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<br />CUNIH I lI./t-n" UF F'EHI'Ilr nr:r:: J.l)(:jV.J: l
<br />(). U.b!L!k~_gf..._,QgJ&tLri~qlf.t.!J~IJ..Q!~.s~
<br />Ihp und@rsignrd understands that this prrtit May be !ub;rct to "d,rd r~gtrictions' "hich ..ay be .ore restrictive than City
<br />(e9ulati~ns. The undrf9igned aSgUles resp~nsibjlity for co~pli~nte Mith 3ny arplicablr detd restriction!.
<br />
<br />f.l . Yltb...I ~s!'!ils_~L,.g,lliiT ~L~J~J]JIi~..tllJQ_..!;,qt!.IB.f!~Iq!L [ts.E$LQ~?I?J ~,LU..s~
<br />If the ~"n!t ha~ hired 8 tontractDr or contractors to undrrtR~e work, th,y .ay br rlqulrrd to b~ licensed in acc~fdancl "Iih
<br />stltp and local rlgulltions. If thr contTlrtor is not licensed as required by l~H, both the ONner and contract,r .ay be
<br />cited for a lisde'ean~r violation under state IaN. If the OHner or Intended contractor .rt untertain as tD Hhat liten'lng
<br />rrquirr,pn~s lay Bpply for the intrndrd "ork, they arp advised to contact the City of lephyrhills Building Drpart.ent, IQ131
<br />7911-(,(,11.
<br />
<br />Furth@r~~te, If the o"ner hiS hirrd , contractor ~r contract-ors, he is Idvis~d t~ h~vl tbv contractor(l) 519" pprtl~n! ~f the
<br />'Contrlclor Sections" vf this application for "hieh lh!y "ill b. responsible. If you, as the O"OPt 'ign 15 .the contract~T,
<br />you Ir@ indiratlng that YDU, rather thin the contractor, ~re r~sponslble f~r the work. If lh. contr~ttof "ishes you to sign
<br />ft5 contractor thlt 111 br an inditatlon that he i, n~t properJy licensed and is not entitled to ptt.ittinq privilpgls in th!
<br />City of lephyrhills.
<br />
<br />C. IRI"N6U1I\TA;r~1 Q!'LU:JPACT f::'sJ~.~...t)N.J~_lJ.L!!:-...uXJ;'h!.ljH~4I) Q!:L..E..I;E~
<br />
<br />n. ~UN6 TRUG.I.!.Q!~:Lb-.!..E!LI"...B.H (CI-"~f~rER '71:3 ~ F!..Of'\.I Dr) ST':HUTES ~ ns AI'1ENIJEI>)
<br />J ttrtify that I, the applicant, have b@rn provided "ith a COpy p( 'fl~rjda's Construction lien LaN . ~o.!o"npr's Protection
<br />Guidr" pr.par.d by the Floridl Dlp,rtl,n' of Agricutturl Ind tonSU~~r Aff,irs. If thl applicant is 50'.onr oth.r than the
<br />'oN~er", I c~rtify thit I have ~btained I copy ~r the ~~oYe describrd dQcQ~ent and pt~.is. in 9Qod faith to deliy!t it to the
<br />"~~n~r" prior \Q [o~.~n[rlent,
<br />
<br />I=:. . G!:lN'fJ..nC TQB..~I (JI:-J~!Lf1":"l:?_J.~fl':J_QD.Y.J...L
<br />I errtJfy that all the in(onal/oh in tlth appHCittl!ln is ICnrah. and thllt all "or~ "iJl bl! dllllP in to.pliilnte "itb all
<br />~pplicBbJr la"5 rrqulating [Qnstrutti~nf loning, and land develop.vnl.
