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<br />1\, IIO'l'lCF, OIJ' DIl:FJD HEB'l'RIC'I'IONS
<br />Tbe llndersJgned understands that: t.hJs pe:nnll: Ill~\' IH: s',lb)e:~Jt. 1:0 "deed resl:r.jntjons" Hhlch-
<br />lIlay be lIIore resl:r.ictlve than City t'egl1l::,t:ioils. 'l'h", \'l!Id':;lslqned aSSllmes respollslb.llJl:y ror.
<br />compliance Hj t:h any appl..i.callJe de€.d [<3strletio:IS.
<br />. B. lrlH.J CH:NSIl:D CON'l'Hi\C'1'OnS AND COj'J'l'HI\C'l\lR RiTIS !?'):IE TIn [, L'l'IE,:J
<br />If the (Hillel: has hir.ed a contr.aotor OJ: ~:CJntl:a,;l-.:)U3 tOlllICI-3J:take Hork, Uley may be regH:1 red
<br />\:0 be licensed .ill auuordauoe I-l1th stal:e and 10,:::,,1 J:eglllatlolls. If t.he c:ontl:autor .Is lIot
<br />licensed as re(jllJred by lSH, both tile o'..mer: alld contrac.:t:Ol: Hlay be oJt:ed for a lid adellnSi:lllnr.
<br />I)'JulaLinn lIuder state laH. If the OHIISl or intended contractor aLe l\IIner'taJn as to HIla\"
<br />I juemd lHj requlr€:lllents lIIay apply tor the lntended Iwrk, they are advi sed to nonLact the
<br />I:.lly of Zepllyrldl.ls BuJldlng Depart:menL, fl13-'/88.6611.
<br />li'ulLlIsl:Illor::e, if the O\'lller has lLi.J~ed a contl'acl:o,l: or contractors, lie Js advlsed to have the
<br />(J()ntranlcn(s) sign port.lol1S of l:be "COl1l:ractor Sections" of tll1s app.Ucation for 111110h they
<br />1/1.11 be I:esponsi hie. 1 f YOII, as the CHlnet s.lgns as I:he conL.r:actol:, you a,r:e indl eal:ing tha t:
<br />you, raLber than the contnwtor, are responsible for I:lle vsotk. If the oonl1:anhn vsJshes
<br />ynll 1:0 s.lyn as contr:actor that lIIay be an .lncJJcatjon that lie Js not: properly Licensed and is
<br />lIot anti t:led to penllt.LUng privileges In the CJty of 2'.ephyrhJ116.
<br />c. 'L'RlINSPon'I'A'I' [ON lt1PAC'1' FEHlS ,AIID U'l'1 LITY CONIIEC'I'ION Jj'EES
<br />n. COHS'1'RllC'I'1I10N ],TEN IJAW (Clli\P'l'ER 'll3, FlnRlDA ,'3']'A'l'U'I'IDS, AS AHEHDED)
<br />I eel:t.! fy thaI: I, the iOIpplJcant, have bean provided Ht\:h a copy of "Ii'lod.da's Constt"lHJtJon
<br />1lell ],all .,. lIolllE:c)\"IT\sr's Protection GuIde" prepared by the E'lorida Department: of Agcl.nult.ut"!!l
<br />and Consumer A1:fajxs. If the applIcant: is SOIO~one other that. the "oHnet.", I ceclfy that 1
<br />have uhtaJned a copy of the above descr1bed aOCll1ll8nt: and p1'omJse 111 good 'FaJth to deliver
<br />it. tn t.he "ol.mer" pr:\,or to comrnencelLlenl:.
<br />H:, COH'I'Hl\C'I'OH' S/OWHH:H' S AFE'1DAVl'l'
<br />I nerU.fy Lhal: a]J the 1nformation in thts appl.lcaUoll Is accurate and thal: aU 110dt III]]
<br />he done .l.n compl:\auce III Lh aU. <lpplJcable lavls regula U.ng construction, zon.lng, and laud
<br />development:.
<br />Appl.lcaUon :Is hereby made to obtain a permJt to do work and installatJon as Jnd:loated. I
<br />cetU fy thaI: no Hork or instal.lation has oomrnenoed pr.tor to isauallce of a pell:ml.\', awi tbat:
<br />all 110rlt HU.l be performed to lIIeet st:andards of all 1a\18 regulat.ing UOllsl:nlOtlol1, C\ ty
<br />codes, zonJng reglllal:j,olla, alld land development regll.l.atJons In the Jlll.JscUct.jon. 1 also
<br />ced:lfy Lila\: I IInderst:and that the l:eglllat.JoIIS of other goveullllent:al. agendes may apply \:0
<br />Llle .Intended wnk, and that it is my !'eaponsibi1lty to ldentL fy l'lhat aeU OilS I IIIlIst take 1:0
<br />be In cOlllpll.allCe. SlIclI a\]encles inc.lude b\l1: are not limited to: ~Deparl:!lIellt: of
<br />H:n v i r'Olllnen l:a 1 Regula l'.ion'-Cypress Bayheads, We t1 and Are as and n:n vi l' 0 I1l1\e1\ 1:a 1.1 l' S ens 1. 1'..1 ve
<br />l,allds, ~"Ja ter-;Wasl:e~la I:er 'l'lea l:ment
<br />ABouLlll/es\: E'},oJ:ida \"Jater Hanagement Distr.tct'-Wel1s, CYP.li:ess Baylleads, Wel:landl\reas,
<br />AJt:Bdllg WateroOlu:ses
<br />-I. THIllY Corps of ffillglneers-Sea\olslls, Docks, Navlgable WaterI'Jays
<br />~)lepa1.l:lllenl: of Health & RehabLUtative Servioes, H:nvirOlllnelll:a111ealth lInlt'-Wells,
<br />WasteHater 'j'l:eatmenl:, SeptJc 'Pa1\les
<br />-All. B. ElnvJ lOlllnelltal I:' rotection Agency-Asbestos aba temen I:
<br />1 also ceLLI fy that, if fill material :Ls to be used .In lJ'lood Zone "A" or' "A,el:c.//, Jt is
<br />undel:sl:ood Lhat a dralnage plan addressing a "cQll\pensaLl.ng vollllne// 1-11.11 be subml tted IIIIJeh
<br />.Is prepared hy a professional eng.l.neer: reg.l.stered in the state of E'lodda pdot" to perml.\:
<br />lsBllanue.
