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<br />No.3065
<br />
<br />P. I/'
<br />
<br />. .24. 2003 4:01PM CITY OF ZEPHYRHILLSHS or pm~IT A~'I~VlT
<br />J a.~~ u_.......""'.J..,., "'.11I0 a~t:r"""l\,;'l'J.tmtt
<br />~he underslqnedunderstand. th~t this p~~qdt ..y b. aubl~at to -d.ed rescrictions" which
<br />. may b. more ~...trtctiv. than City regulat10ns. The unde~.igned ...ume. re.ponaibll1ty for
<br />o~mpl1ang. with .nv .p~licable deed reetrlotlon..
<br />a. ~NLIC8Na.D bONTaAcToR! AWD CONTRACTOR R8SPQHSIBILITIES
<br />If the owner hila hiJ:ec;t a QontUPtor 011 contractor.. to undertake WOtl<, they malt ba requir.d
<br />to 1;1. licenalld 11\ aocordance with IItsl:" I!lnd local regulati<me. II tne ~ontraator i. not;
<br />liceneed .. cequired by law, both the OWner and oontr.otar may ~e o1ted f~ . mt.d....uQr
<br />violation un~.r atat. law. It the owner or intendec;t contraotoe are uncertain as to what
<br />li clilnain9 J:equh_nta IllllY apply for the intended "Qrlc, they ;u;e .dviaad. to OQIltUt &lh_
<br />City of &.phy~h111. Building D~p.rt~nt, 81)-788-8611. . .
<br />F"rth.~~e, it the ownec h.. ~ir.d a eont~.cto~ or oontraotora, he 1. advla.4 to bave Ebe
<br />c02ltJ"actor{,1 .tgn porUona ot tbe "Contractor ".ctionl" of tni, appU.oation tor WhiGb tbell
<br />will be reapondbl.. If YOu,. alii. tho own.c ligna ~a the lKlDtractor;1 YQl,I .~. lnl11oatia9 that
<br />you, rather thaD the oontractor, are re~on.ible for the work. If th. OQntractor wieb..
<br />you ~o algn .a contraetoe th.t ~~.bc an indi~tign that he i. not prQp.~ly 110enleQ and ia
<br />not entitled to p.~tting privl1eg.~ 1n the City of Zapbyrhilla.
<br />c. 'l'MNlll'ORTA'l'ION IHPAlf'l' flU AND UTILITY OOWtf~CTION '11\8
<br />D. ClQtf~'lRUCl'l'tJIOIt LIIlH LNf (CHAP'1'BR 713, rLoRIM S'fA'1'U'1'mS, AS ~DICDI
<br />1 CMlrtify that I, lb. applic.ant, have be.q prQv1dlSd witb a lKlPY Df "rJ,oria.'. Conatruction
<br />lien Law - Homeowner'. Protection Guide" prepa..d by the 'lor!d& DepartmeQt at Agriculture
<br />anq conaunec Affaira, It tho epplic@nt ~. .~Qn. qtho~ t~t tbe nown.r~, l ca~ity taat I
<br />bave obtAln.g A copy of the abovo a..cribed aocument and prami.. 1n good faith to d.li~
<br />it to tbe "ownar" prioc to ~ncement.
<br />S, COH'l'RAC'I'OR' a/OWltICR', Al'lInAVIT
<br />I ~artity tbat all the into~tion in this .application i. .~cueat. and that all Noek will
<br />be done in compliance with all applioable lawe regulating conatruction, ~onll1g, and land
<br />dev,lopmellt.
<br />Appl1"IlUcn 1.1 berabr ..d. to obtain a p.rmJt to do wock and ~".t:all.t.1cm aa 1ntUgatl~. I
<br />ce+t1fy that no work or in.tall.tion ha. D~no.d prior to ta.ullnce of . p.~t and that
<br />all work will be performed to meet atllnder41 of all law. regUlating construotion, City
<br />cod.., zoning cegulatlona, and land d.velo~nt regulation. in the 1urtadiatlon. I .100
<br />certify thAt I UDderstand that th, regUlation. of 9th.r goverQmant.l .~enoi.. may apply to
<br />the inten4ed work, ana that 1~ 1a ~~ r..poA8ibillt~ to id~t1ty what aat10ne I ~.t taka,to
<br />b. in PQ~li.anoe. lSudh agtlllllJi.a ino1L1de but ace not lUntted to I *O.partIMnt of
<br />&nviron~ntal RegulatlQ~-Cypre.e Ba,baad., W~~land Ar.a. and InV1rQnmant.ll~ Sen~t~y.
<br />Lando, Wator/N.at.wacer Treat-.nt
<br />*Gouthw..t r~ori~ Water HAnav..-nt Diatrict-Wal1a, 'ayp~..a Bayh.ad~ Wetland A~...,
<br />AJter1nq Wate~oour.&.