<br />
<br />Aprlie.lien is hlr.by lade t~ obtain I p.r.it 10 do "or. Ind Instl)lati~n as Inditltld. r c'rtify that no wnrt or
<br />in!ltallatil'Q has cu.lrnrrd prittr t~ iSSuance or a Pl!t.it and that all !lbr. IIi II be pl!rfllTled to aut standards Df all IlNs
<br />regulating tonshuttilm, City CIldps, uninq rerjUlatlons, and land d!V!If.lpllll!nt rf!gulations In the JUthdiction, J also
<br />(~rtify thai I undvrstand lhat the regulations of ~thel' 9~Yl!rn_eotal avp.ncies .ay apply to thp intended "Pft, and t~~t it is
<br />Ily responsibiJity h identify IIl1at attions I lust tate tn be in [o.pliance. Elich agentiu includll but are n(lt 1.I'ibd tor
<br />' lkI!.ilrt'l!nt of Envir(ln'I!Rta!J'l!QIlJalion - Cyprus lIayheads, Hetland Ar'il; and ErIYiron.enhlJy Spnsitive landS,
<br />Wall!rlllilstf!"atrr Trest$rnt
<br />I SDuthwtst FIDrida Nater nan.Qtlr"' Dislrict - H911s, Cypress ~ayheids, Hetland AriiS, Altering "atercour&@s
<br />~ Ar.y Corps Df Enginee~ - SeaNalls, Docts, "avigable Water".vs
<br />· D!p.rt.ent pf Health L Rlhabilitative Services. EnvirQn.eotal Hl!.lth Unit ~ Hells, Waltt"ater Trlal.ent, Septit ranks
<br />· US Environ~!ntal PrDt~ttiDn AGintv ~ Asbestos abltr~ent
<br />I Blso t.rtiry tha~~ jf fill .aterj~1 15 to br vsrd In FI~~d lone 'A" Qr "A,etc.'~ it il und,rstood that a ~r.i~a9' plAn
<br />addr~ssjn9 a 't~.pensltjng vDlu..," "ill be sub.lttrd "hich is prrplrld by a pr&fessi~nal engjne~r rlglstered in lhr Sl,t, of
<br />rJ~rida prior to perAit i!5U~Ote.
<br />
<br />A rrr.it ilsued shall be c~n5trued to be . licl!"s. to prot,.d with the wor~ 'nd not .s authority to violatt, clocpl aJter, ~r
<br />set asidl any provisions or the t,chnital cbdes, nor shall Issij~nce of , pf!r~Jt prpvent the Building Offi[i.1 fro. thereafl'r
<br />t!quiring I corrlction I1f !rrol" in pltns, tI1nstru[t1t>ll, or violation!! of any todt. Evuy p!Tllt i!Ilued shafJ b'ctIl!e inva)Jd
<br />u'll!ss the Kork .uthorized by ~Uth per.it is cPI,enced HJlhin si~ Ronths of issu~ncp, or if MQrk auth~rized by the rer.it Is
<br />suspendrd ~r abandonrd for a period of six 'onths aft~r the tile the Mork ;5 (ORiented. One 90 dilY e.tension of ti.e, I'y br
<br />all~"ed for thl! prr.it "ith ree charge of '1'.00. The eJtpnSIDn shall b! rrqllPsted in wriling to the Building Orficlal. An
<br />~pp'oyed insprction .ust be Jogged durinq rich li~ ~onth period, or thr project Nill be considered abandontd.
<br />WARNING TO OWNER: YOUR FAilURE TO RECORD A NUTICE OF CO""ENCEnEHT nAY RE9ULT IN YOUR PAYING THICE FOR IHPROVe"EHTS TO YOUR
<br />PRPPERTY. IF YOU '"lEND TO DarAI" FI"ANG1R5, CONSULT NITH YOlm tEMPER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
<br />COMMENCEMENT. J SUNDER fe,500 IN VALUE DD HUT NEEU TO RECORD AND POST A ~NUTJCE OF CDnftENCEnENT".
<br />
<br />
<br />~-SiG"AiURE:~CT~
<br />
<br />SlAlE or FLORIDA r::> ! I
<br />ramIfY or r We .. /~
<br />lh~ fDregoing instrument "~S ~cknDwl~dged
<br />b"!fr.'n~ me thi9 Ll. i)GL.. , }Sf>~bY
<br />I
<br />I~ ev~ t::Le-.e L . ".___
<br />\-/ho i $ pen;crnall y I:nOl'm tCl me C.r whQ has
<br />Pl"c.tlllced _
<br />~s identific~tio
<br />ta.e a h.
<br />
<br />
<br />
<br />STAlE OF nOlllDfl ~ //
<br />COU"TY OF _ INCf/~ _
<br />The fDregoing instrumentlwas ~cknowledged
<br />befc're me this Ul DEG, l ~~ by .
<br />1 f-(!jC?JCJ
<br />
<br />f6~~ hi slover
<br />"'ho AS pe'-5t,r1a 11 y knDwn to me err whet has
<br />prcrdl.lt:f?d
<br />as en 1 i:\
<br />til~(li1 a oath.
<br />
<br />(Name Typl!d,
<br />NO
<br />- "., l'.~" ARRELJOHN80N
<br />l~Wl :~~ MY COMMISSION # CC 654912
<br />~ .0:;. EXPIRES: June 11. 2001
<br />.~ Bonded lhru Notary PubUc Underwri\erS
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