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<br />". II,)) Il.ll, \)l! lJ/~;H;JJ HJi:S'l'HlC'I'jOI'IS
<br />'1'116 lI11ders.l Ylled IlndeJ:stands that: t.his permit Illay be slIbjeut to "deed res I:]:! ntl <lns" \of/Il.ch
<br />IiIClY be IiIDJ:e J:esl:rJc\;Jve than CJ.tYt'eg111atiolls. 'J'he unders.l gned assumes respolls.1.bJ ru:y ['o!.
<br />cOlllpl lance Id tll any appl.icable deed l:estr\.cL:j,ona.
<br />B, llNJ,](;H:NSl!:ll (;ON'l'H1\C'l'OHS AND COI'/'1'HAC'l'OR RESPUNSIBIl,I'l'IEiF.l
<br />If tile DlmeJ: lias IIIr.ed a cOlltr.actoJ.: OJ.: contractot's to undertake I,wrk, l:lIey llIay be reCJll:l red
<br />to be IJct:msEld JII auuordallo8 vl1tll state and local J:egulatJolls. If t.he contractor.ls nol:
<br />1.I,oellsed as J.:ecJlIl.t'ed by .la~/, both tile ol.mer and contracl:or may be oJ. led for a lid ademeanor
<br />violation Hudel: state laH. If the o'o[ner or lntended contractor ar:e IIllGerta:l.n as tc> Hila!:
<br />I :l.c:ellsJ Ilyrecpd.tewent's way apply for the int.ended Iwrk, they are advised to oontact the
<br />CJt:y of Zephyr:ld lIs Bul.ldlng Department, 013-rI66~'6611.
<br />!i'urLhElrllloJ.:El, if the OHller has hlred a contractor or contraators, he 1s advisllld to have the
<br />cOlltractor (s) sJgn portions of the "Contractor Sections" of tlds app,lj,aat10n tor vlh.ich they
<br />HUl be I:tlsponsible, If you, as the m.mer signs as the oontractor, you are indicaU,ng thar_
<br />you, l:al:her than the contractor, are responsible for the work. If the contrilClI.:or vl,I8hes
<br />you to s.1 \:Ill as cOlltractor that may be an indJ.cat1on that he 1s not: p1;operly 11cElIISed and 1 s
<br />lIol: F.II1l:Jl:led to peulIU:ting privileges 1n the City of 2,ephyrhi.lls.
<br />C. 'l'RJ\HSJ:>OH'l'lI.'l'TON IHPAC'l' FEES AND U'l'ILITY COHHEC'I'ION Jj'EES
<br />n. COHS'I'RllC'l'llJON LIEN LAW ICIIAP'l'ER '713, Ii'IIORIUA S'l'A'l'U'l'ES, AS AHENllED)
<br />I certj ty that: I, the appli.callt, have been provided \-lith a copy of "Il'lod,da' oS Constructj,oll
<br />1 Jen l.all .. lIollleo\mer's Protection Gu1de" prepared by the B'lorida Depa,I7tlllent of Agr..l.ClIl,l:.la'e
<br />and ConsulI\er. 1\1:1:a11'8. If the appllcant is someone other that the "ovUler", I nacl.fy that 1
<br />Ilave obtaJned a oopy of the above desar1bed aomunent: and promise 11'1 good faith to del.iver
<br />i.t to t.he "owner" pr.l.or to conunencelllent.
<br />E:. CON'I'IlJ\C'I'OHI S/OWNIHl' S 1\F/!'IDAVl'i'
<br />J oert.ify thaI: all the information in thls applinatJ.on:l.a accurate and thaI: all Hork l'I.l:\.l
<br />be dOlle .\.11 compl:l.allce I..,Uh all appllaab.le laws reglllatJllg aonatruot:l.on, 2\on1ng, and land
<br />developmenl: .
<br />ApplloaL.lolI ts hereby made to obtaJn a permit to do wode and lnstal.1.atj,oH as llldloated. I
<br />cerU f\, thaI: no work or .lnstal.latioll has aommenoed prJo.17 to issllallCJe of a perlllll'. and thaI:
<br />all vlor!c \111 I be performed to lIleet sl:andar.ds of all laws regUlating oonstulCtiolll Cl ty
<br />codes, zonJng regulal:lons, and land development -regl\lations 1.n the jtlr:.1.scUctjon. I also
<br />cert! fy tltal:I undersl:and that the J:eglllatJons of other govet:mllen~al agene1es may apply to
<br />the Jll\:endecl I-unk, and that 1t is my responsibility to ldentlfy \'Ihat: autJons I IIIUst take t:o
<br />be in COIllp.U,C\noe. SlIoh agencies include bllt are 1I0t limi.ted to I *Department: of
<br />1l:I\v!. rOlllllen \:a 1 Hegula t!.on-CYP1:esl3 Bayheads, Wetland AJ:eas and Jr.nvJ.ronmental.1 y Sensl U, Va
<br />I,Clnds, WCl tar/Was tewa I:er 'l'rea tment
<br />'AS~)lIthHesl; l!'I,oJ:1da Water Management U1strlct-Wells, Cypress Bayheads, Wetland Areas,
<br />l\lted,lIg WatercOlll:sel3
<br />~l~l:llIY Corps of EllIgjlleelJ:s-BeaHalls, fJocksl Navi.gable Waterways
<br />"'IJepar:tlllenL of lIeall:h & RehabLIJta\:lve Services, n:nvlronlllental Health Unit-Wells,
<br />Wast.ewater. '1'J:eatm6I1tl Sept.lc 'ranks
<br />"'11,.':3, E:llvJ tOl'llnental I?roleCJtioll Agency-ASbestos abatement
<br />1 al fiO (lEl t,l;.l fy tha t., 1 f fLU mater1al J8 to be used 1n Inood Zone "A" or "A, ate. ", :l t j s
<br />1l11(lersl;ood Lhat a dralnage plan addreSSing a "GolllpensaLlng volllme" vltll be submttted \'Ih1GII
<br />ls p);ep~ red by a professional eng:\.lIeel: reg.1.stered in the State of f!'lod,da prj,Ot' 1:0 pet:/llLt:
<br />.issllalloe.
