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<br />U.JfI.lJJ'l'JUNS OF' PE:m',:':' ^t;'~':'~)AV!.';'
<br />J,. 11U'l'TCEl Oil' DElEn RE:S'l'RIC'I'IONS
<br />'rile uudenslglled lllldel:stands that tJds permit may b,~ slbJe:.;t 1:0 "deed restdcl:lulls" \"Ildub
<br />IiIClY I.JE: IIlOI:e restJ:Jct:l.ve than Cl.ty regulations. 'l'h" lud',rsl.qned assumes respollsl.bllJl:y Eor
<br />(lompl lance \/It.h any appl.icalJ.l e deed r:estrJc:tloIIS.
<br />B. llNl.lCEiNSlllU CON'I'RA.C'I'oRS ANn CONTRACTOR RES PON 5 T 131 L ['l'lE:;,
<br />J f the Ulmer lias hlI:ed a contJ:actor or c:ontractoul to 'llId"nt:ake I-Iork, they Ii\ay be req\dred
<br />I.ll be licensed In accordance vl1th state and locaL J:egIlLittlons. If the contractor is lIot
<br />1loElIISed as reqlllred by law, both the O\"llleL and cont ti'lcl:or may be alted for a lIIi sdemeanor
<br />ulolatioll llllder' stat:e li'Hl. If the o\"lner or lntendEld (]Olltractor are uncertaln as t.o I/hat
<br />licensing requirelllellts may apply for the intended I/Ork/, they are advl.sed to oOlll:aut: the
<br />ell:y of Zephydd Us Building Department, 013-'IBB.-6611.
<br />J!'t.u::therlllCJl:6, If the O\'lner has Iilred a contractor or contractors, lie 1.a aclvi.sed to have the
<br />Cl(llltJ::actor (s) slgn port.iolla of the "Contraotor Bec:LiollS" of thls app.licatlon for Hh.lch they
<br />Hill be J:espollsjble. If you, as the Oi'iOer signs as the contractor, YOIl are Ind:1 (JaLing Lhat:
<br />YOIl, rather than the contractor, al:etespons.ible for the Hork. J f t.he contnw\:oJ: III shes
<br />YOll to sj gll as coutr.actor that llIay be an indicati.oll that he Js not properly 1.1 censed and j s
<br />Hot ent.! tled \:0 perllliU:ing prl vileges in the Ci ty of ~',ephyrhills.
<br />(:. 'l'!1l\\lSPOH'l'JI.'l'TON H1PAC'l' FEElS A1W U'l'ILI'l'Y CONHEC'I'ION H'EES
<br />n. C01IS'I'RIlC'I'IlION LIEN LAW (CIIA.I?'l'ER '713, FI.ORIDA S'l'A'l'lJ'I'EB, AS AHE:NDElD}
<br />I cet:l:j ty that I, the appl.lcant, have been proviqed IIU..h a copy of "H'lor:l.da's ConstnlOtlon
<br />l j en I,au - lIollleO\'lller'S Protection Gulde" prepared by the B'lorida Department of AYl.l cultu.l:t!l
<br />and Cons\l1IIer l\ffaJrs. If the applJcant is someolle otlie1: that the "ovme.r", T (jeLl fy that I
<br />have u\Jtalned a copy of the above desorlbed document ,ll1d promi.se .l.n good :EaJth 1:0 dellver
<br />J t to the "D\.met:" 11l::Jot to OOlnmelJC)elllelll~.
<br />E:. CON'I'HAC'I'ClW B!oWNffiW S AFJ!'IIlAVl'l'
<br />I oertj fy tlta!: all Ule information in l:l1i.s app.Ucatlon Js accurate and t.hal: all vlOr), Id.11
<br />be dOlle ln qompllsnoe Hlth ail applicable laws reglllatillg construotion, zonl.ng, aud land
<br />developlllelll: .
<br />ApplJcaUon I.s hereby mqde to obtai.n a permJt to do Hork and i.nstal1atlon as lndioated. I
<br />cerl:lfy that 110 IJod, or installation has commenced pr.1.o1' to isanallce of i'I perlnit alld \.hat:
<br />aJ 1 vlOJ:k IV:U I be perf Drilled to llIeet standards of all lal-ls regUlating uonsl:nwtl.on, CII:y
<br />codes, zonJng regulat:1.olls, and land development regulatlons 1n the jur.1.sdl.ction. I also
<br />eel U ty that.:r understand that the regulations of other govenunental agencd.es may appJ y to
<br />Ihe Jntended worl., and that it .is my l:'€lspons.U:)iU.ty to ident.Lfy what actJons I m\l/:il: Lake 1:0
<br />be in compliance. SlIch agenc.iea .include bllt are not limited to: "'Department of
<br />E:nvirolllllental Regll]aLion--CYP1:ess Bi'lyheads, Wetiand Aresf.I and EnvironmentaLly Senslt.1 ve
<br />],allds, WateL'/WasteHater 'f'r.eatment
<br />ASol\Lhwe~l: ll'lod.cla Water Mlwagement lHstdct-We.lla, CYPlZeSB Bayheads, Wel:lalld 1\1:eas,
<br />AI\:e1:JIIg Wateroollrses
<br />Al~J:IIlY Corps of EIIg.ineers-SeawaU.s, DOcks, Navigable WaterHays
<br />~;j)epal:tlllenl: of Ileal th 6( Rehab:1.litaU.ve Ser.vices, EnvJl:'onmelltal lIealth IJnJ,t-Wells,
<br />Wasl:eHater 'l'r.eatmellt, SeptJc '('al1ks
<br />1'\J. S. E',nvJr.olllnelltal ProtEwtJolI Agency-Asbestos abatement
<br />"I also cel.l;ify that, If flll mateclal.is to be llsed 1n Il'lood Zone "A" or "A,eLc.", lt 1s
<br />1II1del:st.:ood that a dt:ai.nage plall addl:essing a "compensating volllme" wLU. be suhlll.ltted wld.c:h
<br />is pl:epa Led by a lJl.ofessiona.l englneer r'eg.1.stered in the state of E'lor:1.da pLlor' 1:0 pennl. t
<br />iasllallce.
