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<br />1,.. HUl'rem OIJ' DillEn RElB'l'RIC'I'IONS
<br />'jibe undersigned 11l1del:stands that Lll:a p",nnJ ~ In,~~' bt~ SII)l.l,eut to "deed restL'lcttone" \~ILlch
<br />IlIClY be IlI0l:e restLlat:l ve than CJty n~glll" tiolJs. I'll., llildtHslyned aSSUlIles respolls !.bl 1 J l;y for
<br />complIance \llt.h any appllcable deed ulstrlctlon:o.
<br />B. IIHI,ICElNSEU CON'l'RA.G'l'ORS AND CON'I'HAC'I'CIH RlTIS!?<JH 9 BII.I'['U!:,S
<br />J f the O\lIlel: has hll:ed a uOlltl:actDr OJ: CDlltJ:acl::oJ..:l to Illldertalte \-Iork, l.hey IIlay be reqll:! red
<br />10 be .Iloensed.l.lI accordance vdtb st.ate and lOCHl legll.laLJolls, If the eontractorls not:
<br />lllJensed as re<}ul led by Jaw, both the Ol'llle1: and contulctor may be cited for a Ildsdemeanor
<br />"J()latioll llndel: stal:e 1aH. If the OHnet OJ:: .1.lltf~ncled uOlltl:actor' are uncertain as t.o \/hat
<br />IJcelisJllg requirements llIay apply fut l:Iw Intended \vork, they are advised to rJolltaul the
<br />r~lly of Zephyddlls BuIlding Department, 013-'/[10'6611.
<br />Ji'I.lLLhermcJl:e, if the O\'lIIer has hlrecl a COl1tractol: or contractors, he is advised to have the
<br />cOlltrac;to.t (e) sJgn port.ions of the "Contraotol Sections" of lids applloatlon tor \'Ih10h they
<br />\1111 ue responsIble. [f you, as the DI'Irler signs as the contractor, you are ind,lnating l:)lat
<br />you, rather thau the contractor, are respons.ible for the Hork. If the contrautO); I/lshes
<br />you to si gn as cOlltractol that llIay be an ind1.catloll L:hat he j s not properly 1.1 censed and 1 s
<br />not ent.l t:1 ed to permil:Ung priv1.leges Jll the CIty of Zephyddlls,
<br />C. 'l'RMISPOH'l'l\.'l'TON IHi:'AC'l' FEElS AlIj) lJ'i'ILl'I'Y CONI1EC'l'ION If'EEIS
<br />n. COIIS'i'RIIC'I'UION I,TEll LAW (ClIA.P'I'ER '11.3, FI,ORlfJA .'3'I'A'I'IJ'I'EB, AS AHE:NDElD)
<br />J oer.tI ty that: T, the applloant, halle been proviqed \11th a copy of "I!']orlda's ConsttllctJon
<br />.I Jell I,all - !IomeOl-mer's Protection GuIde" prepared by the B'lorida Department of Agl.JcUlt:ll.t"e
<br />and ConslIlI\e!: l\ffaJrs. If the app.llcant 1.'3 someone other that the "o~me.t", J uecl fy that I
<br />have ohtaJ lied a copy of the above deaorJbed dOClunent and promlse in good :faIth to deli ver
<br />J I. to the \\o\-llleL.fI prJor' to oommencelllell t:.
<br />U:. CON'l'HAC'I'OH' B/OWUffiW S AFI!'IDAV1'r
<br />r cert] fy Lllat all tile informatIon ill th1s applicatIon Is aCCllrate and thal". all Horl. HI11
<br />be dOlle 1.11 uOlnpli,C\nce 1-/1th aU. appliaable laws regulating construotion, zonl.ng, and land
<br />development.
<br />AppLloaLJon Is hereby made to obtain a permJ.t to do work and JnstCll1at:lon as indioated. l
<br />cel:l:Jfy that 110 \lOrI. or installation has oommenced pr.1.or to issllance of a pennJ\: and l:hat
<br />all \e/otk \-/111 be performed Lo llIeet standards of all laws regulaUng OOlJstnlCltJ.OlJ, (;11:y
<br />codes, zonJng reglllal:.1.olls, and land development regll1atJol1s 1n the .l\ll:JsdlutI on. I also
<br />cert:ify Lhat: '"[ IllHiersLalld that the regulations of other governmental ageneJee may apply t:o
<br />Ihe In\:euded vmrli, and that Jt is my r~spons.u:)ilj.ty to Jden\:ify \./ha1: actions I IIII1S\: [-,ake l:o
<br />be in COIllIJllanoe. SlIch agenc.l.ea include bllt are not limited to: *Depi1r\:lIIent of
<br />R:uvinllllllelltal ReguJ,\l:ion'-Cypress Bp,yheads, Wetland AreCls and EnvJ1'onmenta1.1y SensJtlve
<br />I,ands, Wa Le L /Was teHa t:e1' 'I'tea LllIent
<br />* SOli Llll'le/::l I: 1f'lorlda Water Managemenl llistri at-Wells, cypli"ess Bayheads, Wetlalld l\J:eas,
<br />AI tedug Wate1'oollrses
<br />Al~J:IllY COLpS of Ellg.illeer.s-BeaHal1.s, Docks, Navigable WaterHays
<br />~'})epartlllenl of Health & RehabJUtaLlve Sel:vices, Envl.l:onmental Health \lnlt-Wells,
<br />Wasl:e~lal:er 'l'reatmell\:, Septic '.l'aul.s
<br />All. S. EnvLrolllnental Protection Agency-Asbestos abatement
<br />1 also cerLl ty that, Jf fill materlal Js to be used In B'lood Zone "A" or "A, eLc. fI, l.t 109
<br />11IHlerslood Lhat a draJnage plan addressJng a "compensating volllme" wLl1 be BI.lbml Ctad Hhlch
<br />is prepared by a plofesl:dona.L eng.Lneel: reg.1.stered in the State of fj'lodda prior \:0 permit
<br />issuance.
