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<br />\.UlIUJ'l'lCJIlS UF[:,E',mn'" Ar:'".'!:;)AV; ';.
<br />7\. lIU'l'lCF, OB' lJIJ:F.:n HEB'l'I1IC'I'IONS
<br />']'\le \.lnderslgned Ilndel:stands that: this permit may bf: slIbJ.eul. to "deed restrJctlons" vlldcll
<br />Illay be IIlOl:e restl.lcLJve than CJty ['egtllatiolls. '1hf: UIl<ie'lslqlled assumes respollsl.b.11Jl:y Eot:
<br />complianCE: HI t:.h ElllY appll.cal..Jle deed res\:.LlctiollS.
<br />fj. lJJlJdCHiNSmll (;OU'j'HAC'I'OHS AHD CON'l'HAC'l'OR RESPUHSl 131 LI"'I,iJ;,':1
<br />I f the Ollllet: has hl r.ed a conlJ:actor or contractor_I to 11ndertake l.wrle, they n1ay be reqll:ll:ed
<br />; to be 11 c~nsed jll auuordallce vd.th state and local regulEIU ons. If l.he contractor Is lloL
<br />) Juensed as reqlllLecl by laH, both the OI.meL' and COllt1:Hcl:or lIlay be olted for a lid sdemeanor
<br />viulation IlIllitn state lall. If the OHner or .1.ntencle,d cOIJt:l:actor are t1ncertaln as to llha!:
<br />Iluellsllllj reljld.teJllellts may apply for the intended \\IOJ:k, they are advised to (JDIlI:act tile
<br />l:lty of Zephyr:h.il.ls Blllldl.ng Department, fl13-'/flB'6611.
<br />F'lu'LheJ:lllore, if the OHIler has h.i.J:ed a contr:ac\:or Dr contractors, be Js advised to have the
<br />(JOlltractor (sl siyn portions of the "Cont.ractor Sections" of thls app.UoatJon for IIhleb they
<br />H.U I be U:lsponslble. If YOll, as the olcmersigns ?1S Llle (JOntracto1:, YOll are .tndJnating t.hat:
<br />YOIl, rather' than l:he contraotor, ar.e responsible for Ule Horle. If tile OOlltJ:anl:or Hlshes
<br />YOll t:o s.lgn as contr:aotor that may be an indicatJoll Lllat he is not p~oparly .licensed and Is
<br />!lot entj tled to permitting privileges in the CJ ty of :',ephydlills.
<br />c. 'I'RlINSPOH'j'A'1' [ON IHPAC'l'FEE:S 1111D U'J'ILITY CONIIEC'L'ION WEES
<br />n, COHS'l'RtJC'{'IIION LIEH I~AW (Cl/AP'l'E:R 'll3, F.'IjORIDA S'l'A'I'lJ'I'ES, AS AHEHllI!:Dl
<br />I cerli ty that I, the applicant, have been provided H.i th a copy of "/i'lod.da's ConstnlCtioCl
<br />.1 Jen !,a\1 -- lIollleo\'mer's Protection GqJde" prepared by t:he fl'.lorida Department: of Agd.Clll tllre
<br />and Consul\1er. lU'fa1rs. If the app.lJcant is SOlneone other that the "OI'lllel:", I cen:lfy that I
<br />have uhta.i ned a copy of the above desorJbed documellt: and promise 1n good 'faith to deliver
<br />it to t.he "ol-llJel1" prior to GOlllmencelllent:.
<br />Ii:. CON'I'Hl\C'I'OH' .':l/OWNffiH' S l\FE'IDAVl'I'
<br />I l1ertify Lhal: alJ tile infonnaUll11 in l:ILts app11ca\:101l Js accurate and thaI: a1.1 HOJ~k 1.1111
<br />he dOlle 111 cOlllpl.lallce ld.lh all applj,oable la\-/S r89\11a1:111g constnwLion, zoning, awl lalld
<br />development,
<br />Application ls hereby made to obtaln a permit to do wol'l. and insta.U.at.l.on as lndJoated. 1
<br />cetU f\, Lhat 110 Hark or installation has oonunenoed pr.1.ol: to l.ssllaIlcs of a pennil: and that
<br />aJ 1 Hark H1LI be performed to meet standards of all 1a\;'5 regUlating !.lonstruotJol1, Cll:y
<br />codes, zoning regulal:.I.ons, and .land development: reglt.latJons 1n the Jtlrlsdlction. I also
<br />ce.tl:lfy tllat'1 undetsl:and that the reglllatJons of uther govenllnental agenClJes lIIay apply to
<br />the .Intended vlork, and that .It is my .l'esponsibility to idellUfy \',hat: aut.iolls I 1111I8t ta];e 1:0
<br />be 1n cOlllpJ l.anGe. SlIch agenc1-es :l.nclllde b\lt are Ilot Llmlted to: *nepart:ment: of
<br />H;I\vJronmental Hegulat:iol\-Cypress Bayheads, Wetland 1\l:ea:3 and E:nvJrolllllent.ally SensJU.ve
<br />j,ands, Water/Wasl:e~~al:er 'j'reatment
<br />"Southwest: fl'l.orida ~Ya\:er Nanagemellt District-Wells, cYPli:ess Bayheads, Wetland Areas,
<br />1\ J I: B r J IIg Wa tercolIJ: ses
<br />*l-lrlllY Cor:pa of ElIglneera-BeaHalls, Docks, Navlgable ~laterl;'ays
<br />-A)JepaJ.tmenL of Heal th & RehabLl.l tative Serv1ces, E:nvJrol1lllenl:al Health Unit-Wel.ls,
<br />Wa B t BHa te r '1' 1:ea \:lI\enl:, Sel-> t1 c 'l'anks
<br />+-1/. s. E:lIvi lOll1nsIIta.l. Protectioll 1\gency-Asbestos abatemenl:
<br />1 .dSD cerLify I:hal:, if fLU. materlal.l.s to he used in Flood Zone "A" or. "A,6I:C.", it.ls
<br />understood l:hat a draJ.nage plan addreSSing a "compensating volume" 1-/1.11 be submU:t:ed I/ld.ch
<br />ls lnepar:ed hy a professional eng.l.neel. rey.i.stered in the State of I!'lorlda prl.ot to penn!.t
<br />issllance.
