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<br />, -,- - t P rl t ~ hi L L 6'IOHS 01" PRJUfIT AFIf'l:IlAVl:T
<br />_:-.J ',,: _[~ .::' i Ut.....:~i..K.D'....! i '__\:~ ___'-__......
<br />'"hO u.derd"".d """.r.t"".... t""t _. po_to may b. .obj..t ,te 'd'ed' ..otr'ot,.=._ wkl.h
<br />may b. -... r..tr....V8 tb.. c.tY'r.guLatio... Th. UUdor.'g.ad ....... r.,pO...b',ity fo.
<br />comp1~snc& w~th any eppl~o~le d.ed restr~otion8.
<br />B. UNLIC~SSO CONTRAcToRS AND CONTRAcToR R&s~OH8~BILZTZ.S
<br />IL the oun.r h.. h'r.d · ...tr..ter or ca.tr...or. to undertake Work, th.y May he r'~r..
<br />to be 'ice.'ad 1. ....rd..o. Hlth .t.t. end '0..' r&qui.t..... If th. ...tra.tor .. net
<br />".....d .. required by lOW. b.th rho eun'r ond ...tra...r ..y b. ..ted f.r . od........r
<br />v,."".. U.d.r ...t. '.w. ,. tho .un.r er '.t..d.d contr...er .r. u.OOr.... a. te what
<br />'.....,.. requir....t. mOy .pply fer the '.t'nded MDrk. th.y .r. .dv1'ed t. ...t.e. th.
<br />C~ty of Z.Phyrh~ll. Build~Dg Dep.r~nt. 813-788-6611.
<br />Furthecaere. .f tbe .wner b.. hired · ...tr....r .r ...tr.".r.. h. .. .dvt..d .. b.v. 'h,
<br />contrilctor (e') .1.gn Portions of the "'Contractor S.ct;j.on.... of th~. apP1J.cation for whic:h the
<br />w'" b. r,.po..",.. If you. a. tho eNn.r """. .. tho aa.tr..tar. you ar. '.d'o.t'.. th,
<br />you, rather than the contractor, are respon8ible ~or the work. If the contractor wishes
<br />you to .ign a. oontractor that m.y be ~n ~nd1.ca~J.on that he i. not proper1y 1~cen.ed and j
<br />not ent1.tled to pe,rmdtting pr~vil.g.8 in tho C~ty of Zephyrhi.llB.
<br />c. TRAlfsPORTATION IMPACT J!'JI:E8 AND UT:IL:ITY CONHBC'J'ION nEB
<br />D. CONSTRUCTUl:OH LIltN ~ (CIfAPTlIlR 713~ I"LORI:1lA S'l'ATU'PBS. AS .AtfDfDBD)
<br />" .ert'fy th.t 1. the 'Ppl'o.ot. h.ve b... prov'ded w'th . oopy Of -.'or.d.'. CaO.truatla<
<br />"'0 Low - H~.NU.r'. prot....o. Gold.- Ptoporod by the P'ar'd. nep.r....t .f Agrl.ultur.
<br />o.d c.n.omer AfE.'r.. IE tho app"o..t ,. .....a. o'hor that .h. "ONDer-. 1 a.r'fy th.t I
<br />h.v. obt....d · .opy af th. ebav. d".rlb.d a..u..ot ..d pr..... 1. ,aud Eolth to d."VOr
<br />~t to th~ ~ownerh pr~or to aomm~nce~.nt.
<br />E. CONTRAcTOR' S/OWNER' 9 AFFIDAVIT
<br />1 aort'E. tb.t .." the .of....t.08 in tb.. oPP"e.t.o. 1. ..cur.t. ..d th.t ." w.rk w.,.
<br />b. don. i. .omp',WO.. Nltb ," .'P;l'o.bl. '.No ..gutating cco.truatia.. '0.'.', ..d ',od
<br />development.
<br />Appl'o.t,o. .. b.reby mod. ra obt... . P.DOlt ta do Werk oad lo.t."."on e. 'ndl.ot.d. I
<br />.ert'fy th.t .. Werk or '0.'.'1.t.o. h.. CGoMoo..d pr'or r. ".uo." af a peDOlt ..d that
<br />a" Work w." b. p.rformed to ...t .t"derd. af ." '.we r..ul.t'ug COb.truat'a.. Clty
<br />ccdo.. .0.... regul.t.o... .Ud '..d dovo'.....t r.gut.tiaa. in th. jur..dietio.. 1 01.0
<br />..rtHy that " """.rat"d th.t th. regu'...... af ath.r ,0"'_.to1 ........ mey OPP'y to
<br />tb. '.tann.d Work. .ad that 't .. ~ r.epa.."il.ty to <dent... wh.t oatiane 1 mo.t taka t.