<br />.Army Cprpa of Bn~in&e~.-8..wall., Docke, N.vigabl~ Wateeways
<br />*Veparl:mant Qt B.altb , Rehabilitative Services, Bnvi~gnment.l Healtb Unit-Wella,
<br />"..towater Tre.~MOn~, Septic T.n~a
<br />*U.8. &nvironmsntal .~Qt.ction AgenaY-Aab..toe abat...nt
<br />I alao c.rtify that, it till material ia to b~ u..d in Flood zone ~AH or UA,etQ.., it i.
<br />under.tood that a dcaln&ge plan addreaaing a "compen..ting vol~N/will b. aUbmitted wb1ab
<br />i. peepared by a prof...ionAl snqlne~r'r.gi.tere~ 1n t~~ State of florid. prior to p.~t
<br />ieauano., .
<br />A p.~mit i~.u.. .nal1 be QQD.truad tp be a lie.n.e to prooaed with the work and nat ..
<br />autllocity to violat., oanael, alter, or aet aaide any provlliooa ot th* tochDLQal ao~e"
<br />nor _h.ll i.ouanee of a permit prevent the luLlding Ottici.1 fr~ ther..tt.r r~rlBg a
<br />OQIC,:ectiAll of .uon in plan., "on~~DloUOI}, Dr viaA.~j;!Dna At any aode. "ve~y PW:lI1t
<br />1e'~.d ~ha~l become invalid unl... the work .~tbo.i~.~ by aucb pe~t ia ~noed within
<br />lix IIIOnth. of ie.u"nce, or it work .utbodalld by the perJDit hi .ueponded Dr abandoqf!d ~,r a
<br />p.dod of oix IIlQntha anal' tile 1:1._ the HOlCk 111 ~raci. One 90 day o"talUlicm at ti.
<br />m.y b. allowed tor the perudt with f.. oha1C9. of f15.00. ~he extenaion _hall be ~e~~ed
<br />1h ~ritin9 to ~he Buil~lQQ Offioial. An .ppraveq in.pootion mu.t be logged durt~Q .ach ai.
<br />IIlQnth period, or the pr~j.ot wl11 be con.iei_rod abandoned.
<br />IiARHING '1'0 OWHIIRI YOUR t'AILURli 'fO RlICOBb A HQTlCa 0' CQHNINC~ MAY RUUJJ1' III YOUR.
<br />JAYlMli TWIOa FOR IMIlROVlNlilf'rll '1'0 YOUR I'ROII'&RTY. U' you IHTlIHD 1'0 tlIt'tAtH rlHAMqUIQ. ~IPL"
<br />lITH YOUll LEWPIJI OR AN A'M'ORHI!;Y 8UEllU'! RJICORDING YOUR Ho'1'ICII: or COlICNCIMIDrf. JoN tnlDIll
<br />'~,500 IN VALUB 1>0 NOT NQQ T() RftOORD AND l'08T A '"NOTICE or COMMIIICllaafTu.
<br />
<br />. IL~~
<br />
<br />S IGNATUtUt I CONTRACTOR
<br />
<br />91GNATtJlUh
<br />
<br />OWN aa OR Al31lN'l'
<br />
<br />lITATI Qr 'LORI~
<br />COUNTY or
<br />The foregoing in.tru.ent was aCknOWledQad
<br />a.fore .., thill _ day of , 1!L-
<br />by' .
<br />(na_ of penon ..q<ltfl.dg..d)'
<br />Dwho h per.onally known t~ _, or
<br />
<br />Q who h.. produced
<br />(typ. of id.ntiti~ation)
<br />I!lnu whoD d1c;t Odia not tab an oath.
<br />
<br />8'fA'J'!l 01' I'LORI~ dJ ' II~ horc t
<br />couwry OF I ~ '
<br />Th. foreg01og i~nt w~. ~Wl.dg~
<br />:;tora~. i~: I ~()/~ b~ \'\'. ~.ao3
<br />
<br />'lJ {na_ ot par.on aQkD_lq~l
<br />~~ ie pe~.onally knQNn to me, or
<br />
<br />o Who h.a produc:ed
<br />'type of id.ntltlqA~~onl
<br />and n [ldid ~Q: tAke ~n tllieh
<br />
<br />~ ~{A)J:> V. . (1 ^ 11. ~ .
<br />s{ n.t:ure ot .per.on t,~killg .DkD01fl.dcr-nt
<br />
<br />S1gnature ot peraon ;.~iDg lIoknowledg..-nt
<br />
<br />
<br />~ad, printed or .t.~ed
<br />
<br />Name typed, pr1nted~Qr .t.~~..4~a~..-~r.r~~
<br />
<br />,,'"'" DENISE C. lEAJtJE
<br />COMMISSION , DD06737I
<br />I'IIIJC 'EXPIRES OCT 2A 2005
<br />,- 0"1 IiIONDED 1HIIOUQH
<br />. . RU ~ COIINH'f
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<br />,'to , .'
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