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<br />1\, tIO'J'lCE Oil' Dillin) HEB'l'RIC'I'lOl'lS
<br />~l:bj3 llndera.l gned understands that: tiLLs pe:nnJ I: 1ll0l y bE; s'lb.l e:-:t 1:0 "deed U:lstrj ctl(llIs" Hldcll
<br />may be l!IOJ:e l:esl:rlcl:ive than CJty r'egtl1",l:ioi'ls. 'J'lll" I.l!ldl"lslqned assumes responsib.lIJI:y for
<br />compllarwe \d th any appl.icable deed [f'lstLl.ul:io!IS.
<br />B. 1I1.j T.I CHIN S mn COl-lrj'HAC'l'OHS AND COt'lTHl\C'l' :>R RffiS l?'j;rSU3I [,I'I'T K'l
<br />If the O\/IIet: has hir.ed a contractoJ: OJ: Clontca.']l:'::Jl:> to undertake \'Iorlc, they n\ay be reqtt:ll:'ed
<br />t 1.0 be licensed ill aceordanue \'l1t~h stat~e and l,)'~,~l J:eguLatl alia. If Lhe contractor Is not:
<br />Lluensed as relluJJ.ed by 1a\l, both the o',meJ:' and cont1.Clc1:ol.' may be oited for a 11I1 sdemeanor
<br />viulatioll 1I11del state laH, If the oHner or f.nt'=llded contractor are \1l1r::erta.l.n as to \lhat:
<br />I lueus! ny reqld.relllents may apply to\: tll'::: Int.ench:d \'/Ork, tlley are advJsed to CJolltact: the
<br />1:lty of Zepltyrh.il.ls Building Department, 01:3-'/l:Hl"6611,
<br />F.'1l1LlIl!:lJ:II\Ore, If the O\'Hler- has Id.J~ed a cOlltrac1:u.l or: cont.raotoJ:s, he is advi.sed to have t.he
<br />oontractor (s) sJgn portions of t.he "Conc.ractor :3ecl:1ons" of tills app1ioatJon for \'Ihlch they
<br />\ILl I be responsible, If you, as the mmer s.lgn:3 as the contl'actor, you are i.ndleatJng that
<br />you, LaLher than the conLnwtor, are responsible for Lite vlork, If Lhe contractor 1-11 shes
<br />yon 1:0 s.! gn as contractor that may be an indica t10n that he 11'3 not: p.toperly 1-1 cBnsed and Is
<br />!lot entitled Lo peUllil:tJng privJleges ln the elty of 2',ephyrhL1ls.
<br />c. '1'A1II-18 POH'I'h'1' [ON H1PAC'1' FEfJS ,AIID U'l'I LI'rY CONIIEC'I'ION )j'EiElS
<br />D. COtlS'l'RlIC'('UJON LIEN LAW (ClIAP'l'ER '113, FI,ORIDA S'l'A'l'U'l'IDI3, AS AH!!',NDED)
<br />I c:erLJ ty that I, the applIcant, have been provided \-It th a copy of "WIorida's Constt'\lCtlon
<br />.1 j l::1l 1.all p !IollleOl'/ller'S Protection Guide" prepared by the E'.lorida Depa.rtlllent: of Agt:1C\I1.tt\re
<br />and Cons\llller ALEaiJ:s. If the appl.lcanL is someone other that the "ol.mer", T mu:lfy that I
<br />have obtained a copy of the above desorlbed docllment and promise In good faJ.th to deLiver
<br />it to the "ol-/ner" l'J::lor to C:Ollllllencelllent,
<br />Ii:, COH'I'Hl\C'l'OH' S/OWNPoH' S J\FE'IDAVl'I'
<br />I neJ:t.tfy that a]L the infotlnaUoll in thts app1J.cat1011 18 accurate and t.hal:, all \lode 111.1.1
<br />be clone 111 cOlllpJ:l.ance 1~l.th all app.LJoable 1a\-16 regulaU,ng construction, zon1ng, and l<lnd
<br />development:.