<br />be ~n compl~&no.. Suoh agencies ~nolud. but are not l~t.d to. *De~artment or
<br />Env'r.nmenta' Regulatla.-Cppr... Bayh..da. W.t'end Ar... ..d Envlra....t.,'.y S...'t.ve
<br />Landa. Hatecl.aet.w~ter Treatment
<br />'S.uthw..t P'arid. V.tor Ho.......t n..trlat-V.".. Cppro.. B.yh"d.. W.Ol.od Ar....
<br />Altering Watercour~.B
<br />.Ar~y Corps o~ mn~ine.r.-Sq.W.als, Dock., Navigable Waterways
<br />.n.p.r......t of H.alth 6 .....ebiHt.U.. S._a... "'vt~""'.to1 Ha.Hh U.'.e"."o.
<br />Wa.tewater Treatment, Sept~c Tanks
<br />*U.8. Environmental Protection AgencY-^-beetoB abatement
<br />1 .1.0 o.,t'Ey rbat. 'E fill ""ori., i. t. be u.ed in .'oad Zo.. 'A- or "A.eto.-. .. 1.
<br />u.d'ratOad that · dr.ina.. P'a. .ddr.'.in. . .aaop....t.og valWOo. w'" b. .Ubmdtted which
<br />.. pr.p.r.d by a prof....cu., ..g'o..r r....t.r.d in tho St.t. .f .'ar'd. pr'.r to P.DOl.
<br />ia.UaDce. .
<br />A P'redt '..ued .b.'1 b. cco.trued ta b. . "000.. to praae.d w... th..v.'k ..d .ot .0
<br />.uthorl.y ta vla'.t.. .....,. "t.r. or ..t "'d. woy prov'.,o.. a. the t'chnia., aud...
<br />nor .h." ,....... oE · P.DOlt pr.v..t the BUllding of.'''al fro. th.....t.r r.qulr'oq .
<br />correction o~ error. in plane, con.truct~on. o~ violation. of any code. EverYp.~t
<br />'..u.d .boll b..... '.""d Un1... the NOrk .Uthori... by ,uch PO"'t i. a~a.ed w'thin
<br />..x "uth. Of ......... or i.. Nark outhori'.d by th..P....t Ie .UepObd.d or ab.ndo..d Ear.
<br />per'.d af ... --.tb. a.t.r tb. tLon .b. NOrk i. .ao.onced. One 00 day ..t.a..au oE t...
<br />o-y b. ."aWed 'or the p....t Nlth f.. ".rg. of .,5.00. Th. ..t....o. .ho1' b. r.qu..ted
<br />'u wr't'.. to the Bnildio. o'~"a'.An oPPro... '''P..''.. ...t b. '...ed durl.. ...h .,.
<br />month P.~~od. or the p~oject wi~l b. con8ide~.d abandoned.' . .
<br />-INa TO OWHaR. YOUR -IAnus TO RIlCORD A NO'uCK or ~ MAY Ras",,'P IN YOUR
<br />PAVrNa TWICR ..". -_a '" PouR PBDPER'Py. ,. OU INT,""n TO on"", r1IWfcnra. CONS""T
<br />"'TB PouR LH'u'aR OR "" ..., ORIlEY Bam"" RBCORDING Y N....XCB nr C<a4HaHc_. .roBS UNnRR
<br />'2,500 IN VALUs DO NOT D TO RECORD AND POST A IC~.. CoMMacl!:HJ!:HT'....
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<br />STATI!I 01" FLORIDA
<br />COUNTY OJ!"
<br />The for.go~ng ~nBt~nt walp.ir"owledg8d
<br />B.ror. JIUil tht.- Iflolt: . day of! ,,' .. ~~
<br />by :J:).Q I!!... A. I<i~~
<br />'-M (name of peril on ac 0",1 edged)
<br />~who ill p.rson~lly known to me, or .
<br />
<br />o who
<br />
<br />P 1i5lO
<br />
<br />
<br />
<br />of identification)
<br />take an oath.
<br />
<br />STATE 01' FLORIDA .
<br />COUNTY OF' .Hillshorou~h
<br />The foregoing inat~~nt ~p aDknowledged
<br />Berare - th~. ~h day or...tmr1l- .. -4-82.0.02
<br />by R. M. Williams-
<br />(n... of parson .cknow~edged)
<br />~o .1.. ~.r.on.lly known to 1Ile, or
<br />
<br />o who . ha. prod.uce~
<br />, (typa o~ identification)
<br />.1.d at take an oath.
<br />
<br />Ruth L Gill
<br />
<br />
<br />of parson taking aCknowlaqgement
<br />
<br />PIRES
<br />, . April 13, 2004
<br />BONDED THlU noy fAIN INSU~HCE. IHe.
<br />
<br />PatriC.ia G. Bass
<br />
<br />Ha~ typed, printed or Bt~ed
<br />My Commission # CC985125, Expires 12/12/04
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