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<br />~.,u.r).p).'.'_I_".L().r{s O? PE~n1'.1I'T nfTF'IDA_Vltr
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<br />1\. 1I0'l'lCE OW DH:H:n HES'l'IUC'I'IOI'IS
<br />'rile UlIdel:s.lgned l\lIdel:stallds that: Lh ~l ped:mJ:: iliaI' b., El1lb.leut to "deed l:f:lstl:.lotlolls" Hhlell
<br />'lIlC1Y h,e 1I10J:e resl:1.1ctJve than City n:OUlllaLiolls. 'Ihe ulldellsluned assumes respollsib.11Jty Eor
<br />compl tanee Id th allY applicable deEd n,,'3 t-1Jc,:ioll:3.
<br />B. 1JI.II.ICHiNBH:ll COl'I'l'llACTOHS AND CON'I'H1\I:'I'nn RlllSPI)!lS BIJ,l'I'TF.:.s
<br />If the 011111::1.' has hlr.ed a uontl:actcr 'n: ,:ont.:actots to lllldertake 1-I01:k, l~hey n\ay be requ:lred
<br />to be 1.lc8nsed 111 accordance vTJth Ht:ale and locnl J:egulat.lons. If the contl:6ut:or Is Il(]t
<br />) .Iuensecl as re'plirecl by laH, both U,e Ol-lner' and l~ontlClctoL- may be o:lted for a 1111 sdemeanor
<br />lriulat.inll under state lOlli, If the ol-mer or intended Clolll:racl:or are 1\I\r:et.taln as to Hha!:
<br />I j',ensj ny reljld.rE:lne!lts llIay applyfol llle intended Iwrk, they are adv.! sed to contact the
<br />City of ZephytlLll.1s BIIJ1.dl.ng Department, fl13-'lflfl'6611.
<br />J!'IJ1.L!ISUlJ(Jl:e, If the O\-llle1. has hi.J:ecl a contLactOJ: or cont.raot:ors, he Js adv.ised to have the
<br />oontractor (13) s.ign port.ions of l:he "Conl:ract:or Sections" of thJs appl.ioatJon .for \1hl eh they
<br />tiLl I be l:espolls.ible. If YOII, as the OHnet s.lgns i'lS I:he contr'act.or, you are tndJnating that
<br />YOII, rather than the conl:1:actor, al:e responsible for the Hork. I f the cJontnwl.:ol- t-I.I shes
<br />Yntl 1:0 s.lyn as 001lt):'acto1: that !nay be an lncl1cat1on L:hat he J8 not: p.l:operly Licensed and Is
<br />l10t E:lItJ l:.led to penlJll:tJng privileges in the City of Zephyddlls.
<br />c. 'I'Rl\IHIP<)H'I'A'l' [ON 1.HPACT FEE:SAllD U'l'I LITY CONIIEC'I'ION F.'EiES
<br />D. COIIB'l'RIIC'I'lI1.l)\ol] ,1 Ell IJAW (CHAP']' EH '/13, FI.OR1 [)A S'l'A'l'IJ'I'E.'3, AI3 ABEND!!:D)
<br />I cect::l fV that I, l:he applicant, have bean provided H.iL:h a copy of "li'lor:l.da's COllstl'\lCtJon
<br />1 j 1::11 J.aH lIollleot-mer's Protection Guide" prepared by the E'.lorida Department of Agr:iclIl.tllre
<br />and Consllmer 1I1'(:aJJ.'S. If the app.llcant is someone other. that. l:he "oHner", I carlfy that I
<br />haVE! ol>taj ned a copy of the above descrlbed document: and promise in good fa.Lth to deliver
<br />j t to t.he "0.\'1IIer" pr.tor to COlllrnencelllellt:,
<br />}!:, COH'I'IU\C'l'OH' S!OWNF.:f\' S AFll'IDAVl'l'
<br />I nBl:U.fy thai: aLl. Ute lnfotlnat:jon in tills applJcatJoll Is
<br />l)e clone .l.n compJlallce 1'11th all applicable lavls r:eglll.aU.ng
<br />development.
