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<br />l\. 1I0'j'TCE Oil' j)1l1H:n HEB'l'IUC'I'IONS
<br />'rile 1I1lders.luned lllldel:stands that: tnJs pe,nnl t: llla~' b", ,onb.leut. l:o "deed .lesl:.lint1olls'" \'Ihlch
<br />Illay be 1II0n:: resl:rl.ctJve than City t'1::gllle,l:ioils. 1'h", 1.1'ldl::l.iJ IlJlled aSBllllles l'espOllsib,llit:y Eo!.'
<br />compli-anGe Hl Lh allY appl.1.cable deed Il,stl'lul:.ion=.
<br />fj, IJlHdCI!lNSl!;lJ CnN'l'HAC'l'OHS AND COl'l'l'Hl\(:'l'CiR Ri'!:31?1)1!51BI [, ['I'IE:.s
<br />l'f l:he (Hiller has hlr.ed a cOllt:r.actoI: OJ: ':Ollt.L:actoul to l111derl:ake Hork, t:hey n\ay he reqll:l red
<br />I to be li.censed ill acuordance v/Jl:h sLal:e and lOCi'll J:eglllal:lolls. If t.he cont:ractor Js noL
<br />IJuellsed as reqll.lted by la~l, both the O\'lTler alld:~()lItnH.:t;()r lnay be ojl:ed for a lid sdelllei:'\noJ.'
<br />vJulal:ioll Hlld.:n: staLe la~I, If the OHnel OJ: .i.ntl::nded cOlltrautor are 111lr.ertaJn as to \/Ilal'
<br />I i.u6llslllY recIll.i.lelHents Hlay apply fcn tilt:: .lntendl:d Iwrk, tile\, are adv! sed to COil tact: the
<br />1~It:y of Z,epllyddl.1s Buildl,ng Department, fJ13-'IBll'661.L.
<br />1!'ll1:t:hetll\(He, if Lhe Ol-lller has h.l.J:ed a contJ:actoI: (It: contl:actors, he is advised to have the
<br />contract:QL (8) sign portions of l:he "Contractor ,e3ections" of tills app,Uc:ation for \lId eh they
<br />Vlill be u:spons.ible, If YOII, as the o\1ner 81gn8 i'JS l:he contl:act01:, you are .1nd.lcating thai:
<br />YOII, rather than the cOlJtractor, anl respons.ible for the Hork, r f Lhe eontraut:or 1'1.\ shes
<br />YOII Lo s1 un as contr'actor that may be all indication that he is not properly U cellsed and .I s
<br />\lot ellt! tled t.o penllU:tillg pl:i vi1eges ill the Ci ty of 2',ephydd11s.
<br />C, 'l'RJIHBPOH'l'M' [ON lt1PAC'!' IfE;FJS ,AlID U'l'ILITY CONIIEc.:'I'ION WEEa
<br />D, CONS'1'RlJC'I'III<ll'1 1,1 Ell IJAW (CIIAP'I'ER '/13, Fr,ORI VA ,'3 'l'A'l'lJ'l'ES , AS AHENllIW)
<br />I cert.i fy that 1, the applicanl:, have been IlrolJided 1-/.1 lh a copy of "li'lorJ,da's COllstt'\\rJtlon
<br />1 Jen I,a\l .. lIoltleO\'lI1er's Protection Guide/l prepared by the E'.lorlda Depart:lIIent: of Agr:JOlllLIIU!l
<br />and' Consllltler IIj'falLS. If the appl.lcanl is SOln~one other l:hat the "OI'lIler/l, I c€lrJfy t:llat I
<br />IJave obta,i lied a r.opy of the above descrtbed docllment and promise 111 qood fa.lth \:0 dell. ver
<br />j [', to t.he "o~lJ1et/l prJor t.o COltllflellcelllent.
<br />E:. CON'I'HJ\C'I'OH' S/OWNF.:H' S J\FI!'IDAVl'I'
<br />I <16rt.1.fy Lhal: all. the .1.nfonnaU 011 In Lhis appU.cat.loll Ls accurate and that', <Ill H01:1, \1111
<br />),e done 1n compU,allce \l1.th a1J appl.lnable lavlS rEHJIllating constructloll, zonJllg, and land
<br />devel.opmeml: .