<br />ApplloaUon Ls hereby made to obtain a permJt 1:0 do work and 1nstallatlon as lndloated, I
<br />cerU f\, that no Hork or .installation has aonunenaed prJot' to .iSSU8IlCB of 8 penn1t: and that:
<br />a]l \-lUrk \'I.Ul be performed to lIIeet sl:andards of all laws regulat.lng {jons\:ruotJon, C.lI~y
<br />codes, :;::0\11ng regulatiolls, and land development reglllatJons 1n the J\ll.Jsdlctjon. 1 also
<br />celLI fy Lilat I \Indelsl:and that: the l:eglllations of other govenllllental agenoies may apply to
<br />Lhe lnl:ended \-unl" and that: lt ls my responsibJU,ty to ident.i fy vlhat act.i ons I IIIIlSt take (:0
<br />be 1n cOlllpJl.anoe. SlIch agencles JnCl\lde but at'e not JimlLed to: *neparl:ment: of
<br />n;llVi rOllll\en\:al Hegulatiow'CYP1:ess Bayheads, Wetland Areas and n:nvi.rolUlIentally SensJ.t-.1ve
<br />I.clIlds, WaLer-;WasLel~al:er 'l'.reaLment
<br />*SoUt!lYlE:sl: F.'1.o1:l.da \~ater Hanagemellt District-Wells, Cypress Bayheads, Wetland l\1:eas,
<br />All:edng Wal:ercouJ:ses
<br />*l-ltlllY cOJ:ps of E:l1g.illeeJ:s-'SeaHalls, Docks, Navigable Wat:er1'lays
<br />"IJepaJ:t:.menL of Ileal t:h & HehabilJtat:Jve Services, E:nvlronmelll:al Health IIllit'-Wells,
<br />WasteHaLer 'l'real:menl:, SeptJ.c 'Panke
<br />-A" . s, E:nvl tomnental P rotectioll Agency-ASbestos aba ternen I:
<br />T also cerl:l fy that, if flll materJal :Ls to be used j n E'lood ZOlle "A" OJ.' "A, etc.", 1L .i s
<br />\Illders\:ood Lhat a drai.llage plan addressin~l a "compensating volllme" Ht11 be suhmU:I:ed \Ihlch
<br />ls pu:\pa r.-erl hy a professional englneel. registered in the ,'31.~ate of E'lorJda prior to penni!:
<br />issllance,
<br />1\ perml t .i sSlIed aha 11 be construed to be a license to pJ:oceed \-11th the work and not as
<br />alll:horlLy to violate, cancel, alter, or set: aside any provlsions of the technlcaJ codes,
<br />nor shall i SSlIance of a penl\lt: prevent: the BuildIng Off1cial from theretlfter reqll.l.d.ng a
<br />con:eutlon of eLtors in plans, construction, or violatJons of any aode. Every perm!.t
<br />laSHed ahal] beDome invalJd unless the wor:k authorized by slIoh permit 113 OOll1lllenceri IV,itldn
<br />s!.u months of lssuance, or if \'1Ol:k allthorlzed by Lhe permlt ls slIspended or abandoned for a
<br />pedod uf 13 be 1Il0nth13 after tbe l:j,me the \'lorl, 1s commenced. One 90 day extensloll of t.lme
<br />may be allo\H:d for. the 116rm1t I.lith fee dlaJ:ge of $15,00, The eJttenslon shal.1 be r.Elqu8sted
<br />ill \'Ir11:1ng Lo the Bui.lding Official. An approved lnspec\:lon mllst: be logged dllrlng eElcb 8Ja
<br />1l1Ontll period, Ol: the pt'ojeot \dll be consi.dered abandoned.
<br />Wl\RllHIG I!'O Ovlt-II!lHI YOUR H'AII,1JHffi '1'0 RJiJCORD A NO'I'ICE OF COMt-1H:NCffiNE:r~'1' HAY HHlSm,'(' IN YOllf\
<br />Pl\YHI(, TWICE I!'OH H1PROVEHEN'I'S '1'0 YOUR PROPER'l'Y, IE' YOU IU'l'!!',ND '1'0 ORrl'AItI FJNAtlCIIlf3, CDIHWUI'
<br />WITH YOIIH l.ll:tIlH!:H OH AN A'I"1'ORt-IffiY BHlIi'ORfi', RECURDING YOllH tW'I'Icm Off Cm1MENCfi:HHlN'l'. ,fOBI'! llHDH',R
<br />$2,5()() UI VALliE: DO NOrl' HElED '1'0 RECO!lU AND POS'I' A "NO'l'ICE OF COHl1ENCEI'1E:tI'1'''.
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<br />r,.,t,.\.f..l ,I) !.. '_I.'.L u.~.r s (),': .!? .~,;~,"l>.~'!~1~1 A"5'~I'!: ;}AV'~. r~'
<br />
<br />81 GNA'l'IIH/!:: OWllER (IR A(,EWI'
<br />
<br />----.---.,-~-_._---._----~ -...-- .-- ._.__.... _."~"_"_H_'_____~__",
<br />
<br />SWNA']'IIHE:: CON'I'RAC'I'on
<br />
<br />S'l'l\'I'E: Oli' ll'UlRIIl1\
<br />
<br />CO\Hl'I'Y OE" ,~_,__.____, .____._____________~,_._
<br />
<br />rl'he foreyoJllg lust.rumen\: \las aclmmlledged
<br />Before lIle tllls.,__.__ day of______.___ u, 1.51_._,
<br />
<br />by __._____~...___.,..._._.__,_.._._.._._______._________ __.____
<br />(n~me of persoll acknowledged)
<br />[} \-Iho is personally kno\-lo to me, or
<br />
<br />8'1'1\'1' E: 0 F FJ,ORI DA
<br />
<br />em I N 'rY 0 h~ ______..... ... _,___,___.__ _'______,__......._,,_'._
<br />
<br />'I'he foregotng lns\:r\\lnent Has ackuoI'lledged
<br />Before me thLs .___J.lay of-- ----...,-------, 19
<br />
<br />by .,___________________...____,____,...,
<br />(name of person aoknowledged)
<br />[Lbo is personally known to me, or
<br />
<br />[I who has p roc\uced____,.________,________.....__
<br />(type of JdentJfJeat:l.oll)
<br />and who[J dJd I]clJd lIot ta),B an oElth.
<br />
<br />[] 1'-1110 has prod\lo~d_,_..,_._,__,..,____._.. _...,_.
<br />(type of JdsIlLlfiCJal.!on)
<br />and \<1110 []dld I.]Ud not: talee an oat:h
<br />
<br />gj gllatllre of pet:soll taking ackllo\'lledgement
<br />
<br />.._._._----~-----_._.__._._---_..._----_._.__._.._-_.---~-- ---".._~-.-
<br />
<br />Slgllal:ll1:e of persoll t:aklng aCkllQHledgment I
<br />
<br />. -.""-- ~.__.__.--,.._. .-.-- ...- ~---'- '-"---~"-'----'----'''-'''__'' '_....___.__.___.'r._~____. ,
<br />Name typed, printed 01: stamped
<br />
<br />_..._~--.--,._-<.- .__....--_-----_.~-_....., -_.__.~--~.~---_.._-_.. -.._----_._- - - .._-_._~_._._.
<br />
<br />Hame typed, pLl,nted or: IS \:amped
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