<br />A permit i sSlled shall he cOllstrued to be a IJoense to proceed Hith the \'lorle and not as
<br />altthot:.l Ly to vlolate, cancel, alter.1 or set aside any pr'ovlsions of the teohn.l.cal oodes,
<br />nor aha.l.] j SSlIance of a permtt prevent the Bu.U.d.lng Of fi.cial from therea fter requld.ng l:l
<br />coneuLJoll of ElrrOrs in plans, aonatruotJol1, or Vi(llations of any aoete. Every permtt
<br />.l.aaued shall become invalid unless the work au~hodzed by such perndt 16 nOllllnerwed ~Ji.tld n
<br />si>( lllontha of issuance, or if \>lOrk CluthorJzed by the permJt is slIspended or abandoned r()l- a
<br />ped.od of. 13bt months after the time the worK is oommenced. One 90 day extens.ioll of thns
<br />may be alloHed for the perrott with fee charge of $15.00. 'I'he elttensinn shall be r:equElsted
<br />j n Hri Ling to the Building Offi()ial. An approved inspeotlon InUS t be jogged dud ng eacll 8lH
<br />month ped.od, or the proJeot will be cOllsidered abandoned.
<br />Wl\fUUUG 'J'O OWNElRI 'fOUR FAILURE '1'0 RFJCORD A NO'l'ICE OF COMHI!:NCEHE:N'l' N1\Y nESIJU[' 111 YUUR
<br />P.AYTI/G 'l'WICH: B'OR INI?HOVE:NElN'I'S '1'0 YOUR PHOPER'l'Y. IF YOU IH'l'END '1'0 OA'I'ATtI Il'HIAl-/Cl//lil, COlISIIL'I'
<br />WI'1'lI 'iOIJH l,HlNIJEH OR AN A'I"l'ORNKY BI!iFORH', RECORDING YOUR NO'l're!!', OF COMMHlNCEI'4EH'['. ,JOBS IJHIJI!:H
<br />$2,50U IN VAJ,lIE: DO I/O'!' HE:Em '1'0 RECORD AND POS'J' A "NO'l'ICE DB' C0t111E:NCmME:lI'l'u.
<br />
<br />. '. -,_..._._.....-,- -'-'--~- --~.. -. - . -". '---'-'_'~___,,_~_,>o___
<br />
<br />Sf GHl\'l'lIl1H: I OWNHlR UR AGEN'f
<br />
<br />,')'J'/VJ'ffi Oil' ll'UJRf/lA.
<br />
<br />(;011 N'J' Y 0 E' .____.__.____ .__.____._____.________.____.....
<br />
<br />'J'he forego.lng instrllment vias acknowledged
<br />Before me 1:llls._ ....._ day of._..________.__, l~__
<br />
<br />by ___...._ __.'_.___ .____.._.._.___.._.__._____. ________.__.___..____...______...._
<br />. (name of persoll aCJkno~dedged)
<br />111110 1s personally known to me, or
<br />
<br />1.1 HllO lias pt:oduaed___..____._.__._._~______._______
<br />(type of idelltifiaatloH)
<br />and Hho[]dJd [Jdtd llot take an oath.
<br />
<br />.., "-~""--- ---...--.--..... ..-., .-.-----.______._......._____n._.."'_.__,.,_.~_"__.. ___
<br />
<br />8j gnal:llle of persoll tald.ng aokno\-lledgement
<br />
<br />Name typed, prilll:ed or. stamped
<br />
<br />--.... ___..__..._.4'_.W__...._.___........_____... . _._.,_._..__,~....____ '.-......_..v..___..._._. _,
<br />
<br />S I GHA'l' II RE: C01'1'l'R1\C'{'OIl
<br />
<br />R'I'A'j'E: DE' FLORIDA
<br />
<br />COHN'J'Y o Ii' ______.__.____......._...._ ..._....._..________...___......_
<br />
<br />']'he foregoing Jnsl:r\llllenl: Has auknovlledged
<br />Be fo re me till S _____f.lay 0 f - ....-...-.--.--.-_, 19 _:....
<br />
<br />b y _.._....___..____.~______.____ _ _._____.__._.__..._____.__.__...__..
<br />(nallle of person aoknowl~dg~dl
<br />[Lho is personally kno\'ln to me, or
<br />
<br />[] who has prodlloed_______.___...__,_.___.___.._______
<br />(type of Jdsnl:lfioal:l.oll)
<br />and who lJdJd DUd not: take an oath
<br />
<br />-". '_m.._._..._._..___~...__,._ n._".~_~_......_.._._..._ _ _ _'_.__....,_.~_____._ "_"h_ '__.....~._,
<br />
<br />Signature of persoll takl.ng acknoHlsdgwentl
<br />
<br />lIawe typed, pr.l nted or el:amped
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