<br />Appl.lrJaLlon :Is hereby made to obt.a111 a permJt to do wode and Jnsta.llat,1.on as lndloated. I
<br />ceJ_i:j fV t:hat. 110 II01:k or installation has (Jomrnenoed prJot: to lsslIance of a pennU'. and Ulat
<br />a].1 wnle H,Il J be performed to llIeet standards of all 1al..,s regulating (JOIlSt..t:uc:tJon, r:\ l:y
<br />codes, z01lJng regulal:iClns, and land development regll.latJons in the Jln.l.sd.1 cl:.i on. I also
<br />cerLlfy ll1al J IIndetsl:alld that: the reglllatJrlllS of other govenllllelll:al agenuJes may apply to
<br />Lhe Jnl:ended vlOrk, and l:hat Jt is my responsibility to ldell!:Jfy \'Ihat ac..:t:.1ons I IIlllsL I:a);e 1:0
<br />be .in cDlllp.llallce. StICh a\Jsllcles Jnc.lllde bllt are not Jim.lted to: *nepart:ment of
<br />mil v j t'01l1ll8n La 1 Hegu.1Cl L1 Oll'-CYPU'SB Bayheads, We tland Areas and E~n vi rOlHlIen ta 1 J Y SellS 1\',,1 ve
<br />j,e\llds, Wa ler/Was l:eIVa Ler 'j',tea tlllent
<br />*BollthYlesl: l!'l.od.da \1atel: Nanagelllent llistr.l.ct-Wells, C:YPli:ess Bayheads, Wetland Areas,
<br />1\ I terJIIg WatercollJ:ses
<br />'1-ltmy CULpa of ITIlIg.llleel:s-BeaHalJ,s, Docks, Navlgable Waterl'/ays
<br />J'I1epartlllenL of Health 6< RehabUJ tat.lve Se1:v.iees, H:nv1rolllnelll:al Health lIIIJt-Wells,
<br />Ivastewat:er '1'reatmsllt, Se}?tJc '['anles
<br />"'IJ, s. H:llv.i LOlllnelltal Protect:i.on Agency-Asbestos abatement:
<br />1 also cerLI fy that, JE fill llIal:er.1.al .Ls to be used ]n IJ'lood Zone "A" Ot' "A,etc.", .l.t .is
<br />Ullderstood Lhat a drainage plan addJ:essillg a "colllpensaLlng vol.\Ime/l Hi.ll be suhmU:t:ed I/Id,ch
<br />Is pl:epaced by a I.JLofess1ollal engJlleer: regIstered 1n the stat.e of E'larlda prlot: t:o penil!.!:
<br />iSS\laIH.Je.
<br />]\ perm] t i sl::llled sha 11 be construed to be a licellse to Pl:oeeeel Hi th the Hork and not as
<br />alll:lIOr1 Ly to vlolaLe, ciilncsl, alter, or set aside any prov1sions of the teohnJcal uodes,
<br />nor shall I SSIJance of a }?ermi.l: prevent the Bll.U,c!Jng Off1c1al from t:heretlfter 1:e'11l11:1ng a
<br />cou:euUon of errors ill plans, construction, or violations of any aode. Every perrnll:
<br />lBBued shall beGums invalId unless the work autho:dzed by suah perml t Js nOllllllenceri I'd lid II
<br />sill mouths ()f lS9\lBnce, or if \'lor\;: authorIzed by Lhe pend,t 1s suspended or abandoned for a
<br />period (J f sbe months a ftet tile tJme the Hork 1s commenced, One 9lJ day S}(\:SIISJoll of t I lite
<br />llIay be a.l.lolled fat: tile permi,t I'l.ith fee chal:ge of $15,00, 'I'he e)(tensiOll shaLl be requested
<br />JII Hr1\:il1g La the BuildJ.ng offic:Lal.An approved .lnspectJon lilUSt be logged dm::lng each sl l[
<br />month pedod, or t.h,e pt'oj ect 1'/i11 be considered abandoned.
