|
<br />,:,!~ . A.A. t i\~. _,'.Li......... J.~
<br />
<br />i\. !!Qll<Jf..Q!':" VEJiU UES'!'JUC'.lfIO.NS ' , .
<br />the IJndeClIVlllJd Ullll"ttllandilliil thin pei.U .ar be 8ubj8cl. lo -dll8d reltricUOIla. "b1eh 'tll' be lOr, I8ltdcUfP I h"n Cltr
<br />[!guJatlonl. the under81gned 888U1e8 reRponlibllily for cUlpllallce ,ltb any applicable deea ~eltrlctlon..
<br />
<br />D. UNLICENSED CONTnACTOns ANU CONTlmCTOIl ImSPONSIOILITI8S '
<br />If lhe owner bf. hirfd a contractor Or contractors to undlrtaln ~Q[', they .ar be regulrtd to be llcenlea In .ccoldllcl with
<br />etate Bnd locll rlvul.tlont~ If the conlrattor 18 not licensed as requirea br Ja", both lb' OIDlr inG COfttr.ctor .., ..
<br />. clled (Ot a .Itdeltsnor violation under 8tate Is". If the owner or Intended contractor are uncertain I. to ,bit l1C1111ng
<br />rtguir,.ent, ~J arply [or the Jnlended Nurk, they ale advl8ed to contact the City of Zupbrrbllls Bullftlng Dlpartllnt, (113)
<br />788-6611,
<br />
<br />l'ultl,ellOll!, if lhe (lwner has hhed a conbaclor or eonllllclolR, be 1s advised t,Q haye tho contrlll:llor(.) .lga POIUoetor tilt
<br />'Contractor Section,' of lhl. application for whlch lhey will be reaponsible. If rou, II the OWDIt llga II tb8 caDtr.CtDr,
<br />YOII are lnc1lcating that Jou, lither, trian lhe conllaclo(, iue re8ponsible {or the IIOd. If the contrador w..... fOIl to....
<br />18 contractor that .~, be an Indlcati~n that he Is not properly licensed and IR not entItled to ptrllttlng prl'!l.... In t..
<br />CllV of IepbrrhlllR.
<br />
<br />C. 'l'lWiBPOUTA'l'ION IMPACT FEES ANU U'.l'.Il.ITY CONNBC'.l'lOlf rHEB (i
<br />-------..---. ----"--- -. .---~,----...-,---...-----~~- ~-_....
<br />
<br />IJ" gONJfl'R'y.Cl'lOff LIEN LAW (Cllnp1'EJl 713, l'r..ORIOA S'l'I\"rUTES.I AS nHBMDBU)
<br />I ,tartUr lbet 1, lbe eppllcaiit,.b.ve fit.n plovldea "ith a copy of "Florida's Construction Lien Law - IIoIeoIlaIrf. 'ruttcUOO
<br />Gulllu" prepared by lhe Florida DeputJent of I\grlcullure am' ConS\lQr ArfalE,. If the applicant II ..... otlter tItu tilt
<br />.uwner", 1 certlfr that 1 hlle obtained 8 copy of the abovp. dn8crib~d docutenl and pro.J8ft tn good f.lth to dell,er It \0 t~
<br />'owner<< prior tn l~..once'8nt.
<br />
<br />F.. cor!,.l'R.l\~]'Q!!.:~Lo.~It' S AFfIOl\V.tr.
<br />I certlfr that all the In(orlltlon In this .~plleallon 18,~ccur8le end that eil wOlk wIll ba doni In cOIpllaaCl wltb .11
<br />8ppllcable 1,.. Ilgulatlng construction, lonlng, and land de,e'op.ent.
<br />
<br />Application Is hOlebr lade to obtain B plr.it to do work and instailation a. indicated. I certifr thet no IOrk Dr
<br />Iftltal1atlon bas COIIIACtd prior to IRluence of a per.it ana that all worl ,III be perforJld to ...t ItlDllr4t of .11 1...
<br />rftgulltlng eon.truellOft, C~tr codel, lonlng regulltlon" and land deytlopllnt I"ulltlon. In the 'url.tlallon. I 1110
<br />celtlf, that I under_t,nd thlt the [egulltlone of otber govltu.enlll Igenelet '1' appl, Lo t~1 IntlDGlI vorl, ana talt It I.
<br />., r.lponllblUtr Lo identify "hat Bctions 1 .Ult take to be in COIpllantt, 8uch agencle. Include bit are not Jilin.. to:
<br />· Deparllent of In,lrORleRtal Regulation - Cypree8 Bayhtad8, Wetland Arl.s and In,lronaentallr 88D81tlvl LIDdI,
<br />Vate[/Ma8lew,tlr treatlenl
<br />t Southwell Florldl Water ~nag..entUllttlct - Velie, C,prele Ba,beaa., Wetland,Areal, Altering W.tefcourl81
<br />· Atl' CO{PI of ~IPlirl - .e,wllll, Doel', .avlgable Waterway.