<br />Appl.l.caU on ls hereby made to obtain a permit to do work and Jlista.llatJoll as 1.lIdioated, I
<br />cerLi f\, that 110 Hode or .lnstal.latlol1 has conunenced p1:101: to l.sSlIanCB of a pennlt: and that
<br />a]] vlOrk \'111 1 be perf.ormed to JllBet al:andarda of all lah's regulat.ing uonstnlOUOl1, C:l ty
<br />codes, zonJng regulat10ns, and land development reglllatlons .ill the JIILl-sdJotJ on. 1. also
<br />ceLl:I ty LllaL: I undersl:and that: the regulations of other goveUlI1I8nt:al agencdes Hlay apply \:0
<br />Lhe Jllt:ended vlork, and L:hat it 1s my ):'esponsibil.i.ty to JdenUfy l'lhal: aut.ions I IIlllst Lake 1:0
<br />be in compll.ance. Sitch aue!lctes Jnclude but are !lot: 11m.\. ted to: "'Department: of
<br />F.:nvi rOlll1l8nta 1 Regula !:iOI\'-Cypl:eS.9 Bavheads, Wetland Al:eas and n:nvirolHnental.1 y SensU'.Jlfe
<br />I.<lllds, WaLer-;Wastet~al:er 'l'.reatmellt
<br />'Southwest: J!')otida \vatE:l: Nanagemelll: llistr.1 ct-We.Lls, cyplress Bayheads, WeLl.and l\reas,
<br />AlterIng WatercoIll:ses
<br />"1-II:IllY C:orpe of mllg.l IlBel:s-BeaHalls, Docks, Navigable WaterNa\'S
<br />*IJepal.L1nenL of Heal th & RehabUJ tal:lve Senrices, H:nvJ.rolllllBIII:a1 Health lInlt'-Wel.ls,
<br />WasteHaL:er ']'l:eatment, Sepl:!.c '1'anks
<br />"II, S, l!:lIvJ LOlllnental Protec:t:J.on Agenoy-Asbestos abatement:
<br />T also ce1.LI fy that( .i.f fl!.1 lIIal:erl.al :l.s to be used .In li'lood ZonB "A" or' "A,eto.", it .is
<br />lIlHlersl:ood that a drai.llage plan addressing a "cultlpensaLtng volllme" 1-11.11 be SUbmitted \'11d.ch
<br />109 pn;pa t'ed by a (Jrofesslona.L engln661. reg.i.stered in the State of E'.Iod.da pr!.ot \:0 pennll:
<br />Jssllanue,
<br />1\ perm] t .I sSlled sha 11 be construed to IJe a license to pJ:oceed Hi th the Hark and not. as
<br />aUl:hor-j Ly to vIolate, canGel., aiter, or set asl.de any provisions of the l:e0l1ll1.ca1. IlOdf.ls,
<br />nOl: shall i SSlIance of a perrnU: prevent the BIIJlcUng ()ff.i.oial from therstlfter requJrlng a
<br />con:euLion of eU:OrB in plans, construction, or violations of any aode, Every petmi.t
<br />leBlled shall beDome invalid unless the work authorized by suoh permit is r:OllIlHencer! H1Ud n
<br />silt lIlol1ths ()f iss1l8llCe, or. if Iwrk authorized by Lhe perm!.t .1.s suspended or abandoned for a
<br />pedod uf aJ}{ months after the \:1.me the Hork.is commenced, One 90 day ex\:ensJoll of tIme
<br />lIIay be allolled for tlie IJennit I~.ith fee chal:ge of $15. IJO. '['he s}{tens1oll shaLl be requested
<br />III tniting 1.0 the I3l1iJdl.ng Official. An appr.oved .1nspecU.on mils\: be logged duelng each sll[
<br />lI10nth period, (ll. the project td.ll be considered abandoned.
