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<br />07/87 :082 e::5E 8:85418'31 <br />"". HoneE 0" DaD RIUITRIC'J'laNS <br />The underaigned underat.nda that tb!. p.~t may be .ubjec~ to ~de.~ reatr1etlon.N wblch <br />~~ be more re.trlct~~ than City ~e~.tigna. The Uhdereiqned a..unea re.poaeibiitty fg~ <br />c~liance with any .pplicable ~..d reatrlctiona. <br />B. tlHLICENSI:D COJlTJlIAcTORS Att'D CONTMC'I'OR U5PO>>.uBILr'lIe <br />If the OWDe~ he. bired a contractoz or contrac~oe~ to uuderteke WOrk, they may be ~.qulred <br />~o be licensed in acoordance with atate .ad 10c.l requl.tlon.. It the contractor i~ not <br />lia.n~ed ae r~quired by law. both the owner and cootractor ..y be oltad for . M1adame.QQr <br />vialation under atate law. If the owner or intended contractor are une.rtain .. to ~h.t <br />lic~n.ing requirement. ..y apply tor the lntanded work. they are advi..d to COntact the <br />City ot Zep~ycbilla BUilding nepartment, 8lS~788-66l1. <br />Pqrthe=more, it the O~er haa hired a contrectoT ox contractora, he 1. advi.ed to have the <br />contraetor(al .1gn portion. of tbe "Contractor SeetionaM of tni. applieatioh tor which they <br />will be reapon.ible. If you, a. the owner 8igne a. the oantractor, you ar. indicating that <br />you, rather than the contraotor, are r..ponaihl. ror the work. Xf the con~raotor wieh.. <br />you to .1gn ~a contractor that ..y ba an indication that he 1. not properly licenaed and 1a <br />not entitled to pe~~tlng privilege. in the City ot Z~hyrhi1Ia. <br />C. TJWiSPoR'l'A'l'ION IMPACT I1!;ElI AND UTIl.ITt OOIOO!:CTlotl FEI!IB <br />D, COHS'I'RUCTUIQM LIEN LAlIt ICHAI'TG 113, rLOIUDA 9TATUT!B. AS ANl:NnI!lD) <br />1 certity tbat I. the applioant, have been pro~1ded with. copy of "Florida', Conatruotlon <br />lien Law - H~.owner'a Protectloo Guide# pr.paced by the rIor~aa DepAro..nt ot Agricultuee <br />and C~n.uqar Arrai~.. I~ ~ha applicant i. aomeO~e othar that the ~ownar., J o.r~fy thAt I <br />have obtained a Oupy ot the aPove aa.crlD.d doe~t and pr~.e in goo~ faith to deliver <br />it to tb. "owner' pr10r to c.......nc8lD&nt. <br />K. CONTRACTOR'S/OWHBR'8 AFFIDAVIT <br />I cert1~y that all the ~n~ona.tiQnin tbia appllcatlon la aC~U~ate and th~t a~l ~r~ wi~l <br />b. done in compliance with .11 applicable law. regulating conatructlon. sonin9. .nd land <br />davelOpment. <br />Application ia hereby -ct. to obtain a pa.rmtt to do work .n<t tn.tAIl.tion ... indicated. J <br />eectity that no work Or inatallatioD b.. oo-.enced prIor to ie.uence of a p.~t And that <br />all 'fOrk will be per1'oaa.d to meot .tllLru!ilrd. of ..11 lava ""quliltinq Qorllltruction, Cl.ty <br />code., ~oning regulation.. and land development reyulatione in the juri.~iotion. I alao <br />aertl~y thatr uDderatand that the regulAtion. ot other gO~rnaent.l agenciea may .pply to <br />the intende" work. eo4 that it ia m~ r..pon.~bility to identi~y whet Action. I muat take to <br />be in C~l!ance. Snch aq.nci.. inc~qde but aDD not ligited to: *Dep4rtment of <br />!nvlron.enta~ Regulet1on-Cyprea. Baybead.. ..tland A~ea. and EnvirOnMentally Seneltive <br />Landa, V.t.