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<br />\-')fWJ "J.'lUNS OF PERMI'I' AJi'E'IDAVI'J'
<br />A. NUl'lem OB' Dmmn RffiS'l'RIC'j'IONB
<br />'1'lIe unde!:s.iyned understands that t.his permIt: may be s\lbjec.:t t:o "deed rest!:Jrrt:tons/' \jldol1
<br />llIay be III01:e restJ:Ict:Jve than Clty regnlations, 'l'he undersigned aSSlllnes responsl.bJlJty for.
<br />compliance \lJth any appl.icable deed Les trlcLJoIlB.
<br />B. lIH1.ICI!iNSI!:D CON'l'RA.G'I'ORB AND CON'l'HAC'l'OR RElS PUNS I 811.1'1'1 E:S
<br />1 f the Dlmer lias hlJ:ed a cont1:actor or C:OlltractoL S to IIllder take Hrnk, they lI\ay he reqlli.u
<br />1:0 be .1Jcensed.Ln accordance ,11th state alld locaL reg\llatJons. If the contractor is IlOt.
<br />Ilnensed as reqllJ led by ] aw, both l:he o \'/11 e 1: and contraotor may be olted for a IIdsdemeanor
<br />lIiolatiOlI IlIldsr' state li'HL If the owner or l11tellded contl;aotor: r.tte lllwerta.! n as to \llIat
<br />Licensing requirelllents may apply fot the inlended Hork, they ar:e advlsed to (JolIl~allt the
<br />CU~y of Zephydd lIs BuJlding Department, 013-'166'-6611.
<br />li'uLLhermcH:e, if the Dlmer has hlred a contJ:actor or' contractors, he is advised to have the
<br />Cl(lIltt'acto.r(s) si.gn port.ionB of the "Contraotor Sectionsll of thJs app.UcatJol1 for Hhlch they
<br />Vllll lJe responsible. If you, as the OHner signs as Lhe contractor, you are llldloaUng that
<br />you, rather than the contractor, al;e respons.ible for the I/Ork. 1 f the contraul:(H Hlshes
<br />)IOU to si gl1 as contractol. that Illay be an inulcatioll that he j 01 nol: properly 1.1 Genaed and is
<br />IIDI ent:.lUeu to perllll.tUny privlleges J.n the City of ZephychU.l5.
<br />c. 'I'HAHBPOH'l"J\.'l'TON H1PAC'l' FEElS AlID U'l'ILITY CONHEC'I"ION IPEEJS
<br />]I, COIIS'l'RIlG'I'lllOH LIEN I,AW (CHAP'l'ER '713, FI,ORIDA S'l'A'I'IJ'I'EI3, AS At1Ir.NDE:J))
<br />I oer[:j ty that 1, the applloant, have been provic\ed Hlth a copy of "Ji'Jor.lda's Con5tr'\lUtJon
<br />.I Jell Lall - 1I01lleol"lller' 6 Protection Gulde" prepared by the B'lor.ida Department of Ayd C111t:llce
<br />and Consumer l\tfaJrs. If the app.Ucant: is someone other: that the "olmer/', T uer.lfy I:hat I
<br />halfe obta.lned a copy of the above desoribed domunent andprom:lae ill good :falth to deU vel.'
<br />It to t.he "U\'/IleLII l'rlor to COlOmencelllellt:.
<br />11:, CON'l'HAC'l'ClH' S/uWUIilH' S AE'Il'IDAV1'{'
<br />I ceLt.! fy that aU the .information in thls appl.lcatlon lIS accurate and that all ,JOrl. \lj 11
<br />I>e dOlle 111 complianoe Hlth aU. applicable Jaws regulating constnwtlon, zonl.ny, alld land
<br />development: ,
<br />AppllcaLioll Js hereby made to obtaJn a permJt l:o do \York and lnsl:allatlon as indioated, I
<br />cell:ify \:ha\: 110 I/Or!. or lnstallatlon has commenoed prior to issnallce of a peunt\: and Lhat:
<br />all vlO[). 1'1111 be performed to llIeet stalldards of all Jaws regUlating oonsLrllcltJon, Cll:y
<br />codes, zOll.l.llg :regulaU.olIs, and land development :regulations in the j\Il:.l.sdl.ut.iun. 1 also
<br />celLi fy thal;'r IlndersLand that the regulaUons of other governmental agencies llIay appJ y t
<br />Ille Jntended ~mrk, and that .it is my t'filspons.ibility to identLfy l'lhat autJons [ I1\llst take I"
<br />be 1n cOlllpl.lanoe. Such ayenc.1.es .include bllt are no\: limited to: ~DepiHt:ll\enl: uf
<br />E:nvironlllental RegIlJaUow-Cypre13s Bayhead5, Wetland Areas and EnvlronrnentaLLy Senslt.Jve
<br />Lands, WaLer/Waste\~at:er 'l'reaLment
<br />~SoIlLhl~esl: Ii'l calda Water Management: llistd ct-We.UI>, Cypress Bayheads, ~vel:Iand J\I;eas,
<br />AltecllJY Wateroonrses
<br />~l~cIllY Corps of Engineer.s-Beal;al.Jsl flooks, Navigab.Le Waten/ays
<br />~]lepat:tlllenL of Ileal th & RehabiUtaU.ve Se.t:vices, EnvJ.1;onlllental Hea.Lth Unit-Wells,
<br />Wast:sHal:er Il'reatment, Septic 'l'anJ,s
<br />AI). B. E:nv.l.rollmental Protection Agency-Asbestos abatement
<br />1 /:llsu ceLl:! fy that., it fLU Illatar.l.al is to be used in Ii'lood Zone "All Dr "A, eLo. II, it Js
<br />IUldersl:ood that a dralnage plan addressJng a "compen5atlng volume" wLU. be suhllt.l tted IIId.ch
<br />is prepared by a pJ.ofes::liona.l eng.lneer l'eglstered in the State of Jj'lod.da prJor 1:0 pennll:
<br />issuance.