<br />1\ peuuJt jsslled shall be CallS trued to be a li.cellse to proceed Hith the work and not as
<br />authorjLy to vJ.olate, cancel, alter, or set: aside any provisions of the teohllJoal nodes,
<br />nor shall isslIallce of a perrotl: prevent: the BuJlcUng Offloial from thereafter reqlllr:tllg a
<br />con:eoUoH of errors i.n plans, construotion, or violations of any code. IIlverv perm!.t
<br />isslIed shall baoome invali.d unless the work authorized by such permit 1s COllllllenaed wJl:ld n
<br />fli)l IIl'HlLhs of iSSlIl:lllOe, or. Jf Hork authorJzed by the permJt J.8 s\lspended or aballdolledf.o!: a
<br />pedod of sb, mOllths after the tll1le the work is commenced. One 90 day elctensioll of tl1l1e
<br />lIIay be allo\-led for. Llle permi.t \1ith fep charge of $15.00. 'l'he e1ttens.ton shaLl be .requested
<br />In \/1.'1 t:illg Lo the BlllldJ,ng Offic:ial. An appr.oved inspection IUust: be logged dud ng each f:l.ll'
<br />month ped.od, or: the project \..,1.11 be cOllsi,dered abandolled.
<br />Wl\RIHIW '1'0 OWl/mHI YOUR ll'AlJ.UHE '1'0 RfiJCORD A NO'l'ICH: Of!' COMHIr.NCIr.Mlla~'1' MAY HffiSmil' TN YO(J!\
<br />1:'1\l'HI13 'l'WICIi: lI'OIl IMI?ROVEHEN'1'S '1'0 YOUR PHOPgR'l'Y. IE' YOU Ill'rEND '1'0 OB'1'1~rN f!'IHAIWIW3, COIHlllJ.'I'
<br />WITH YOIIH I,rulllJElH OH AN A'l"l'()RNJl~Y Bl!lll'ORI!: RECORDING YOlm NOTICE OF COHMU:NCHlMEH'J'. ,roBS IJlWIf.H
<br />$:2, 500UI VALlIli: DO NO'l' HIl:ED '1'0 RECOIW AND 1:'08'1' A "NO'l'ICE: (W CONMENCEMEN'I"'.
<br />
<br />- .;.. L, \.... -' .f\:_"~' ..L ..,!h 'v
<br />
<br />...-----~---~.-.-. .-...--._ 'W___'__"_'_ ..__.....R_.._____..__..._.__...___
<br />
<br />SlGNA'l'UHE:l OWNER UR AGENT
<br />
<br />----_._._-_..._---..._._---._--~~~..........,~...._.._--_._._..-,
<br />
<br />SIcm1\'I'URE: I CON'l'RA.C'l'On
<br />
<br />S'j'.l\'l'E Ob~ l!'j'(JRIUA.
<br />COIlN'j'Y Oil" '__'_,____,_____
<br />'I'lle torego.i.ng i.nst.rllmeut vias acknowledged
<br />BeEol:e lIIe t:lds _"'.''''_'_ day of..__,____~., l~._
<br />
<br />by.,.. ,___ '..____._.__...___.._'________,___,____________._
<br />(name of persoll acknowledged)
<br />[] 1'11'10 is personally knoHo to lIIe, or
<br />
<br />[I who has p l:odllced___________.____
<br />(type of identJficatioll)
<br />and who!] dld L]dJd not tal.e an oath.
<br />
<br />S'l'A'l'El OF I1'J,ORIIJl\
<br />
<br />COlIN'I'Y OH' _____.________,____,__,_.._,_.._
<br />
<br />'rhe fot'ego.i.ng 11151:rlllllellt was solOJovlledgEld
<br />Before me tlds ___j,lay of-----..,..--.-_, 19
<br />
<br />by ____'____.________,_.___._,____.~_.,___.__,
<br />(name of person acknowledged)
<br />Chllo Js pet'sonally known to 1118, or
<br />
<br />[] vlbo has pr.odl\o~d__.___.___._.___..__,._,
<br />(type of Jdellt.:l..EJ.cJaLlon)
<br />and who Od.l.d DUd lIot take lilll ost:h
<br />
<br />....--.--..--.---...---..-......-.-.-.--- .-----.-.--------..---..
<br />
<br />81 Yllatllre of pel:son taklng acknowledgement,
<br />
<br />_..__._'--~-----_.._._--------_._-----_._-------.-.._.-
<br />
<br />Slgnatllre of persoll taklng aclClloHledgment I
<br />
<br />-"'-..-," -.-..----.-.,-....--- .....---.--.-.---.----..--.-..-....-------...----...
<br />Name typed, pd.llted 0.1: stamped
<br />
<br />-.-----.---.-------......---..--.-.--------.-..---.
<br />
<br />Name typed, p1.'.~,nted or stamped
<br />
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