - - -- - - -- - ~ --: -~ ~! ~- -- - - - - - --- ---
<br />A~ ~ /) "
<br />NOTAHY AS TO /' Ii t.. - - k/~ ~.
<br />mlNEI1 on AGENT __~:"_____-__~_____-___-_--._
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<br />
<br />
<br />Ii C!-'
<br />NrJTAny n!,llJ ; --,----.}-
<br />CONHlnC-l Ull__6Cf--::.~~_k-__~~~
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<br />rw connISSION
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<br />EXPInES "'" 1'1'( cmlf'w;~;r()f.l
<br />---~~~7~~~----OF~CrALSEAL
<br />,II' _ .~d -II..
<br />:. ":k., '. d', Barbara R. Costello
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<br />\ i"~~} My C~~:,I~~i~~9~Plres
<br />.....'l.~nr.'t4. Clilinli'l. NI;j. CO 054525
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<br />E X I' r flES _ _ __ _ __ ___~~ _ _ _____
<br />....~~..~~.\ OFFICIAL SEAL
<br />: ~rrr \ Barbara R. Costello
<br />: " J1 ! My Commisslon Expires
<br />.. ' .
<br />\.... .' Nov, 2, 1994
<br />~'tOP'~. Comm. No. CC 054525
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