<br />A permJt Jsslled shaLl he construed to be a llcense to proceed Hith the Hork \!Ind not as
<br />authorj Ly t.o vJolate, cancel, alter, or set: aside any provisions of the te()lllllcaJ codes,
<br />nor shall issllance of a permit: prevent: the BI\.U.dJng ()ffloial from thereClfter reqll.1.dng a
<br />con:ecL.lon of errors in plans, const.ruatlon, or violations of any aode, IIlvery permlt
<br />issued sha.11 baDome invalid unless the work authol::ized uy slIoh permit. ls OOllllllenced H.H:ld n
<br />fiiu lllouths of lss1l8noe, OJ:" if \'ior.k allthod.zed hy Lhe perm.!.t is sllspended or abandoned for a
<br />ped,od of eht months after the U.me the l-wr}, is commenced. One 90 day e.Ktensioll of t.lme
<br />lIIav be a:l lOlled tor the tJennlt "lith te~ oharge of $15.00. '['he extens.1oll shaU be I.eqllesl:ad
<br />l.n Hritillg 1.0 the Building Offio1a1, An approved .inspection mllst be logged dlld ng each al){
<br />month ped.od, or: the project Idll be consi.dered abandoned.
<br />WAIUIJlIG ',1'0 OvlNElRI YOUR li'AII,ORE '1'0 Hi'JCORD A NOT [eF, OF COMNENCEHl:!lN'l' MAY HIr.SUJil' 111 YOtlR
<br />PAYHIG TWICE ll'OH UIPROVEHI!JN'I'S '1'0 YOUR PROPgR'!'Y. IE' YOU IH'I'EHD 1,'0 Ofl'1'AItI F.'JNAIIClIH3, COlHJlIW'
<br />W1'1'lI YOIJR I,ElIIJER on AN A'I"l'ORNfl~Y BEIfORa~ RECORDING Youn NOTICE OF Cm'1I'1ENCHlt1EH'I'. ,lOBS l1HnR',H
<br />$2,5()() 111 VALli!!: DO 110'1' HIl:ED '1'0 RHlCOHD AND POS']' A "NO'l'ICID OF COHMIDI'ICEMH:JoI'l'''.
<br />
<br />f,.,l.).r) :J .:'_ '.*.1 ~l~ U,~! f::' () .~.... ,,? ~~ ~1\..\~ .~~ I!\ 1\:T ~l'~: ;) AV} ~J.l
<br />
<br />51 G1IA'l'UHH: lOWliER UR lI.GEN'1'
<br />
<br />-......_-~--'-~-_.~._--_._-~--...---~.__. ..-..-, "-'---~'" ..-~ .-._-~--,-"_._---_.
<br />
<br />SIGNA']'IIRn:: CON'l'RI\.C'l'OH
<br />
<br />S'l'A']'Hl Oil' l:!'UlRl DA
<br />
<br />C01JN'I'Y o Ii' .-----.._~_._._________.___._____.__._
<br />
<br />'J'he foreyolng .1nsl:rlllnent lias acknolrl1 edged
<br />Befol:e !lIe tllJs -on__'._ day of,._.______, l.~_._
<br />
<br />b V ......_.,__."" __.__ .., _._._._.._ .___________..____,.___,_._.__...
<br />(name of persall Bclmow1edged)
<br />[) I~ho is peJ:6onally ItnoHIl to !lie, or
<br />
<br />[I Hila has prodllced____._____.____._,_..____
<br />(type of identifJcatJon)
<br />and IJho(] cUd [lei ld !lot tab: all oath.
<br />
<br />fl'I'A'j'!:!: OF FLORIDA
<br />
<br />em J N'j'Y () j!" ___.________._.__.__..__________._.__.__
<br />
<br />'l'he fa Lego.ing JI1 s l: rlllnen t I/!':l S a elwol-sledged
<br />Bafore !lie tIlls ___Jiay of-----....,---,--, 19
<br />
<br />b V .'..___'_._._..______.__...__.,___,__..,_____....., ,_,_..,...
<br />(name of person BcknoHledyed)
<br />[1ho ls personally known to me, or
<br />
<br />[] Vlho has prodllc'ild___.....__.___.._______._.
<br />(type of I dSIlt.i Eieat. lOTI)
<br />and vdlO [ldl d I.]Ud 1I0t take an oath
<br />
<br />--. .' .-.-.-.--.------~...~--.~--.---~-_..-.._-----~-__.__ _~._.______~..__ ___._M'___
<br />
<br />SJ gna\:\Ire of persoll tak.ing ackllovlledgement
<br />
<br />Signature of persoll taklng aaknollledgmentf
<br />
<br />_."... .. .......' ._._~.._,..w. ,_._
<br />Hallie typed,
<br />
<br />printed 01: stamped
<br />
<br />Hallie typed, pl)lIted or sl:ampBd
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