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<br />1\. IIO'j'ICF.. Olj' IlI11Hm HE8'l'IUC'I'IONS
<br />'J'116 1I11de.ts.lgned ullderstallds that: t.his pennJ I: IlBY hE: s'ilb.leu1: t:o "deed r6str.Jctjolls" l'fhLch
<br />llla.y be 1II0re .tesl:t:lctive thall City t"eglllaL:ions, The u!ldel S 1 qlled assulIIes respolJstbtl Jl:y tOl
<br />co;np lla~lOe IIj th any appLicable deed rest!.teL:j,o,15.
<br />B, lJIlI.IC/!lNSI!:ll CON'l'nAC'I'OHS AND COl'I'l'HAC'['OR RESPIJI18! BIT, L'['T ff:,S
<br />r f. Lhe OllJler has hIr.ed a contl:actor or cOlltracr.oul to lI11d,,,rtake Hnrk, I:hey olay be reqld red
<br />t Lo be IJcellsed ill at:uordance \-l1th st:al~e and lOCi,l l:egu.LutloIlEl. If. t.he contractor: Is noL
<br />] Juensed as reqllJ Led by Jail, botll the ol.me]::' and ':~ont.tact;or lrIay be nlted for a nd sdsllleanor
<br />'.II ulal:lon 1111<.161 state laH. If the Ol1ner or Jlltt,ndE:d contracl:or Eu:e \\Ilr.ertaln as to I/llal'
<br />I luellsj Ily r81)Id.lelllellts llIay applyfo1: tile Int.elldl~d I/ork, tlley are advised to contact the
<br />l~lly of Zepllyrh.11.l B BuJldtng Depa.t::t:l1IenL, fl13-'/Bll"6611.
<br />F'lllLltel:lllol:e, If Lhe mIner:- has lLl,l:ed a COl1tr-actoJ: 01: contractors, Ite 1s advised to have the
<br />(]()ntrac;l:()j: (5) siyn port1ons of. t:,he "Contractor ilections" of thJs appljeatJon for I'lhl eh they
<br />11111 be u:sponslble, If YOll, as the OI>Jl1eJ: signa as I:he coni:1:act.ol:, you are lnd,jnatlng that:
<br />you, ra Lher than the contra.ctor, are responsible fot: the lIor1>. I f the contraol.:or \.ilshes
<br />YOll to s.l gn as contr:actor that llIay be all inc!lcation Lhat he Js not properly 11 cellsed and 1 s
<br />lIot elltll:led l.o pennil:t:Jng pl:ivileges ill the CJty of ZephyL"llil1s.
<br />c. 'l'R1IHflPOH'l'A'l'ruN U1PAC'l' FEmE .AlID U'l'Il.ITY CONl1EC'I'ION H'ElEB
<br />n. COIIB'l'RlIC'f'tllll\'! ],IEN IJAW (CHAP'l'ER '713, InORIlJ}\ ,'3'l'A'l'lJ'n;S, AS At1ENll!!:D)
<br />I cerl:! fy that I, the appltcant, have bean provided 1-11th a copy of "P,'JorJda's COllstl"1HJtJoll
<br />1 lon I,all .. lIollleol-mer's Protection Guide" prepared by the E'.l<l1:ida Department: of AgrlClllture
<br /><lnd COllsIlllle.t AI:EaJrs. If the app.Ucanl: is someonE: other l:hat. the "m.mer", I cSLlfy that I
<br />have ubtaJned a copy of the above descrJbed docllment: and proml.se 111 CjlJoc! :fa.l.tll to deliver
<br />j l' to the "uI'lJJer" prJor to cOlllrnell']E:1lI8nt.
