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<br />MAR-25-2003 09:33 AM ECO PRO AQUATICS
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<br />813 845 1573
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<br />p, 03
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<br />SIGHA'l'l1REI OWNER DR AGEN'1'
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<br />l;UNU.L'~'HJNB OF f BlRMl '1' AJ'JI'IllAVI'l'
<br />,~, NO'J'ICIll lJlf UIlIlD RESTRICTIONS
<br />'rh. Ulldu81gned Lmdeutand. th"t thh p.rrn1t may be IUbject to "de.d re.trlotiQn." which
<br />"'.Y b. JnOl8 re,l;.riCltlv. than City r.gulat~ion.. '1'he undera.1gned a..tlmes .responsibility fo!.
<br />aOIIlIl.! iIUICJ~ wi th allY appl:t (;able deed rest.t'ictiontl.
<br />B. UNLICI!:NSEfl (~ON'rRAe1'oRB AND CON'J'RAL:'!'OR RESPONSIBIM'UES
<br />If I-he (;WOer ha~ h.ired iii contrl!lt.~t:or Ol! l;lontractnra h', \Il1dertak. WO.;k, they may be ....,Ljl.l,! {'ed
<br />t.o j.}~ :u CI8l1!1ed in ilacC'/rclilJlCf! with 4lt.at.e &ud 100a.1 1:'~gulatj,(,)ns. If the (:ontra(~lor i8 Jlot
<br />lic&nsed a~ requjl~d by law, both Lhe ownet and contractor may be ailed far _ misdemeanor
<br />violli1tion uUlh~4r state la\l, If th~ OWner or tntended COlltr..otor .U:Eit lltlCel:t:.iu..1f to what
<br />:u l.JensllHJ u.quj t'elllentlil IlIay apply for the intended "IQ1:k, they liIre advtsed to cont.lilpt the
<br />C.i.ty of Zephyd1ilh J;uilding DEtpartml!!llt, 8J,3-788-6611.
<br />FlIr.th~J~Il\Ol.'fll, .i f t.ha OWIISI- "".;t hired" I""'ontraotor Ol: oontrQcto1.a, he i8 adVl.sed to have the
<br />oafit~actor(~j sign portions of the "Contraotor SectlonsH of this application for which they
<br />Hill be: reBp'H\lIdble. If you, as t::he OWQet: s.igns ~8 the Dante.etcu:, YQ4 .ore 111dioat:lng that
<br />you, l: at. l14i1l: th~w t.h... oontract.or, u:e l.t.':tlpomlibl e tOl: the work. If the contractor wi..hea
<br />you to sign ~~ uontr~ctDr th~l may be an indication that he 1s not prop.rly licen$_d end is
<br />lwl entj thd to l'etlllittilH} privlleg8s in the CJ.ty of ZephydliJ la.
<br />C. 'll"MHH'Oh'l'A'J"1 DN I MPAe'l' FEEls AND U'rU"l 'fr l...!UNNI!iGTION FI!lBJS
<br />D. CONtl'l'RlIC'rUION I,UlU LAW (CUAP'l'ER '113, i'LORmA B'fATU'J'I!lS, AS AMENDEI))
<br />1 olil.ttity tIHH. I, th~ liPpllcant, h..ve been })l'Ovlded with a cOlly of "l'lori.da' B CCHultructioll
<br />11 ",n l,rilW II milt: u WIII::lL '.. (> J:oteot!on <;uid&" p.repru:ed by the nod da Depilrtment of Agricul tun
<br />and COHaumer Affairs, Xi the applioJll1t i. SOlneone othel: that the "owller". r a.rify that I
<br />Itave obtaJ.neci a copy of the ahove de.cribed dOdument and p.t:'olllll'l~ in good faith to delivor
<br />i. t;. to the "own~r" pr:101: 1.:0 conlnlencement.