<br />WARllJllG '1'0 lWmElHI YOUR ll'AII.llHffi '1'0 RlilCORD A NOTIe!!', OF COMI'1Ir.NCffiHElU'I' H1\Y HHiSIlJ,'J' JlI YOUR
<br />t'1\YTI'f(. TWICE 1mB H1PROVEI1EN'I'S TO YOUR PHOI?Jilfl'I'Y. IE' YOU II', '1'0 OA'l'AHI If'JNAI/CIIH3, CUlISIII,'j'
<br />WI']'}! YOU ,H:IIIlF.:R l!H AU A'l"l'ORHF.:Y BEIi'ORIl', RECOHDlIlG YOUH I, 'Ie: I OF COMt1E:NCH:NEH'I' ,fOBS IJNPFr.R
<br />.2,5"" ,. VA],"" ") 'I.,,:on "'n R"COHn AN/! pns'I' A "N()'~' .'7..'''':'''''''
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<br />--~ ----.--.-- --. - ------- -.. . ----------.
<br />S I GHA'l'[J HE:: Cl IN'l'R1\C'I'On
<br />
<br />
<br />
<br />(IR AGENT
<br />
<br />B']'l\']'E: Uff' E'l.ClRIIlA
<br />
<br />CU1JIl'J'Y OE' ______._____..________________.___.____.___
<br />
<br />'l'lIe forego.ing illstrlllnelll: Vias ackllo~11 edged
<br />Be tOLe me l:Id s '_"___._ day of _.____________, I. ~___
<br />
<br />by ____. ...__ _... ___.. __ _ _._._.._._... __._______.___.______..____. _____
<br />
<br />(name of persoll acknowledged)
<br />[] \~lIo is personally kIlOHI1 to me, or
<br />
<br />[I HllO ha 13 produced ____.____________.__._.....___
<br />(type of identJ.fleatlolll
<br />and WIIO[) dJd [Jclld !lot take an oath.
<br />
<br />,.- ..~...-.._._--- --.- .--.'-----.---.---.- ~-~____'._.'__.._m____.
<br />
<br />S1 gllature of pet'son takJ.llg acklloviledgelllsnt
<br />
<br />. ." ---'.---.'--..'-"- --- ..- .__4._._..______~__.______. .'_0'. .,_ . ___.____".~.___,,_.
<br />
<br />lIa1ll6 typed, pl:1 ld:ed OJ: stamped
<br />
<br />accurate alld that: aU Hode ill]]
<br />cOIlst.rllctlnn, zonIng, alld Iflllcl
<br />
<br />
<br />
<br />f3'l'A'I'fi: OF ITJ,ORJ \)A
<br />
<br />CO! J WI' Y 0 b~ -------_ _.__.__.___ _.____.._____ _._n_.____
<br />
<br />']'he fOlegoJ.ng Il1sl:rllll\enl: \'1E1S aclOlol-lledgsd
<br />Before lIIe t1ds _____JiEly of----.------.---._, 19
<br />
<br />by _.____. ____._______ __________....___________..________ .___
<br />(name of person aoknowledged)
<br />[Jlho .is personally known to me, 01:
<br />
<br />I] vi h 0 has prod II e i;ld _.____. ___._____ ______
<br />(type of JdellLJfJCJiilUOII)
<br />and vJllo []dld [IUd nol~ l:ake an oath
<br />
<br />--'-,...-.-.--.-------.--....-.~-.-.-.--.---.-,.----___'"_ ~.._u..__.____ ...._. __...___.~
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<br />SJ.gnal:ur'e of person talc L.llY ackllollledgment I
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<br />--.----..--..--..--...--..--.--.--_.,.__ ... ___u.__~____~..._.__...~__.. ,,___~_._ ..__.___.._______.
<br />
<br />Hame typed, printed or sl:amped
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