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<br />~&JI1' 10~S OF tEfUttI'r AI:'rlDAVI1'
<br />A. NOT! ':.E or DIU' ua\T.4c.......lC;.S
<br />~ ~....... ....._..-1 .e...trJ.ct.4.J.\s'" which
<br />The undc::~.iQl\ed und.U:6\;u,'.". \":,na;-''-lai5 perm) t ..,.y ..,~ en_ ,:~~. -~ "-
<br />may oe r..::...-re re.tri,:,'.:.l". ..~,...n '':It:v l.e9IJ1.tionll. Th: ~!~~~:;"'~:;~::i a..ume- ~e.pon.J.bi~!ty for
<br />complial';:..;e wi.th an! "~!,:...Lc:.j;)l.. <.I1r.d r..t rir:t1';m.,
<br />B. UNL::'~EHSED CONTRAt"'[.)~ ~L< C.vlh'AAC'lOR KES'ONSIBIL:[Tll:~ , .'
<br />r f the- t ,.1~eT ~&al hi. <:":><<1 '!! <::''':''!'1tract.ox or C'ont.ra-::torso ~.;;; :....,J..c;; ~.""~a "If't'l(. ~n"V 1Nl~' oe requ1..l:ed
<br />to be l;;....en..d i!! ..":'':'~Xl::lanc:. W1 th !!Ita ';;li!' and l..,c:.l .':';"J -,~Jlt i....:r. . T ~ t Pl"! r.~"t' r.t:~"r ls not
<br />licen.e~ a. required b~' LaW, Doth tl'\~ Qwner and. con~::\H;t:O:": lNIY be t:"~.t:...,. f-:-17 a ~:i,.dem.iIlnor
<br />violation under .tate law, If the o~~r ~r i~~~"~.ri ~~ftt~~~~A~ ~~- ',~~~rt~;~ -~ to what
<br />11cen'1ng requir...,.1\t'.s.y l"Pr'h' ~':':" "~'e j '::~("",nd'l;:: w,,+.. ~~,~. IUi rd.'. r,1!.--;' tc t;"":>.lt.t,::,t t"te
<br />City of Zephvrn.tll. 8u,il,tti"'.'" n.-~"l,,:,t;""~!,," ~1~-"~'-!T'l. ,
<br />FurtherMOre, if thtl!l l."WI1.P,I' ~!IS ~i""e';ti " contractol' or c:ontractor... he is advised to have the
<br />contra.....':'~!~; ::::.;;"". ~(\Tti.l)l'!t f'f t'he ':(.om:.raccor :!!;l!II~t;1~'n,.~' C,;) .;'1\' ,\ applj,c~";i ..... tor w}-,t...~ they
<br />will be re.pon.ible. If yo~, as the owner s~9n. a. t.h. contractor, you are indicat:n~ that
<br />you, r'!~~'!!!: ':~~~ t~. ;;;,;:,iit..;......ur;, are xespons.t.t'.l't! ~~r tto... "'('I~k. t~ the ;.:,.t,..,t.... t...I.\eS .
<br />you to .ign as contractcl tl1at Illl.lY be an indication that hte is! not: properly licensed and....
<br />not entit~_': tv .._uY.i;i:ing prlv1leges in the C.1.t.y of !.phyr':lil1~.
<br />C. TRMSPORTATION IM'}:,CT FEES AND UTll.ITY CONNI~CTIOt,: FEES
<br />D. COt::':'nuC'i"uivn J...lUf w\w (CHAPTER 7lJ, FWP'!l)}, ~"'&;~I't1Tt:', .~-, .\.'i!"'DED 1
<br />I certify that I. the 1l,on1icant, have been p~:ovld.d "pith a copy of "Florida's Construction
<br />lien Law - Ho...owner'l Protection Guir;l;P" ~-:"!p~.r.~d l:-~' t~'" '!':'...,r:~.:l.:". ~f:rltr~:"r.:<t:'\t '...; . c,~~-:ultur'"
<br />and Conswaer Aff-1ra. :..i che "'rr-Licp.'" 5." ~o';:".<;""'rl(': cr';;{'.- ';~.~. t-",c ..r......r,~:.', -;.,.... ':hat r
<br />have obtained _ ~opv ot ton!! .above csescrib~d document ",... ~ :Ol,/;'H, ;\'. ',:~ .'~ ::a,~' '. 1." .:. .lver
<br />it to thfll "t.'w.r!~!''' pJ:1.01" t:t"l commencement.
<br />E. CO~Z~~~~~~:~iOWNE~'S AFFIDAVIT .
<br />I certify that all the information 1n thill appJ.l"c.t;tinr. i,l accurate and that all WC)IK will
<br />be done in compliance \11th all applicable laws requll\tin9 construction, toning, and land
<br />development.
<br />.&.pplication 1s hereby IMIde ~(; Ql)~a~il a perrni t to do 'oforlt and inatal.l.ation as indicatad. I
<br />certify that no work 0:: installation ha!! (;Olm\tmced. p:~ior to ieu,uance ot a p.,rmit'. and that
<br />all work will be perto::med to meet standards of all law8 regulating construction, City
<br />code8, zon1.nq regulat11)n8, and land development requ,Lat10ns in the jurisdiction. 1 also
<br />certify that ! underst,and that the regulae ions of ol:''\er governmerltal aqencif'!s may l'lpp.l.y to
<br />the intended work, and that it is my respona.1.bility 1:0 ident1f.ywhat ',actions I must take, to
<br />be in compliance. SUC,l agencies include but u'e not limited to: *D.par.tment of.
