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<br />1\. . 1I0'J'lCF. Oll' DlilEIl HEsrl'rHC'I'IONS
<br />'l'be llnders.l gned lInde!:stallds tbat: t!leis fH,:unJ L Iliay be sllbJeut to "deed rest:rJetjcllls" ",lIlell
<br />Iliay be Ilion: resl:l.ictJve tban CJty u:\J111:ltiollS. 'I'he unders.l \llled aSSllmes respolls.t.h:11Jty for.
<br />compI lance HJ t:h any appll.cable de,,,d J:HS l:lJcl:ion:3.
<br />B. 11lHdcrm'ISI!:l1 (;ON'l'HAC'I'OHS AN)) C()I'i'['Hl\(~'['()R RlTISI?UIISIBIT,I'l'IF,,9
<br />J f tbe O\Jn6t: has 111 r.ed a contr.act'Jl: ell: l:ontracj-ots to undertake I-lnrk, \:Iley >>lay be r.eq\l:l red
<br />I Lo beLl.censed 111 Eluuordanue \"I1tb state and locid l:egulatlollS, If the contractor.ls !lot
<br />lJoensed as reqll11.ecl by laH, both the O\.meL' and contrtlctor IlIay be OJ.ted for a lid fldemeanor.
<br />vJulal:ion IInde.L' state 10111, If the OHner or .i.ntendecl COlltractor Ell:e 11Ilcer.taJn as to Hha\:
<br />I lU611Si llY re1lld.teIll611ts llIay apply for tlle intended I~ork, tlley are advised to oontact the
<br />City of Zephyr:ldlJs Buildlng Deparl:lIIsnt:, fJ13-'1flfl'6611,
<br />l!'u.L'LhEll:lnore, I.f: the OHnElt' has h1.J:ed a contractor or cont.ractors, he 1.s adv1.sed to have t.he
<br />oontrao[;o.t (a) s1.gn port,ions of t.he "Conl:tactor Sections" of tlds app,Uoatj,on for I'1hich they
<br />HLll be responsible. If YOII, as the OHner s19ns as the oonl:rac:tol:, you ate ind.lcating that
<br />YOII, l:al:het. than the cOlll~ractar, aJ:e responsible for the Hock. If the aonlJ.:anl.:or HJshes
<br />you [:0 13.1 yn as cont:ractoJ: that llIay be an indl.catlon that he is not pr'operly 1.1 cBnsed and is
<br />!lot entj t:led La pe.tlllJtti1l9 pl:ivlleges in the Cit.y of :Z,ephyddlls.
<br />c. 'I'RANSPOH'I'A'J'ION IHPACTFEElS ,MID U'l'ILITY CONIIEC'I'ION F.'EES
<br />n. CONS'l'Rl/C'l'1I1C)N LIEN LAW (CIIAP'l'l!:H '713, FLORIDA ,'3 rl'A'l'lJ'l' IDS , AS AHIr.NllH:D)
<br />I cel:tj fy that: I, the applicant, have bean provided I-Jtth a copy of: "Jj'lorJda's Constnwt1.on
<br />lien IralJ ,- !Iollleolmer's Protection Guide" prepared by the F.'lorida Department: of Agr.icIllt.llre
<br />and Conslllller JU:faJl:S. If the applJcant is someone other that the "OHne1:", I ceclfy that I
<br />have ubtaJned a copy of the above dflsarJ.bed docllmen\: and promise 111 good :faith to deliver
<br />1 t to the "()~J11e.L" pr.1.o r. to commencelllenl:.
<br />E:. CON'I'Hl\C'I'OH' a/OWNER' a AFE'IDAVl'I'
<br />I <JerU,fy Ula\: alJ the informaUon in this applicat.J.olI Ja accur.ate and that: all Hark \JIll
<br />he dOlle Jn compLl.allce \/tlh aU. applJeable 1avls re9\11.al:1,1I9 construction, zon.1.n9, Blld iElnd
<br />development,
<br />ApplJeaUDIl .J.s hereby made to obtain a permJt to do wod, alld Jllstallatlon as 111dloated. I
<br />cetLif\, \:hat: no Hark or installation has oomrnenced prJor: to is511a1lCe of a penni\: aud that:
<br />aJ 1 ~lOrl, HU 1 be performed to JIIeet standards of all laHS regulat.ing construction, CII:y
<br />codes, zOlling regulat:.1.olls, and land development: reg1l1ations in the JlIl.1.sdlct.1on. [also
<br />cerl: I fy Lllal: J Illl<lel'sl:and that the reglllations of other goveUllnental agencies llIay appJ y to
<br />t:lIe JntE:lIded ~IOJ:li:, and l:hat: it is my responsibility to idenU iy I'/hat autlolls I HIIlst take [:0
<br />be in cmnpJ lance, SlIch agencies inclllde bill: are nol: Limited to: *Department of
<br />H;I\vJrollJnenl:al Hegulatioll'-CYPU:SB Bayheads, Wel:land A1:eas and E:nvironmentalJy SellsJ\:.1ve
<br />l.clllds, WaLer-lWasl:eHater 'I'real:msnt
<br />*SOl1l:hv/esl: E'l.orlda \~atel' Hanagemsnt LJistrict-Wells, cYPli:ess Bayheads, Wetland Areas,
<br />AJ t:ed.llg Watercollrses
<br />*l~lI11Y Corps of F.:ngJl1eeJ:s-SeaHalls, Docks, Navlgable Waterl</ays
<br />*IJepartmenl: of liei'll t:h & HehabLUtat:ive Services, E;nvironmeul:al Health lJnJt'-Wel1s,
<br />Wastewater 'I'J:eatment, SeptJc 'Panks
<br />....11, S. Elllvj LOlllnental Protection Agency-Asbestos abatement:
<br />1 also cettl fy tha!:, Jf fill material Is to be used j n E'lood Zone "A" or "A, etc.", I.t .1 s
<br />llndersl:ood that a draJnage plan addressing a "colllpensaLtng volume" 1>/1.l1 be submitted I'/Id.eh
<br />Js prepated by a p1:ofessional. englneer registered in the state of I!'lod.da prior 1:0 pennLI:
<br />issllallCJe.