<br />Ii:, CON'I'lUICl'On' S/OWtlfi:f\' S l\I!'ff'IDA\ll'I'
<br />I certify Ulal: a] L the inforlllat:jon 1n Lllis appllcat.Joll Is accurate alld t.hal: all Hode 1-11]1
<br />he dOlle 111 uOIllpllallce Id,th all applJcable laHS re\:llllaU.ng constnwtlon, 2',onI119, alld land
<br />developmelll: ,
<br />Appllcal..loll :Is hereby made to obtajn a perm1.t to do wade alld 111stallatJon as Jlldiaated, I
<br />eer U f\, Lila t no Hork or .installation haa aomrnended prJor to isslIallcB of a penni I: and that:
<br />aj 1 ~/orlc \"l.1I 1 be performed to lIleet standards of all lal1S regulat.ing unnstulCltlol1, C\ l:y
<br />codes, zonlng reglllations, and lalld development regll.lat.l.olls in the JurJsdictJon. I also
<br />cerLlfy UlaL J Illldelsl:and that the l:eglllat:ions of other govenllllent:al agendes llIay apply to
<br />Lhe IIl\:snded \-/oI.'k, and that: It .is my l:esponsibiU,ty to Jdent:.l fy I'fllat auttons I IIIlIs1: take 1:0
<br />be in cOIllpllan(]e, SItch agenctes inclllde bllt are not l1mited to: *neparl:msnt of
<br />H:nvlnJlllllt:lntal Hegulatiol\'-Cypress Bayheads, Wetland Al:eaf.l alld ll;nvll:olHlIelltaLI y Sensil'..tve
<br />I,allds, Water"/Wast:eHal:er 'j'.reaLment
<br />^SOlltll\-lesI: F'lol:lda ~~ate.r Nanagement: lll.str.tcthWells, cYPJress Bayheads, Wetland Areas,
<br />1\1 tedlly Wa \:ercolll:ses
<br />'l'ltmy corps of mug.J lIeel:s-BeaHalls, flocks, NavlgabJe WaterNays
<br />*IJepar.trnent of Health & HehabilJtat:Jve Services, E:nvirolllllelll:al Health lInit-Wells,
<br />WaateHater '1'1:eatll\en1:, Beptle Tanles
<br />"lI.S. lJ:nvJJ:Olllnental l'rotectJoll Agency-ASbestos abatement:
<br />T a.lao cerl:,lfy that, if fill material :l.s to be used In E'lood ZOlle "A" or "A,el:c.", .I.t.1s
<br />understood Lhat a dtalnage plall addressIng a "colllpensa Ling volume" Htll be submU:ted I./Id,ch
<br />j s prepa l:ed by a professional eng.l.neel registered in tile state of E'lorJda pdot. 1:0 pennl.t
<br />iSSlIallue.
<br />1\ peUllJ t .i sSlled shall be construed to IJe a license ro Pl:oceed Hith the Hork ~nd not as
<br />alll:llorJt.y to vJolaLe, cancel., alter, or set: aside any provls1olls of the teclmlca1. Godes,
<br />Ilor shall I SSlIallce of a permJl: prevent the BII.U.cUng Offt.ciaJ. from Lhereelfter reqlllrll1g a
<br />cou:euUolI of errors in plans, construction, Dr violations of any code. Every permll:
<br />Issued shall bSDome invalid unless the work aUl:hoJ::ized by such permit, is oommenced H.i LId II
<br />alll Illouths of lssuance, or if \wr.k authod.zed by Lhe pennJ.t is s\lspellded or abandoned for a
<br />period lJ f silt months a fter the I:lrne the Hork .is commenced. One 90 day ex\:ens.illll of t j IIle
<br />lIIay be allo\"lt:d for the lJennit I.litll fee charge of $15.00. The el{tenslolt shall be I.eqllest:ed
<br />III Ilrit:ing Lo the BlIilding Official. An approved lnspect.ion lIlllSt be .Logged dllJ:! ng each sJ 1I
<br />month period, ell: the IHojecl: 1-lJ.ll be COliS ide red abandoned.