<br />W1\R1lJIlG '1'0 OWNlnHI YOUR H'AII,UHE '1'0 HFJCORD A NO'l'ICE OF COMtlIr.NCffiNIl:U'1' HAY HffiSlIJil' 111 YOIlf\
<br />PAYTlW 'l'WICn: 8'01\ U1PROVEMEHTS '1'0 YOUR PROPgf\'l'Y. IIi' YOU IH'I'EIID '1'0 OA'I'lUN jf'JNAHC1W3, COIH31)j,'I'
<br />WITH '{Olin 1,1!:tllll!ll\ OR AN A'l"J'ORIIKY BEIi'ORIr, HffiCORDHIG YOlJn HO'l'ICffi OF COH1'1ffiNCElI1EH'I'. ,lOBI'! llHllffiH
<br />$2, SOO 111 VALlIE DO 1'10'1' NH:ED '1'0 RECOlln AND POS'!' A "NO'l'ICE~ OF COHMIilNCEt'lE:N'jll'.
<br />
<br />~",~).'''.') .!. '.'.'.L Cl,t! 5} () ,~. .t? ~~~~\~ ';~I~n l\YT ~I'~: JJAV,r 'Jl
<br />
<br />,.---------------..-.., .-....--. ~.-.-._----,._-~.-.~---._._-_..._-_.__.~.._._--
<br />
<br />SIGNA'l'llHE:: UWI/ER OR AGEN'I'
<br />
<br />_.~~._~--'----..-._------..._--~ -""-"~..-. ..~._--. - _.' - ....---------..---.. '"
<br />
<br />SI(3NNl'IJRE:: CON'l'RA,C'I'On
<br />
<br />f:l'J'NJ'ffi Off' jj'UlRILlA
<br />
<br />COIIN'!'Y 0 II' .__ .._'.'___.'.h,_.___'_____.._....____,_...
<br />
<br />'I'he forego.1.11g Jnstrlllnelllt vias ackllo~d edged
<br />Befol:e me tide _.._....,_,_ day of"_._'___m_.' l.~_,_...
<br />
<br />by.... ..... ___ _.., __..'..._.....,..._ '..._.........._ .__...____.____..___,_____....
<br />(name of persoll aclmowledged)
<br />[) l'iho is personally knoHll to me, or
<br />
<br />S'l'Nl'E: OF FLORI IJA
<br />
<br />COllN'I'Y OF "'---.., .--...-..-...--.---~...______u_,_..._
<br />
<br />'1'he foregoing Jns l:rl1lnent l'ias ackllo\'lledgeul
<br />Before me tlds ,___flay of-- '--'-.-..----.-.., 19
<br />
<br />by _,_____ ________...___..._'___.....__.........__._...,....__._..."'_
<br />(name of person aoknowledged)
<br />[~ha Js personally ImoHn to me, or-
<br />
<br />[I Hha !tas pl:odllcecl__..._,___...____,_____.....___
<br />(type of JdentJfJeatJ.on)
<br />and who(] dld I]cIJd lIot take an oath.
<br />
<br />[] v/ho bas prodl\c~cl...._.......__...,__..,__...___., ,_,
<br />(type of JdelltlfJCJatlon)
<br />and ~Iho []dJd I.]i.id not take an oal:h
<br />
<br />"."'-'-'---'---'- --- -----._-~--~._.-.._--- .--.--.-..-.-..-----
<br />
<br />___ _ ._u.__..._._________~."._.__,_.____...._.._,.._.______. ____.__...______._.. ._.____.'_.~
<br />
<br />Eli una tlll'e of pel'son tak.ing acknoYlledgement
<br />
<br />,gJgnal:lIl:e of perSOll takJ.ng acklloHledgrnent I
<br />
<br />Hallie typed, printed OJ.' stamped
<br />
<br />-. .-..--.--.........-. "-.. n ~--..,..-~_._-~-___.___..__~___ u_....._. "~"-'----"-.'~--__'___'_'~._n_..
<br />
<br />-.,------..--.-- .__...__._--~._---.... -."--.-.----,.--.--.-~~--.. ..._- ..__.__ _.' ..__u____.. __"__
<br />
<br />Name typed, prJnted or stamped
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