~/.A.t.water Treatment <br />~3o"thweet r~~rlda Water Hanag-..nt Diatcict~Wal15. ~ypre.e Bayb..da. WetlAnd Araaa, <br />Alte~in~ WaterOOur..a <br />.Acmy Corpa ot Bbvin..ra-S..WAlle. Docke. Haviqable Watecwa,a <br />.Oepartmant of ae.lth , Rehabilitative servioea. Envlronaent.l a.a1th Uni~-..lla. <br />w..t.w~t.r Tr..~nt, 3ept1c TADk. <br />.U.s. ~Dvlronment.l erotectlon AgenCY-A.be.to. &b.t~nt <br />I alao certi~y that, i~ t111 materi.l ie to b. ".ed in Wlood Zone ~^- or "A,_to.N. it i. <br />UDderatood that a draina~e plan .dare.ainq . ~oonpen..t1nq vol~. wlll be aubbdtted which <br />1. prepared by .. peofe.aional engineer regiat.red in the atate of Plarid.. prior to pe~t <br />i..u.n.... <br />A pe~t la.UeQ ahall b. conatruad to be a Ileana. to proceed with the Hock and Dot .. <br />authority to Vlolate, ~.ncel. alter. or set .aide any provla1Dna of the technical oOd... <br />nor aball iaauanc. of a penmit prevent the BUilding Ofticial from thet.atter requiring M <br />correction of error. in plana, conatruction, or Violation. of any code_ ivory permJt <br />iaeuad eball ~.C~ ~nvalld unle.. tb. work authorized by euah pe~t i. oQmmcnc.d v!th!n <br />six ~ntha or ~.aqenoe. o~ if work authorlzed by ~he permit 1. .uapended Qr Abandoned roc a <br />period of a.:1.x montha altar tha ttae th_ work i. co_need.. One 50 da, exteneion ot tllllC <br />may be allo_d for the pel'1ll.1t wit.h :t.e chACI,,_ of Gill. 00. The _~_aion at.a.l.l be raqu.."t..d <br />in writing to the auildin~ Orficiel. An ap~roVBd inspeotien mo.t be 109Ved du~ing ....oh .1~ <br />month pariod, or the project will ~. considered abandoned. <br />WARNING TO OWWall: YOtfR FlULUilI!: '1'0 RlWORn A NarIcE or COHMkNCI!:MDlT HAY RBSULT IN YOUR <br />PAYINa nllCI!: roll IMPJlOVKMD/"rS TO 'ioUR l'ROl'lR'l'Y. I r '(OU HfTBND TO OM'.\!H I'INMCING, CONBULT <br />WITH YOUR LI!lNDaR OR 1lH .\T'1'ONfSY BP;roR!; RSCORDIHG YOUR HOTre! Or COMMDICEMKIl'l'. J08S UIl'oEJI <br />'2.50 W ~UI!: Do HOT NEED TO RECORD AND P05T A ~NOTICE or CONMBNCaMEN'1'N. <br /> <br />~=b~~~~l"I~~i~llH\V l."J.' <br /> <br />F'AI:iE <br /> <br />e:: <br /> <br /> <br />SI~! CoIfrRACTOR <br /> <br />actno",ledgedl <br />bo"", to ...., Or <br /> <br />"TATE or noRI:1lA <br />COUlftY or <br />The foregoing in.t~t Wa. aCknowiedged <br />aetora - t1\1. --.slav 0/:__, 19_ <br />by <br />(n_ ot peJ:.OIl. acknowledged) <br />Clho ia peraonelly known to m.. o~ <br /> <br />Owbo he. prodUced <br />(type of identific.tionl <br />and llQ)Q Dd.1d DUd not: taka a1) oath <br /> <br />ana 111I\00 did <br /> <br />tiJ.. <br /> <br />o who ha. prgduced_ <br />(type of i~~nt1flcation) <br />~id 1)ot take an o.t~. <br /> <br />~.n~~ <br />of peraon t.t~nQ ~~nt <br /> <br />8lgnatllr.. Qf peraon taking ..c1moWl4OClgmall.t <br /> <br />Mama ~y.ped, pr~nted or .t~ed <br /> <br />Hama tYP.d, printed or .t.-pod <br /> <br /> <br />JAMES B. ALBURY <br />COMMISSION /I CC976666 <br />EXPIRES NOV 03 2004 <br />IlONOl!D lHROUGH <br />1oDI1Wf~ NOTARY <br />