|
<br />CUNI) I I I UN8 UF F'f.:f~I'II r ()r: r:: J. lUN I r
<br />() . tJu lly'.g,._Yf..._.Qg-'&IL[i~qlfll~IJ..Qti~t
<br />Ihe undersigned understands that this pertit May be ~ubiect to 'deed r~strictions' "hich .ay be .ore restrictive than City
<br />r~9ulatio"s. Th~ under9igned aS5U.~S r~5p~nsibjJity for co~pli~nte with any ~pplicabl~ de,d restriction!,
<br />
<br />f:l . !JJth..I G~NS.s:_Q~,Q!iT R!..tIdJ]J.[i8...tll.t9._,.r;.Qt!.lB.Q4~Utri._ [<'~9J:~Qt!P.J.J.rJ ~.LL!gS!.
<br />If the ~Wnet has hired. contractor or contractors to undertake ~prk, th~y ~af be required t~ be licensed in acr~rdance with
<br />stat! and lotaJ r@guJltions. If the cpnt11ctor is oot licensed as required by laM, both the o"ner and tontracter tay be
<br />cited for a lisdel~an~r vi~lation under state la". If the ONn~r or intended cDntractot art unc~rtain as tD "hat licensing
<br />requirp~en~s .ay apply for the intended Hork, they are ~dvised to contact the City ~f lephyrhills Building Dpparteent, (9131
<br />7BB-blrl I.
<br />
<br />Furth~r~or!, if the D"ner hiS hired I (D"tr~ctor ~r cQn\r~ct~r5t he is advised t~ havl thv cDntractor(l) sign pprtlnns ~f the
<br />.Contrlctor Sections. Dr thi5 application for "hlch they "iJJ b. r@sponslble. If you, as the PHn't sign 'S 'the contratt~r,
<br />y~u ire indicating that Y~u, rather thin the contractor, art r@sponslble fer the Morh, If the contr~ttDT ,ishES you to sl9n
<br />il5 contrlCtor that I'Y be ilO indiutlon that he i5 nd properly licenspd ilnd is not entitled tCl pttlittinq prtvil'gu in thll
<br />Cily of Zephyrhil15.
<br />
<br />c. IRANSFOF:\T.AJ WN I NPf-\CT f::'Ii..~~"LlltJ.Q_lJ.I.!!:-l!X,_.~t!L~!:f.IF.GIJ..QI'C.f:...r;~
<br />
<br />n. ~tJNS fHUGll.QtLb-.!"I;!LJ".aW (CI.I{;"f~TF.:R'7 J:3 ~ FL.OH.1 Dr) STl-lTUTES ~ f~S AI'lENI)EI>)
<br />, t~Ttify that I, the applicant, have been pr~vid~d "ith a COpy of .Fl~rJda's Construction Liln La" ~ HOlf~Hnpr's Prot,ctipn
<br />6uid.. prepared by the Florid. D'part,pnt of Agriculture and Consuw!r Aff.irs. If th, applicant 15 snetQ"' other than the
<br />'o"~tr., I certify thQt I have ~btained I copy ~r the '~oYe de&crib~d d~cu~ent and pto.is, in qood faith tD deliver it to th~
<br />"~~n~r. prior to co~sence.ent,
<br />
<br />I=:": . ~9N 'r: Rf:"tC.LQB..~L (J\:oIl~.~_f1":"~__Hfl:J..r,}.o.~.tI
<br />I cntify that all the infonatlon in this allpJiuthn is accunte and lhllt all Horl "ill bl' dOlll' in to'pJiilncll "ith all
<br />~ppljCibl~ IlKS regulating constructi~n1 loning, and land developl!!nt.
<br />
<br />APrllc.lien is hereby ,ade to Dbtain a p.r.it to do ~or. ,nd Inst~llation as indit,tld, r crrtlfy th.t no IIDrk or
<br />instillation has co..encrd prior to i5suance of 1 p~r'lt and that .11 WDrk ~ill be perforll'd to I,.t !tandards of ,11 liWS
<br />requhting tonstrudil!n, City codes, illning requhtlons, ilnd land dnell.lplllent regulation!! in th~ jurhdiction. I also
<br />certify thai I understand lhat the regulltiDns of othe,' 9l.lvfrn~ental aQ~"(les ,at apply to the lntvnded "ort, .nd t~~t it is
<br />~y responsibility to identify "hat actions I ,ust take tn bl' in co~pliance, Such agencies includr but are not I.i'it.d tor
<br />· ~.rt.ent of EnvirQnlvnlal ReQulatiDn .. typress ~ayheads, Hetland Ar'~; and Environ,entalJy S,nsitive lands,
<br />Waler/Haste"'trr "tat'tnt
<br />I Southwest Florida Nater nan'Qe.ent DIslri[t - Hells, Cypress "yheads, Hetllnd Areas, Altering HatercDursEs
<br />~ Ar.r Corps of Engineers - SeaNllls, Docts, ",vjqabl, Nater"'Y5
<br />, DIP.fteRot of Health l Rehabilitative Services, Envirgn.ental Health UnJt ~ Hells, Haste"lt'T Trvat'Ent, Septic Tanka
<br />· US EnvironlvntaJ Protection AQency - Asbestos ablt,~.nt
<br />1 also certify tbat, if fill .at.rlal is lo b~ used In FI~~d Zone OA" ~r "A,etc.', it is understood that a ~t'i~'g' plan
<br />addressJn, a "t~Mpen5ating yplu~e. Mill be sub.itted "hich i9 preplred by a pr~fesslonal engineer reg\stered in the St.te or
<br />rlorida prior t~ per.lt 1$5U~Ot!.