<br />Environmental Re9ulatl)n-Cypres. eayheadl'S, Wetland. )lI.[ea. and Environmentally Sensitive
<br />Landa, Water/Wa.tewatet Treatment
<br />*Southwest Florida Water Manaqement District-Wells, ':ypress Boyheads, Wetland Areas,
<br />Altering Wat.rcour.e.
<br />*Army Corp. of Engine.r.-Seawalls, Docks, Nav19able 'lfaterw.y.
<br />*Departntent of Health' Rehabilitative ServiC:l'!!t, Em'iroN!lental Health Unit-Wells,
<br />Wastewater Treatment, Septic Tanks
<br />.U. S. Environmental pr;)tecti~n Aqenc:y-A:lbestos abllt4!r.nent
<br />! also certify that, if fill -.-teri.l is to be used in !'lood Zone "A" or "A, ete':, ", it. is
<br />understood that a drainaqe plan addressing a "c:omperllatinq volume" will be !luk>mitted which
<br />is prepared by a prof/f!..ional engineer registeJ:ed ir: the State of Florida prior to pel'.'mi t
<br />issuance.
<br />A permit issued shall be construed to be 11 U.cense 1:0 proceed with the work IUl.j net 8S
<br />authority to viOlate, cancel, alter, or set aside .~y provisions of the technical cod~sr
<br />nor shall issuance of a permit prevent the Buildinq Official from thereafter. requiring A
<br />correction of errorl ~n plans, construction, or violations of "oy code. Jl~ve.ry permit.
<br />issued shall become. ir,val1d unless the work au1:hori:l:ed by such permit is commenced wit.hin
<br />six months of i..u.nc.!, or if. work. l!Iuthc.cized by thl!! permit i. suspended or abandoned for .tl
<br />period of .Lx months 'Itter the time the wCork i:s comnericecL One 90 day ~t.n.ion ot time
<br />may be allowed tor th.! perll\1t with fee charg'e c,f $l'~i.OO. Th.. extension .shall be requested
<br />in w1:1 ting to the Building Officia l. ~.n IlIppro....ed inspection must be logged during eflch six
<br />month period, or the Ilrc;>ject will be considered abandoned.
<br />WARNING TO OWNER: YOUR FAILUitE TO RECORD 11\ NO'rlCE ::F COMMENCEMENT MAY RESULT IN YOUi<
<br />PAYING TwICt l"OR IMfRClVDtl::NTS To YOUr E'HOP~:RTY. ,Ill' YOU. itiTEH'D TO OBTAIN !'INANCIN..., CONSUl.'f
<br />WITH YOUR LENDER OR All AnORNEY 8Ef'ORE R!C(iFUJING YOUR NOTIC!!: O!'COMMENC~ENT. .J08S UNDER
<br />00 IH VALUB DO H~r HB.D TO .ECORD AND POS'l'~F C~C"""~
<br />
<br />-_.----..~ ':/~ .' ~.~~~.q---_._~_..-
<br />
<br />SIGNATURE: OWNER OR ,s.GENT 311#lol,."I'UIU:: CONTAAC'fOR
<br />
<br />
<br />STATE OF r~ '~
<br />COUNTY, Q.~.- ....~ _ -'-,~.....,'h_"'~
<br />. ..' .........,
<br />The !oreCiJoing inal:rwn'ent was' acknowledged
<br />8etn!:,!! ~ ~h~~,51..1A-~.iY v!. ri.A.-lt../ _ ,~'}N7\8-"
<br />by ""-DB (\ n.a.... ,~' ,,09"- .. --- u -,-'" -~
<br />_/ (n;;;... ,;,! ....lo.gn ilc;itnowledgedl
<br />Dcf"who is per.onally '~nown to me, or
<br />
<br />o who ha. produced._ .
<br />(t~pe of identification)
<br />an~ whoD did Ddid. n,~t take an oath.
<br />
<br />~,~~~
<br />
<br />Siqnatu::e of person tskinq aCknowle~1gement;
<br />
<br />SLb.c.o..n Ilnn ~.~oJ J e ~
<br />
<br />Name typcad, ~rlnted or stamped
<br />_~iJ"I,..__~...........lI'I\t. ;>."tII.,_......._'~">..~'~
<br />
<br />S'rA'l' E: OF.' FLOIU LV-t--p .
<br />':':'~'rl'?':t \,ct ,..~-?__d._<;?.______..._. ......-
<br />Tile foregoin<J instrument was acknowledg"c
<br />Befote me::' 1$ ~q' d'Xk\.-.L.,..~-_., ~~
<br />by._
<br />_ (name of person acknowle'::I9.d I
<br />~ 1s personally known to me, OJ;
<br />
<br />o '~'ho hilS prodlJced _--
<br />(type of ldentificat
<br />
<br />,al~i~~ o~th
<br />
<br />Signature of pp.cson taking acltno,""",J.qlT. t
<br />
<br />S ~(VY\ An 1\ 4v ~Al~.~__.. ...._.
<br />
<br />Na~Le typed, pr-.! nt.,., "r stamp"d
<br />
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<br />
<br />"-'.~"1
<br />
<br />
<br />,'''', t
<br />..-....
<br />:".:.i'
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