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<br />C[i!.JD I T I m,E; ("e- F[
<br />A. NOT I CE OF DEED F:ESTi~:.I CT U;;n~Li
<br />The undersigned understands that this perlit lay be subject tD 'd~ed re5tricti~ns'
<br />regulations. The undersigned assutes responsibility for cOlpliance ~ith any appli
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<br />B. UNL I CENSED CONTR~~CTORS AND Cm-nRr,C~Hm___J~~[~5F'(JII~ r: U- T I I'
<br />If the ollner has hired a contractur or contractors to undertake ue,rl, they "'0)' be rc';',i,d te, [Ii ljli.n~(.ii il. <c;,cc,CP 'It',
<br />state and local regulations. If the contractor is not licensed a:; required by 12rl, be t the ;"i'.?r 2i,j Onll-":.,;, ,ji be
<br />cited for a lisdeleanor ,'iolation under state law. If thp owner or lntenc:Ed [~n,.]ct,r e J -i'rte. 0, ti' ,,' t ::,(:;"1',1"
<br />requirelents lay apply for the intended ilorl, they are ad,'ised :c, centact th~ C:'.. :;', ,;i:, i', f-_. '~'.: >; .;c; >, .
<br />788-6bll.
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<br />Furtherlore, if the Oriner has hired a contractor or contractors, he is ad
<br />'Contractor Sections' of this application for which they riil] be fisponsit ~,
<br />you are indicating that you, rather than the contractDr, are r~sp: Sible
<br />as contractor that eay be an indication that he is nc,t pfeperl! li,ensed d
<br />City of Zephyrhi]ls.
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<br />TRANSF'ORTATlm'J H1F'ACT j'_EES rIND UTU",.lJ.Y~_
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<br />D. CONSTRUCT I ON L I EN LAW (CHAF'TEF\ '71 3, F-'L ': C::i1'I' :'1", t "1 "j nt'l[.' ~_ L' ,
<br />I certify that I, the applicant, have been pr':vidl.'d with a copy e,f '~i:,:-i.i, 's l'-:'1i5'.iUCtIC( i_ n ,- :i:'!ee'~IPr'5 Ii(,ti:;t;:::
<br />Guide" prepared by the Florida Dl.'partlent of 19riculture and Consumer Iffdl'S. If tre arpllc.nt SD~e0ne cIne: than the
<br />'OllOer" , I certify that I have obtained a cop of thp above described jc~'~ nt ,,":. '1([,::;(" 1(: ,'. ,t tel dell'E.' ;t t: '.'c'
<br />"ollner" prior to cOllenCl.'Il.'nt.
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<br />E. CONTRr~CTOR ' S/OvJt~ER I S PI F I DA\)l T
<br />I certify that all the inforlatio:1 in this ,',plication is accurate and lh,' all ~I,rk hjl;
<br />applicable lalls regulating constn:ction, zo!:ing, and land de'/elJpment.
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<br />Application is hereby lade to obta n a perlit to do lIork and installat on dS incic3ted. [[Pi~,' ii
<br />installation has cOllenced prior tr issuanre of a perlit and that all ark "II! be perf:rmpJ [0 ~e~
<br />regulating construction, City coder" zonir~ regulations, and land deve,optent rl:, 'L;t10r,s ",;-.(:,U::5
<br />certify that I understand that thl.' regulations of other govl.'~n~ental agencies ~ y lDI; to '~e Int'
<br />.Y responsibility to identify what c.ctions I lust take to br in c(i(:pliafice. Sl,:t' oL :jl::~:f.j:: inc~u,jo <'
<br />f Departlent of Environ.ental Rl.'Qulil_'lon - Cypress Bayhl.'ads, ~e\Jarrd Areas ar,d:,...irorif:',',:, :,.
<br />Watl.'r/Wastl.'lIater Treat~ent
<br />I Southwest Florida Water /'lanaQelent _listrict - ~ells, Cypress 8ayheads, ~etlan' lr"jS, i):tpc",::2' i[{,
<br />f ArlY Corps of EnQinel.'rs - Seallalls, ~!cks, Navigabll.' Watl.'f~ays
<br />f Departaent of Health ~ Rehabilitati\e Sl.'fvicEs. Environllll.'ntal Health U"'( - ~,,: I; j<;tOri::'
<br />f US Environlental Protection AQl.'p~- Asbestos abatl.'lIl.'nt
<br />I also certify that, if fill latl.' ial is to bE uSl.'d in Flood Zone 'A' or 'A,e!,,',
<br />addressing a 'compensating yolul" lIiil be sublitted ~hich is prepared by a pfof[ssj~
<br />Florida prior to perli t i ssuanc, .
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<br />A perlit issued shall bl.' cons';.ued to b.' .3 lic.'nse to prc'cel.'d with the He'll a,-,d .:c,t
<br />set aside any provisions of l,re technica codes, .or shall issuance of a per~i t ~ri 1, \:,e ~ lel- e,f!
<br />requiring a correction of e'l!)rS in plar. 0, constr 1(tion, Cor vi(,jatioDs of an)' C11d
<br />unless the lIork authorized J, such pl.'rlit is cOlel~(ed within six ~Dnths Df is.~ .(', f' f.
<br />suspended or abandoned for a Jeriod of six tonths Her the tifle the worK is [(,f ' ,,[f
<br />allolled f,or the pl.'rlit with 1,?~ chargl.' of $15.00. '"I' l.'xtension shall be feqllE' f',11
<br />approved inspectiDn Ilust be hjgl.'d during each six tonth period, Cor the I'fo.;e,' ,;iIIl [['I-,:i.':':i., "::,,ne, ,.,
<br />WARNING TO OWNER: YllUR AlLUm: TO RECORD A NOTICE II COMMENCEMENT MAY RESULT' i YOUR .~,'i!,.,,:; ':<1CC Ole n'
<br />PROPERTY. IF YOU INTEND TO Of:TAlN FINANCIt/S, CONSUL \lITH YOUR LENDER OR f\N ' [ORriEiFC~.C: c.c':C':['! .,::
<br />COKKENCEKENT. JOBS UNr:ER $2,5('0 IN VALUE DO NOT NEL' ~O RECORD AND POST t, . W. ICE Of" C'I:t'::C,i,,':r',
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<br />SIGNATURE: OWNER OR AGENT
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<br />_...........1...... J ...........""'::;.~~...!"'.........."~'Ill__ur~:~1II..~
<br />SI:;N~IUR~: CCh'R~[l:.
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<br />STATE OF FLORIDA
<br />COUNTY OF
<br />The fDregoing instrument was acknowledqed
<br />befc.re me this____, 19 by
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<br />0:, 'Y OF
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<br />who is personally
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<br />as identification
<br />take an oath.
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<br />known to me or who has
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<br />and who did/did not
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<br />(Signatun,,)
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<br />(Name Typed, Printed or Stamped)
<br />NOTARY PUBLIC
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