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<br />li"l" 1',,,,, Ji/!;r!,); Hi!;,')'J'Hli;'J'j(li'lS
<br />'J'lld 1l1ldelSl<J1led Illldel:stands that: this pennit Illay be sllbjeut t:o "deed t:esl:L!rJ1:lons" 1'1111cll
<br />'11i:ly'be IIIOJ:e resl:r:JcLJve than City regulations, The unders.lgned aSSUllles respolIsJh.ILi.l:y ['..1':
<br />comp] iance Hi \::h any appLicable deed .restrlcl:iolls,
<br />B, lJIH,ICH:NSE:lI CON'l'HAC'I'OHS AND COl'/TRACTOR RE:BPONSIBIl,I'I'Il!',S
<br />If the Ollllet: has hlr.ed a contr.actor or oontractors to IIndertake I,wrlt, l:hey llIay be reqn:1 red
<br />Lo be .U.censtHl Ju auuordauce \-d.l:1J state aud local regulatJolls. If t.he c:ontrantor .1.6 nol:
<br />lJoensed as reqlllJ::'e<l by laH, both the o\-mer alld contractor Inay be (dted for a lid sdemeano!:
<br />vil)lal.:iol,l IIqdcq: 5tate laH. If the Ol,mer or lntencled oOlltractor are llllcerta:l.n as tc> Hha!:
<br />I lusnsJ II\Jt'el}u1.1elllellts Illay apply for the intended Iwrk, they are advised to CJontac:t the
<br />I:Jl:y of Zepllyr:ld lIs Bul.ldlng Department, 013-766'-6611.
<br />F'ur'Lherll101.:e, 1 f the O\'llIer has h.i.red a contractor or contractors, he 1.s advl.sed to have t.he
<br />cOlltraotor (s) sign. portions of the "Contractor Sections" of thl.s appU.oation tor \'lh.1oh they
<br />VILli be J:E:lspollsihle, If you, as the m-mer signs as the oontractor, you are ind!.oati.ng that-.
<br />YOIl, !:al:hel: than the contractor, are responsible for the work. If the contrElClI.:or W.\ shes
<br />YOIl 1:0 s.l gl! as 110lltractot that may be an inoJ.oat1.on that he 113 nol: pJ;operly l.icBllsed and 1 III
<br />1101: ell!:! l:led l:o penllit:tillg p17ivileges ill the City of Z,ephyrhi.lls.
<br />c. '1'R/IN8 l'OH'l'Nl' [ON U1PAC'l' FEES AND U'l'ILITY CONHEC'L'ION B'EES
<br />ll. COHS'l'RlJC'I'1I10N LIEN LAW (CHAPTER '713, H'I,ORltJA S'l'A'l'U'I'ES, AS ANENllED)
<br />I cel:tj ty that I, the app.U.cant, have been provided Hith a copy of "II'lor.1.<la's ConstrllcU.ol\
<br />1 ten 1.all 'n lJomecl\.mer'llI Protection Guide" prepared by the E'lc>rida Department: of Agr:lclllt:.\lre
<br />and Consumer lltfalL'S, If the applJcant is sc>meone other that the "Ol,met", I net::\.fy that I
<br />lla\fe obtedned oj oopy of the above desaribed aomullen\: and promise in g(wd faith to deU.ver
<br />it to the "owlleJ::-1f pr.1.or to COllunencelllen t.
<br />E:. CON'I'H1\C'i'OH' S/OWNH:r\' S AFI!'IDAVl'I'
<br />T nertif.y thai: all the informaUon in thls application :La accurate and thai: all Horl. HJll
<br />be dOlle In compJ:l.allce \-11th all applioable laws reglllatlng oonstrllOtion, zon.1.ng, a III I lEwd
<br />development,
<br />J\pvU.oaUoll is hereby made to obtajn a permit to do work and lnstallatton as indioated, I
<br />cerU fV thaI: no v/Ork or .lnstal1ation has CJomrnenoed pr.t.o.r. to issnslIClB of a penn.U' and thOlt
<br />a].l wnk \'IU I be performed to lIleet standards of all laws regulatlng oonsl:J:llCltloll, CI ty
<br />elodes. zoning regllllll:Jons, and land oevelQpmentreglllat.1.ons 1n the jll.t.1.sd.1.ctjol'l, I also
<br />certify that! understand thaI: the J:eglllatJons of other governll\ental agenoies lIIay appl y t:o
<br />the Jntellded vlOJ:k, and that 1t is my responsibillty to ideIlt.L.fy \-Ihat actJons .I IIIllst t:aJce l:o
<br />be in cOIup.U.anoe. SlIch agencies i.nc1l1de but are not limited to I *neparl:ment of
<br />H:llvlronlllen!;al negulal:!oJ\-Cypreaa Bayheads, Wetland A1:ea8 and Envi.ronmentally Sensll:.1.ve
<br />I,ands, WClLel'/Wastewal:er 'l'reatlllent
<br />'~S()uthHe.sl; l!'l.orida Water Management lJistr.ict-Wells, Cypreaa Bayheads, Wetland Areas,
<br />J\lt:ed_llg Watercourses
<br />*ArlllY Corps of ElIgJueelJ:s-BeaHalls, Doolts, NaVigable Waterways
<br />....)lepar:l:.llIen I; of Ileal th & RehabU.l ta t1 VB Se.rvices, a;nvironmell L:al Ileal th lhd. t-Wells,