<br />A penult j sSlled shall be construed to be a license 1:0 proceed Hith the work and not as
<br />allthod Ly to vJolate, cancel, alter, cn se\: aslde any provis.l.olls of l:he teohn.l.cal codes,
<br />nor shall j SSllance of. a permit prevent the BuLl.cUng OfUoial from thereafter requldng iii
<br />correuLJon of errors 111 plans, construotlol1, or vi(~lationa of any code. Iilve.ry permlt
<br />!.saIled shall beaome invalid unlesa the wor:k au~horized by suoh permH Ja nOllllllenoed Idtld n
<br />abt !l1cmths of issuance, or if Iwrk RlIthod.zed by the perllllt is I3llspendeci or abandoned for a
<br />perlod of six months after the time the work .is commenced. One 90 day eJctenaJoll of time
<br />lIIay be aUOI-Jed for the permi.t with fee charge of $15.00. '1'he eJttenslon shall be tequested
<br />.ill Vlriting to the BuilcUng Offic~ial. An approved inspeotion lIIust be loyged dllr.:illg each s.llt
<br />lIlonth ped.od, or the projeot Hill be cOllsJdered abandoned.
<br />WARNHIG 'J"O OWNElRI 'tOUR B'AIlrURE '!'O RFJCORD A NOTICE OF.' COMMENCi!lHEN'l' Nl\Y H1l:filJI.'1' l"lI YUlJR
<br />PAYTIIG 'l'WICE: HUR IHPROVEHEN'l'S 'I'D '{OUR PROPER'I'Y. IF YOU IWI'EHD ']'0 UB'l'hItI li'nIAI"IU 1 J.Il# , COIl 13 \I I.'I'
<br />WITH YOIlH I,Elt/DER OR AN A'l"I'oRNF"Y BEFORt!'. RECORDING YOUR NOTICl!', OF COMHH:NCfl~MEN'l'. ,JOBS IJNIII!:H
<br />$2,5()(J IN VA J.lI E: DO NUl' NH:mD '1'0 RECORD AND POS'l' A "NO'l'ICE: OE' COHI1E\NCfi:Mfi\N'I'''.
<br />
<br />SIGlIJ\.'I'LJRHlI OWNER UR AGE\N'J'
<br />
<br />.-. .~._.___..".~. ." ..'_4_._,_.....__.__~_ .._._.... . _._..___._.___..._~~,___
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<br />--.~.._-_...~-,.._..,~.. -_.-,._-----"-.-...-._~ _.,- . --~._-----_. .--....-. ......-...-..--. ~-_... ,
<br />
<br />S I GNA'l'lI RE:: CClN'I'Rl\( ~'l'on
<br />
<br />f:l'J'I\'J'ffi Ol!' H'l.URTJ)A
<br />
<br />COil WI' Y 0 f.i' ______,____ __.___._.________________.___..._
<br />
<br />'J"he foreyo:lny inst::rllment 110\03 acknOWledged
<br />Before me 1:ll1s.___..._ day of.._____.____.__, 1!t_.
<br />
<br />by .._ ... __..__. _._____ .._..___..__ ..__.__ ____ _____________.._____......____..
<br />(name of person au\{no\dedged)
<br />[) Ilho is pe!:sonally kllowri to me, or
<br />
<br />fl'I'A'I'E OE' FLORIDA
<br />
<br />COUN'J'Y o Ii' ---_______.__...__....__ _. .u___.__.h_.____.hP_
<br />
<br />"}'he foregoing illsLJ:\lIl1ent \-Ias acknolll edged
<br />Before me this __un_flay of.---.--.....-___, 19 _~_
<br />
<br />h Y ____._..__...__._...________._____ _..__. __...__...__._.._._...._"..._... '.'__."__
<br />(name of person aclOlowled9lid)
<br />[1ho .is per'F.lonally Imo\.w 1:0 me, Cll;
<br />
<br />LJ IIho has p r.odlloed______._._.___..~.__._________
<br />(type of identJfioaUolI)
<br />alld Hho[ldJd [Jdld noL take an oath.
<br />
<br />[] who has produced_____..__..___.____._______.___._
<br />(type of Idsnt1.ficaLJOI
<br />and \lho []dJd [}Ud not tal.a an oath
<br />
<br />SJgnatllle of persall talcl.ng 6nknol-/ledgemant
<br />
<br />~", -----------_.~..__.-._._._.__..._,~-~.-.~~
<br />
<br />_ .---...--.....'..----..--'- ._..-.~ .--.....-..-.-,-.,.- --..--..._.________ .,_ _n__ _~.... ".__
<br />
<br />81gnal:1Ire of per:soH i:al>1.l\g aclmmlledgment I
<br />
<br />.. ....- '-" n. ..-....-..-..-~___.....___....~__ -.--.--.,-...--___T_~__~...
<br />j,iame typed, pdnt:ed 01'. stamped
<br />
<br />--'---'~'- .,--...~.---,,---.-~-..--,.-~--. . >-.-'------.,..--.-..--..-.-.~ .-. ,-_,,____.._ . '.0. _'~.'''___'__"~_,,,
<br />
<br />llame typed, prJnted or stamped
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