<br />1\. permIt jsslled shall be construed to be a lloelllse to prooeed \-lith the work and not: as
<br />allthod Ly to vloll:lte, oancel, alter, or set aside any provlslons of t.he teohnloa1. oodes,
<br />nor shall issuance of a permH. prevent the Bulldlng offioial from thereafter requll;JlIg a
<br />corteuU all of el"lors in plans, construatiOll, or vic)lations of any oode, Hlvery permlt
<br />laslled ahall become invalid unless the work authorized by 6uoh perm:!t :Is oomlllenoed Hil:ld n
<br />sjlt lllollths of issuance, or Lf ~wrk RllthorJ.zed by the parmI. t: is slIspended or abandoned for a
<br />ped,od of sll{ months after the time the Hork. is commenced. One 90 day eJ.tens.lOIl of t lllle
<br />lIIay ue aLloHed for the permit Hith fee charge of $15.00. 'l'he e){tenslon shall be requested
<br />.Ill Hrittng to the BuJldi.ng Offic~ial. An approved inspeotion IIIUSt: be logged dllrlllg eElell !:Ita
<br />month perfuel, or the projeot: \'Iill be oOllsIdered abandoned.
<br />Wl\RNJlW '1'0 OWNERI X'UUH FAII,URIiJ '1'0 RFJCORD A NOTICE OF COMMENCElMEN'l' Ml\Y HfflfilJJ/I' HI YOll!t
<br />PAYHIG 'l'WICEI BUR H1PHOVEMENTS '1'0 YOUR PROPER'I'Y. IF YOU IWl'END '1'0 OB'I'1\.TN Ii'HIAIH;lJ.ll3, COllrS111/I'
<br />WITH YOIJR I,HaI/JER OR AN A'I"I'ORNFJY BEFORE RECORDING YOUR. NO'I'ICF. OF COlv1l'1ENCf.;t1EN'I'. dOBS IJlWF.:H
<br />$2 r SOU [N VAI,UE DO NO'I' NEED '1'0 RECORD AND POS'J' A "NO'l'IeEl OJ!' COMl1E:NCfiJMfl:N'I"'.
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<br />\~tJJ:'J.I)}'_I_'_,~r,;,':~)S O,t? .J~~?,?'-~I'J.\ AE'WIDA'VI'f
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<br />S I GNA'L'lI Rill: OWNER UR AGEN'f
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<br />-<-" '-'-'--~"'-_._~--~--- ..-. --..._-_._._--_.-."'~~---
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<br />w_,..... -__~...__.___A.~..~_._'______._.._...___._..
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<br />S I GNA'l'lI RE: CON'l'RAC'l'OH
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<br />., ~ --'~--"'---"-----. -.'...----.--.-.-.-. ~
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<br />S'l'A'1'1lJ OF E'I,ORTlll\
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<br />COB WI' Y 0 E' .____,____ ._._.__.______.___.____,~_...__
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<br />'J'he torego.ing Jnstr\lment was acknOWledged
<br />Betore me tltl.s _......._ day of ,.___"_.____.__, l!L...
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<br />by ._____.__,_.,____.._..,._._..__ ,_.____ ___.____.__'___..____.______,_
<br />(name of perSall a(jlmol~ledged)
<br />[)\-Iho 1s pe.rsonally known to me, or
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<br />B'I'A'l'E OB' FLORI DA
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<br />COUN'I'Y OF.' ____.__.__.__._._....__. '. ._._..__..__._..,..___
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<br />'l'he forego1ng ins\:r\llllent \"Ias aclmovlledged
<br />Before me this ____r.iay of.---..-...----______, 19 _.:..._
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<br />b'l ___._.......____.__..__.___._ ___. __..___'..__.,...______,.._..
<br />(nallle of person acknowled9~d)
<br />[Jvho Js pEu'sona 11y ImO\m l:o me, oc
<br />
<br />LI Vlho has p tod\lGed______._.___.__~__.___.___.,_
<br />(type of idenUfloatJoll)
<br />awl who[)d1.d []dld lIot take an oath,
<br />
<br />[I Yiho has prodlloed___...,__..__.__._.._______._......
<br />(type of 1 delll:lflcaLJoll)
<br />and who [Idld [liid not take an oath
<br />
<br />SIgnatllre of person takIng 8nkllo\-lledgement
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<br />. "', .-_.~..._-- -._...__.__....... n.' .,._____._._____....,___,_._~._..._.__.___~_
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<br />Slgnat:ur'e of person takl.ng ackllO\lledgmentl
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<br />...--._.*....._--_._--_._..~-_.~..._,,--,--,- ~.- --.-..-.~---- -....,. --_......-._-~_.-.._..- '.'-...------..
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<br />)~~ Il{~--l~- Yl)'~ci:" [l ~-i~;-i:_;;;l-;;~:. .~-t;';~;~.;i--..------.
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<br />-'-'--'-.- .,-~ -'~-" '~-~----"--"---
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<br />lIame typed, l-n.lnted or stamped
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<br />-.. .......-..--,---...'~_...._. "'04_ ,.... '_'''__''''
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