<br />Wast.eHater: '1'.r.eatmellt, Septic 'l'allkll
<br />.. U , S. 1!:lIvJ r:omnental Protection Agency-ASbestos aba tement: _
<br />I also cer:I:Lf.y \:hal:, if f.1..lllllater1al:l.s to be used 1n I!'.lood Zone "A" or "A,ato,", :\.t Js
<br />understood that a drainage plan addressing a "eJOlllpensat.tng vo.1.IHne" wtll be suhmi.\:ted \'IhJGh
<br />is pl:ep~ r:ed hy a !ll'ofessiollal eng.l.nee.t. J::'eg.isterttd in the state of 1!'.1.orlda prlor 1:0 perllll.l:
<br />lsslIanue,
<br />A peUII1t jsslled shall he COilS trued to be a license to proceed with the work and not as
<br />authorl Ly to vlo1.ate, oancJel, alter, or set aside any provisions of t.he teohnlca1. nodes,
<br />nor shall issuance of a permU: prevent: the Bu.U.dJng OffJcial from there&fter reqllJr.1.ng a
<br />con:eul;Joll of el'rOrs i.n plans, nonstrucl:ion, or violations of any code. Every perm.i.\:
<br />isslIed ahal], bElDome invalJd unless the work author:ized by such pernd.\: 18 oOllllnenced wi tld II
<br />a.i.ll lllC>lllhs ()f 18sualloe, or. If HCll:k authorJzed hy Lhe permlt is suspended or aballdolled fot: a
<br />pedod of. Sll. mouths after the \:j,l1Ie the work 1s commenced, One 90 day elcl:ellsloll of t.i1ne
<br />may he allo\Jed for. the permit \-lith fa!, chal:ge of $15.00. 'l'he el(tens.li1\l shaLl be r.eqllesl:ec\
<br />III \niU.llg to the fill11ding OfficJial. An appr.oved inspection mllst: be logged our:l ng each !:IIH
<br />month per.1.od. or the project \011.1.1 be consi.der.ed aballdoned.
<br />WJ\RllJllG 'I'() UWl,/IUHIYOlJR H'AU,unm '1'0 HJiJCORD A NO'l'ICE Off' COM~1ENCI!1MEan' MAY HmSlJlil' 111 YOIIR
<br />L>1\YHH; TWICE If OR IMPROVEI1ElN'I'S '1'0 YOUR E'HOPfm'l'Y. IE' YOII IWl'EHD '1'0 OB'l'/UN FINAIWIHl3, CONSlllil'
<br />Wl'l'l! YOIIR 1,I1:IIDEm UH AN A'l"l'()RHP~Y BEll'OR!!.: RECORDING YOUR NO'l'ICE Off COMMENCH:MEN'J'. ,roBE! 1JHPfr.H
<br />$.2,50011'1 VALllH: DO 1'10'1' NH:EIJ /1'0 RECO!U) Al'W 1'08'1' A "NOnCE: OF COMMENCEMEN'l'".
<br />
<br />,t,lj
<br />
<br />,..----- --____~.__. '_4..__ .._...._.__..___..__..~.~_~_______.._.__.___
<br />
<br />B 1. GNA'l'U HE: I OWNER UR A13EtI'f
<br />
<br />c~~~ '.
<br />
<br />~~--_._._,_...- .-.--...........-..---.-----.-...,......--.-
<br />
<br />SICmA'l'IJRilll CON'l'RA.C'l'On
<br />
<br />S'J'l\'l'E Ub" 1!'],clRlUA
<br />COIIN'J'Y OE' .__'_,_____._____
<br />'J'he forego.t1l9 i.nstrlllllellt \'16S acklloH.l.edged
<br />Betol:e me tlds _'_'_'___,_ day of ....__.____._, l~_
<br />
<br />by _.,,____ ...____._.__.__._._.__________.
<br />.' .' (nallle of !lerson at.ilmoWledged)
<br />ITHho is'J)ells.onally knoHo 1:0 lIIe, or
<br />
<br />[] who ilas p roduoed_________..__
<br />(type of identification)
<br />awl wholJdJd fJdJd lIot take an oath.
<br />
<br />R'rA'1'E: OF Il'l.ORIIJA
<br />COUN',['Y Db" _P ~~EE....____.__.___.__.._,____
<br />'l'he foregoing :1.11strl\lnent was aololo\-lledCJtld '
<br />Bafore lIle thls ~.-"lay of.-Sep:t...---,_,~_?_~02
<br />by ..-Hina. Whitworth __ '___..__._____.
<br />(name of person aoknowledged)
<br />Uho 1s peraonally Imown to lIle, or
<br />
<br />o ",ho has Pr.oduo"c1___._.___.__._._.._._.
<br />(type of lelell tLE1.clii L.I,clTl)
<br />and Hho Odid ~id not talte an oath
<br />
<br />~_._---,._---_.---_..._._._...._------_._--_._--
<br />
<br />Siynature of person takl11g acknowledgement
<br />
<br />---.-------.-.--------.------.-------.--
<br />
<br />Slgnature of persoll taklng acknmd.edglllent j
<br />
<br />-~'_..-".. -....---.-.-......---- .~~ ..__.~._-~._-_._.~_..__._-_.._--_.._-_._...
<br />Hallie typed, pd,llted OJ:' stamped
<br />
<br />-,..._--_.._--._-~-------_. ..----..--.-. -------~._---.._...
<br />
<br />Name typed, prJ;I1ted or el:alllped
<br />
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