<br />1\ pell1l1 t j sSlled shall be construed to be a 11cense to Pl:oceed Hith the Hork and not as
<br />allthori ty to v101aLe, cancel, alter, or set asJde any provi.sions of t.he telJllIIl.ca1. codes,
<br />nor shall I SSII!lllce of a permJt prevent: the BIIJlcUng Off.!.aial from thereafter reqll.i.dng a
<br />con:eu\;llJll of errors in plans, construdtJon, or viol.ations of any dode. IIlvery permi.t
<br />.tss\led ahal] beoomf:l invalid unless the work authol:ized by suah permit 1.s ootlllllsnced \;I.itldn
<br />ai)( lllouths of i.ssuElnce, or i.f \'iOl:k allthor.!.zed hy the perm.!.t .i.s slIspended or aballdolled for a
<br />pedod of Sllt months after the I:Jme the \'lork is cOlllmenced. One 90 day extensioll of t.Jllle
<br />lIlay be a.1lol'led for the permit \'lith feE:. chal:ge of $Hi. no, '['he extensloll shall be requested
<br />III Hril:ing 1.0 the BuUd1ng offioial. .An approved inspec\:.ton must: be logged dud ng each fill(
<br />month per.l.od, OJ. th.e project: \;,ill be considered abancJoned.
<br />W1\RI1HlG 11'0 OWHffiHI YUUR Jj'AU,URffi TO RJiJCORD A NOTICE OF COMHIr.NCENF.:U'I' NAY HIr.SlJI,'1' IN YOUR
<br />P1\YHh, TWH:ru ImE IMPROVEMENTS '1'0 YOUR PROPER'J'Y. Ill' YOU IlI'rEND 'ro OB'l'l\IN If'JHAHCHI13, COHSIJI.'I'
<br />WITII YOUR I,I!:I/IJI!:R OR AN A'j"l'DRHfl;Y BEffORR~ RECORDING YOllH IIU'l'ICE: OF COt1l'11!:NCI!:MEH'j'. ,fOBS IlUIlEH
<br />$2,50() 111 VALli!!: DO 1'10'1' NE:ED '1'0 RIf.COHU AND PUB'!' A "No'l'Iel!; OF COHMENCEME:N'j"'.
<br />
<br />..__ca~_~_____.._..___
<br />
<br />Ell GHA'l'UHE: I OWHER (lf~ AGEN'J'
<br />
<br />B'l'Nl'El UIi' E'j.o~jA 0
<br />COIIII'l'Y OJ!' "_____.~~~_____________....:____.___
<br />The forego.tng .111s\:rurnellt Has acknoviledged
<br />Befot'e lIle t:lds ."'_.'_'_ day of ...___.____.., l~__
<br />
<br />by _ . ._.____ ___ _______ _.. _.___._____..______________________...
<br />_ / (name of persall aclmowladgedl
<br />I'StHho is pe.t:sona.\..ly krlOHn to IllS, or
<br />
<br />
<br />N.lIne
<br />
<br />m.....JAUUH.cMUAPHV--.-.._. _________._._.___...._
<br />.;.\ ~'t:doMMIS6iO"CCf189mP J
<br />':i EXPIRES: Apri127, 2003
<br />.' Bonded Thru Notary Public UndelwritefS
<br />
<br />
<br />~:J'
<br />-...---- -- --- ..-- -.--.-.........-.- ..._.._~-----_...
<br />SIGNA'I' !:: CON'I'RI\C'['OH '0---
<br />
<br />fl'rA'I'E: OF Fl,l>R:rD1\
<br />
<br />COli N'J'Y () l!~ __._____________.____.____________.____
<br />
<br />'J'he foregoing 1.os\:rI1l116nl: Has acIOJo\"ledgsd
<br />Bf.lfore me tIlls ____Jlay of------...--_.__, 1.9
<br />
<br />by _______________._.__.____.___._..___..__.___
<br />(name of person aoknowledged)
<br />Ckllo .is personally known t:o me, or
<br />
<br />[] \-lho bas prOdIIC.;ld..___._.__ _.________...
<br />(type of ldsllUflc:aI.Jon)
<br />and VlllO [Jdl d DUd not l:ake an oath
<br />
<br />--', '~...-----------~M._._H._.__~.__._..____.___._. ___.___.___ _____"'___
<br />
<br />stgnatllre of persoll taking ack110Hledgment I
<br />
<br />--.-------.-------. .-...---.--.---....., .~_._._-----.--_._..__.. ..-- .~_._--,---,.- '---'-'---'---'
<br />
<br />Name typed, prl,llted OJ: stamped
<br />
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