<br />· De~rlfent of Hpalth , Rlbabl11t1tl'e Serfle.., Bn,IIODlBntal Healtb Unit ~ MellI, Maetewaler III.blBnt, Slpllc IIdlI
<br />· US Indr....tal 'Iollctlou AgenCI ~ bbeRtOS abatell811t I
<br />I al.o CArtlfr thei, if fill I.terlal Is to be ueed In Flood Eone BA" or 'A,ttc.., It 18 vnderltood that I dtllDlgl pllD
<br />addres.lng a 'cOIPftQ.atlng YOIUIB' .111 be .ublitte4 which 18 preparld bv a profel'ional ~n9Jneer [lvI'tered 18 tbI 8tat, of
<br />Florida prior to per.lt, ISluance.
<br />
<br />. l pelllt tlsued shall be con.trued to be a license to proceed with the wor. and not .1 aulborltl to 'lol.t., gaaQll .lter, or
<br />.,t 11141 anr pro,lllone ~f lb. technical' cOOee, nor Bhall l.~u~ee of . plr.it prevent the Bulldlog Offlclll flGl ~ltlt
<br />requiring I correction of 8rrors in plans, con8truction, or ,iolatloni of anr coa.. ."11 peralt I..... ....1 becDIe !Dralll
<br />unI..1 the work lutborhed by hch perIIt.lIeo.encI4 within all IOhtbt of tsl1llRCl, or if 11011 IlItIIorl.1l1 br U. plnlt II
<br />11I8pended or abanaonl!c1 for 8 periOc1 of .Il IOnths after lb, U.I the work II .:oiiencec1. on. 90 11e, attalloa Df u., ii, lie
<br />allowed (or tbt per.1t with fee. cbuV' of U5.00. tile utenlion ,hall be (equeatec1 In IrlUng to tM BuIlIl89 Offlolll. In
<br />IIppro,ed in8pectlon .UlJt be logged eluting eacb sll IOnth pedoc1, or the ploJecl ,Ill b, cooelc1l.rll 1ItIaI1aDtIl!.
<br />"WI.; TO WIER: YOUR FAlLURI TO RBCORD A JOlICB 0' CtltltlRCIIIIIII ItAY a.I II lOUR PAIlIIS f1Ilt1 roIlIIPIIOVMIII8 10 mil
<br />PlIOI'lm, IF IOU InlJID 10 0111'" PUlAICIMG, CONSULt WITH tOUR LUDIR OR II A11OII1I11 IBPOU RICORDIIQ lOUR IIOIICI 0'
<br />ctmllC!HBft' . J08S UIIDBR t2, 500 1" VALUI DO NUl lEBO 10 RICOIID AIID POST A "IIOIICI ur COI1KltKCBHlJlt'.
<br />
<br />. t;;?~ //
<br />
<br />
<br />_.._---~_.-.--, ,.~, -_._---"._~-
<br />SlUM^lURI!: CUR RACTnn
<br />
<br />~g~. ~~, 0_ (\
<br />... 9i(;,,~:~~f.t lln 4G8Mfl~---~. -..
<br />
<br />iTA'. Of fLORlO~ '
<br />coon, OF _.~.__tll L__~~O i<.. 0 () ~. H
<br />TII9 foregoing In.tnunent...,Jf8e ac)mo"ledged
<br />before lie thla .. 023 P- b.:IyfJa:9_11. by'
<br />..:::r It VVf ~ S L. f3 v f<. tJS ( b 'E.
<br />.1;u'-iapeiiiollaliyknoMn to me or Mhu haD
<br />produced . 'p R.. I vt:" I<'S L I C. t N S E
<br />ft8 id~'ti(l~Tion Bnd who dididld nol
<br />l8~en oatil. n () ~ . (
<br />~a.....'~
<br />fSfg;;"tui:e.j- ".., ,d',"__,,~~__~~._.u'_,.~.__
<br />
<br />. --'~-_._."-'U--.l. .. .,..,._.,,'u,___..___~_____~_~
<br />(li"..o '1'YP9U, l'dnted OJ: Stamped)
<br />.,or^RY I' FFICIAL NOTARY SEAL
<br />."-.--.. ,. "'~DIANAMDADDARIO
<br />NOTARY PUBUC STATE OF FLORIDA
<br />COMMISSION NO. CC625202
<br />MY COMMISSION EXP. FEB. 272001
<br />
<br />
<br />SIArl OF FLORIDA
<br />COUNn Of II I, L ~S 7? 6 1<-0 ~ Ai
<br />Tbu foregOing inetnUlellt wae acknowledged
<br />befors me this :2:?p!.~."LF!f 19_,...i-2. by
<br />
<br />_ ' A;'VI A Q C) "!? LA f.J c;..H fc i<-<:J
<br />who is perBonally )Uto"" to me or who b..
<br />produced I ~_~-.". .
<br />a.~entifica,\ion 8ml "hO.. did/did not.
<br />tak {\II oCltb.. ~ ~
<br />
<br />'..- ._.._._-~........._.. ,". ..,.....,:...,-~~~._...._-...----
<br />(alYIIRture) ,
<br />
<br />(tfame 'l'yped, Pdl".fo"J O(".'iifMped)
<br />~O'l'^.!t'L P,!BLt~
<br />
<br />OFFICIAL NOTARY SEAL
<br />DIANA M DADDARIO
<br />NOTARY PUBUCSTATEOF FLORIDA
<br />COMMISSION NO. CC625202
<br />MY COMMISSION EXP. FEB. 27.2001
<br />
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