<br />
<br />A rer~it issu,d shall ~e c~n5tru~d to be a lite,,!p to proc"d with the "or~ 'nd not IS authority tn violat', caocel alter, ~r
<br />set .sidv .ny provisions o( th~ technical codest nor Ih~11 15su~nce Df , per.it prpvent th~ Building Official fro. thereafl'r
<br />rrquirinq I corr'f;thn vf errDI'S in phns, Cllostrllcth'n, ~r YI~Ii1tlon! of any cod,. Every per'it iuul!d shaJl b1rC/.II!!l! invalid
<br />u11les5 the work authorized by SUth prr.it is c~M'~n(ed Hlthin six .onths of issuant., or if work authnrized by th, rer.it 15
<br />SU5pl!Ildl'll ~r Ilbandonl!d for a period {If sill lonths aftl'r the till' thl' Hork is (~,..ented, Ooe 9() day utensil'n of ti.e, ley be
<br />all~"ed for the p,rlit "ith fel' (harge of 115,00. Th! ext!nslon shall b~ Tl!quested in .rlting to the Suildlng Official. An
<br />~pprvyed in5pection Dust be J~qged durlnq rach sj~ ~Qnth period, or th~ pr~jl!tt will be considered abandpn,d.
<br />WARNJNG TO ONNER! YOUR FAJLURE TO RECORD A NUTICE OF r.O""EnCEnENr nAY RESULT IN YOUR PAVING THICE FOR IRPROVE"ENTS TO YOU~
<br />PROPERTY. IF YOU INlEHD TO DBTAJN FINANCING, CONSULT WITH YOUR If"PER OR AN A'TORNEY BEFORE RECORDING YOUR NOTICE OF
<br />COHnEHCEHEHT. JOBS UNDER fe,500 IH VALUE DO "UT NEEU TO REtORP AND POST A "NOrICE OF to"nENCE"ENT",
<br />
<br />
<br />.I
<br />
<br />Ya~
<br />
<br />
<br />-
<br />
<br />-
<br />
<br />SlATE OF FLORIDA
<br />rOUfm or / / h / /4,;
<br />lh~ fDregoing instrument
<br />b~fr.'n~ me this J2;Z: >t
<br />
<br />STME OF FLOAIDft
<br />WurHY OF P/h ,.; foe:< ~:~U
<br />The fDregDing instrument!was ~cknowledged
<br />bl!1fclre me this lkc.. .>7A ~ 1922-. by ,
<br />
<br />13 J i 'Iit-, ~ S- ~,;.,.. t:' ~:
<br />",ho is .pS:>'-I:,..t1Allv Imc'\'lD-!.fL!!I.!1 or who has
<br />prodl.lcP-d
<br />~..s id _______&ntifica.t .ion ~ .no. who did/did not
<br />
<br />.___ar~
<br />(Si gniltL"-,,,,)
<br />
<br />~
<br />
<br />w~s ~cknowledged
<br />, 19 97 by
<br />
<br />Jo 4 to
<br />I-lho i $
<br />')1" c, d II c: to tI
<br />,:IS idenl;ific~tion and who
<br />
<br />~~h.~~
<br />(I. lire)
<br />
<br />
<br />Jlt 6 c /({I!..t .,__
<br />11 J:nOI'In to me C.r who has
<br />
<br />did/did IlCIt
<br />
<br />(Name Typ~d, Printed Dr Stamp@dr--
<br />ttOTARY P
<br />
<br />--
<br />(Name Typsd, Printed Dr St
<br />NOTARY
<br />
<br />",'w..v.'f~."" DARREL JOHN
<br />l!i~':-~ MY COMMISSION * CC 864912
<br />~:. .7:f EXPIRES: June 11, 2001
<br />~'1.~ 0" h~~"- Bonded Thru Nolary PublIc UndelWl11ll11
<br />"'unl' ~
<br />
<br />
|