<br />WARlIHlG '1'0 OWNmn: YOUR ij'AII.\JHE '1'0 RECORD A NOTICE OF Cm1HENCE"1I!\U'1' !11\Y HffiSlIJ,'l' IN YOUR
<br />P1\YHIG 'I'Wrcn: IfOR H1PROVEMI!:N'I'S '1'0 YOUR PROPERTY, Iff' YOU IH'I'EHD '1'0 OR'J'Anl If'JUAHClI-Il3, CONSlliil'
<br />WITH YOIIR J,n:!IIlElR on AN A'l"I'OR1IR:Y BffilroRl!~ RECORDIlIG Ycmn IIO'I'ICE OF COt1J'1E:11C~;HEN'I', ,lOBS lJlWIr.H
<br />$2,500 111 VALUE DO 110'1' NI!:EIJ '1'0 RECOIlD AND POS'I' A \\NO'l'TC~; OF C(JHHE\IICE~1fi:N'l'".
<br />
<br />~_,l,)JJ.U ,,_ 'J'.1 OJ! S ~} .'":' .I?~~~),;~'~ '.~ ':\ A'5'~l'!: ~}A.V :.;, t~~
<br />
<br />..-___. .__ ._____..__._.___u ._.....___ .__.__._,.~__...____._._~_...___.__._.............__
<br />
<br />S IGIJA'1'UHE: I OWI/ER un AGF,tI'J'
<br />
<br />-...._--_.,._~-~-~---------...---~ - --...._-, ..-.--...., '" ~"".'-'-~~----'~-",
<br />
<br />SI(3NA'l'UHE:: CON'l'R1\C'1'On
<br />
<br />S'j'i\'I'E. o Ii' E'j,ORlIlA
<br />
<br />COllll']' Y 0 E' ___... __.__._..._____'..________________.___
<br />
<br />']'ha foregoing Justrmnenl: Vias acknovl1edged
<br />BetuLe lIIe 1:\11 iii __._..__._ day of."._________, I~L._..
<br />
<br />b V _'_'_' __'n ___ _.__,... '_,_....._ '..'_ _...._._________.____________..____._
<br />(name of. persoll acknowledged)
<br />[) I~ho is personaLly knoHn to me, or
<br />
<br />fj'rfl.'l'E: OF FLORIDA
<br />
<br />C 01 J N 'I' Y () v~ ___.. ..______._.__ _.________ _"___"_'_
<br />
<br />'l'he fOLego.ing 11Isl:rl1lnenl: W;j5 aclUlo~lledgsd
<br />Before me tlds ___J,iay of------.----_.__, 19
<br />
<br />by _.___.__________________...._..______.______.,..,
<br />(name of person acknowledged)
<br />[JJho .is pe1'sonal.ly ImoHn to me, or
<br />
<br />II Hilo lias p I:oduced____,______._______.._..__.___
<br />(type of JdelltJfJcatJ.olIl
<br />alld who[J cUd I]cltd /lot take an oatil.
<br />
<br />[] I-fho has prOd\lO~d__u._________._.____..__. _...._
<br />(type: of Jdelll:JfJoal: 1011)
<br />and vll\o [Jell d []Ud not take an oa"l:ll
<br />
<br />.~ "~...-.~_._.__._.. .__.._---~---_._-_.- .---~-_..._._.-_._-_.
<br />
<br />... . .~.. ----------,~.-.--,-.-------.-, ....-..--_..._. ___..__.h___~__.__..,_._.__.~
<br />
<br />Sj gnatnre of perso/l tak.illg ack/lo~/ledgement
<br />
<br />Signature of. person takLng acknolJledgmentl
<br />
<br />Name typed, pdllt:ed OJ: stamped
<br />
<br />. ....~_._-. "'-.-..-..._.~ ....-.---...-..-.--------,..----...-..,.-. .~..--_....~._-_.-."
<br />
<br />_._-.----,._--._.._-_._-~---_. .-... "'-"_.~---_.,.----_. .~_.. ._-_.~_.-.-
<br />
<br />Name typed, Pl)nted or sl:amped
<br />
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