<br />1\ pennJ t .l sSlled shall be COlIstrued to be a license to proceed Hith the Hark and not as
<br />allLhori \.y to vJolal:e, cancel, alter, or set aside any provisions of: the t:eolllllcal codes,
<br />\Jor shall i SSlIance of a permit: prevent: the BIIJldJng Off.1.aJal from thereaft.er reqllJd\Jg a
<br />con:eut:j Oil of ElU:ors in plans, constt'udtion, or violations of any aode. Every permi.t
<br />laslled ahall beoome invalid unless the work 6uthor:ized by sltoh permi t .i.s aOlllltlenced HH:ld n
<br />siu months of lsstl6noe, or If Hork allthorlzed hy Lhe pennlt is suspended or abandoned for a
<br />peLlod of. all' months after the 1:1me the Hark is commenced. One 90 day elctells.1.oll of t.ll11e
<br />lIIaV be a.1JolJed for the permit \dth fee chaJ:ge of $Hi,OO. 'I'he el{tensinll shal.l be r.Eiqltesl:ed
<br />In 1/1:11:il1g to the BlIl1dlng Official. An approved inspect:.ion mllst be logged dllr:lng eEluh ail(
<br />lIlo11l:11 pedod, (n the Pt'oj eet Itl.l1 be cOlIsldered abandoned.
<br />WARlIHlG '.1'0 OWNlilHI YOUR jj'AII,lJHE '1'0 BI'JCORD A NO'l'Jew. OF.' COMMENCI!lMElU'l' NAY HI!lSUJil' IN YOUH
<br />PAYING TWICE jj'OH IHPROVEMI!lN'I'S '1'0 YOUR PROPER'l'Y. IF' YOU IH'l'EHD '1'0 OA'l'Anr F.'JNAI/CnH~, COlISIJI,'!'
<br />WI'l'lI YOllR I,I!:tWER on AN A'l"l'ORHF.;Y BEIi'ORR~ RECOHDIIIG YOlJH HO'l'ICF. OF CONt1E:NCJJ;t1EH'J', ,fOBa IJNPf!:R
<br />i?2,500 111 VALliE!: DO NO'l' HE:En '1'0 RECOH[) AND POS'I' A "NOTICE elF COHHEHCEI'lE:N'l"'.
<br />
<br />'.,U'IL'.!.','1.0:IS OF P)i~roH'I' AFIi'IDAVI'j'
<br />
<br />.._-~._--~----_....._. ,~-...._-, '-.-.----'"__..___..~._..H.______._..____.._.____,_.
<br />
<br />SIGIIA'l'UBE: I OWNER ()R AGEtl'r
<br />
<br />_....._n__.._~_~____,_____...__~ _.". .~..~ ..______'.._.._....,..___._.____._...
<br />
<br />SU3NA'l'lJRE:: CUN'l'R1\.C'1'On
<br />
<br />f:!'J'A'l'I!', Ol!' l!'I.clRJDA
<br />C01IN'I'Y Off' .__.._._'__'__.._'.._________,__._
<br />'l'lle f()l-egoJIl9 illstrmnent Vias ackllo~l1 edged
<br />Befol:e I\\e t1d 8 _"_"'_'" day of..___._____, t!:!___
<br />
<br />by _"__,___,,_ __....._____'_'__._.._________....,________,__..
<br />(name of person aclmo\"ll.edged)
<br />[) I~ho is personally kIlO\-ll1 to me, or
<br />
<br />STA'l'!!; OF FJ,ORIlJA
<br />
<br />COUN'J'Y () If ___....,_,________..,_ ._,___..____ __...__..,_
<br />
<br />'l'he foregoing 11ls l:rllll\enl: Has acklloVlledgsd
<br />Before me thl. B _____Jiay of ---'--...---.-_, 19
<br />
<br />b V ..___.______________,_..._..___.___..__....___..,.....
<br />(name of person aoknowl.edg&d)
<br />[hho -is personally Imown to me, or.
<br />
<br />[I Hha has pr:ochwed_______,___.___.____
<br />(I:vpe of idenU,fJoat:Jol1)
<br />and HllOl]eHd I]eltd llot I:al,e an oath.
<br />
<br />lJ v/ho has prodllofild_____,_.___.______.....__.
<br />(type of JdSlIL-JfiCJal.lol1)
<br />i:1l1d ~1I1O [ldJd []Hd nol~ l:ake an oath
<br />
<br />8.1 gllatllre of perSall taklng ackno~lledgement-
<br />
<br />'-._-~._._- .--.___________c____._ .__.__.___~..~_.___..
<br />
<br />31gnatllre of: person ta k Lng aclwollledgrnent I
<br />
<br />.--. --.--~______._'R._.___.______._, .._.____~..__ ______._.________ _'__.._.,__._~
<br />
<br />li~'ll\~"-i;yi~';' ~i; - i'; ;i'; ;-t:~~l-~~-'~-l~~I )~;i--"----"-'-'"''
<br />
<br />-,-- .--..--. -.-- .-----.----.--.-..... ..-...~~__~ "h__..,_,._____ >___ .~_.__
<br />
<br />Nallle typed, pLl,.nted or sl:amped
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