<br />Ii: , CON'1'HAC'l'OR' S/OWNER' S AFIi'IDAVI'r
<br />1 cert.ity that: i111 thl;! information l.n this alll,'li f:!ltl1.on i. aCOUJ:kt;l;: .-nd \:hllt Ill1 wIJl.k "Itll
<br />be dOhe In c;ompUanotl wJth all applicable laws l"egu]at;J.ng constl'lIct:J.ou, zoninlJ, and land
<br />devEllopllIemt,
<br />App1111at:ion 1s hereh.y made t:n nhtA.t.h a per;mlt to do wad, ahd inlllt.cd.lclLj.(Hl as j.nCJ1Cilt:.,L I
<br />':e~.tity ~:hat no wu.rk or inatal1atj on has cOlllrnenceu' }).t::101: to i88ulInoe of a perm1 t and that
<br />!l.11 work \'1111 be performed to meet standards of 6111 laws regulat:1.ng cOllstruotion, CJty
<br />COdfsi, ~oning r.~UldFlt"jt\nB, an.d l.and devolopmenlc cC9ul~t;J.uUtsiJl the Jurill(jlCtton. J also
<br />CElt"t:lty that.1 undeutand that th~ l:egulations of otl.ler governmental ageno!ea may apply to
<br />thet int:tflhded wolll., and that it 1. UIY reapons,1,bility to ident:t.ty what itotioll" I must: bl}ce to
<br />be 1.11 cnmrdi"..oe. Such agenoicD incl.ude b\~t a.Lc: lIut. limlted tOI "'Uepartment ot
<br />l1lnvirollll!el1tal R-9uliltiorl~Cypr&tiUj 8ayheada, Wetlaud ArtUIIM and Emrironmeut.ally Hen.j.tive
<br />J'l:lllds, Water:/Wabtewaler Treatment:
<br />....lJouthw.llt 1l'J.~l:ldi4 W~tc:u: J'o1.na~oll\c:uL lalltrlm:-'welJ.I3, 'CYPJ::es8 Bayhf.llld., Wetland Areas,
<br />AlterJ.ng Watercou.t::ses
<br />*Army Corps of EngJneers-Seawalls, Docks, Navigable Waterways
<br />"')JI:VCll.l.llI"nt: at lll!lAl th & t(lShabl1itat.1.\Ie Servioes, El1Vl.ronrnentaJ. Hea.lth Unit-Wella,
<br />Hastewllter: 'l'l-ellf.lusnt, 6el>tic 'l'anks
<br />"'U, a. EnvirolJhlental l>rol:ec:t.ioll Agency-Asbeetos abatement
<br />I alao cart!!y that, it till material j,8 to be used in Flood Zone ~Au or "A, eta.", it i.
<br />ulldet:atood that a dt:a1n&ge plan addressing a "compensating volume" 'w:l.ll h. iml.lll\ittec:1 Which
<br />18 l)tepa1.-ed by Q pI:ofesdol1al engineer registered in th~ Stat~ of Fl()dda pri tlr i:o penn:! L:.
<br />1aUlUauce.
<br />A pelllllt ifUlUdld t/hal1 bfs construed to he a licetlse to proceed wilh the work and not iUl
<br />aut.hority to violate, C"lIcel, allIlH', or. IHe\: aside IHIY prnv:tSions ,)f the t.80h111cal oOdall!l,
<br />nOl:' Shiill iSSIIAnce at a peL'm:\t prevent the Build;! n9 ofticia.l from thereafter requJ.dng a
<br />cor,reolJ on of anon 11& J..llans, aonS~l:uction, or viol~tion8 of any oode. Everv pel'uU.t
<br />is.ued aha l.l beuome i n'Ual .1 ci \Inl'!uIB . th. \J~.a:k' Inltho~i lIIcd by "t~oh peunll. lit uUllun8ncliilcl Wlth1n
<br />sJ,x montha of J8slIllnc8, or: if WOJ;k authorized by th& petnnit j.. stl8pended or ilIlJlltU.\01l8ct for a
<br />plISd.od ot SlJI month~ e.ft::er the tJJl\e the war), 113 oommenced. Olle 90 UfaY eUltensi.on of t,tll\e
<br />may bEl lidlnwad fnt. t:he p6l:rnit. with felC~ t)hiOlrg8 of $15..00. Thtl ~ltLt!l1l1110n 8hall be l:e'JUliili~8c1
<br />:t u wr1 t.1 rig to the l3uUdIng Official. An approved inspectJ.on rnu"t he logged during eaoh ,d"
<br />lIIonth ped oil, or the projept wIll. be considered abandoned. .
<br />WARNUW 'J'O OWNIi1R, 'tOlJl\ I'AU.U1l.m '.['0 RElCOR1) A J'fO'fICIt OJ!' r:OMt!J!!lNGl!lMIliN'l' MAV RI!IBUL'l' IN YOUk
<br />PAYING 'l'W1CE FOR TMPRove:MEN'l'S 'ro YOUR PROJ:lB:Rrty. U. YOU INTI!:ND TO na'r}\IN ll'INIUIGIWq, .pqw,UL'j'
<br />Wl'l'H YOUR J.END.II:R OR AN A'l"J'ORNEY BEe'OR/!: RECORDING YOUR NO'l'ICIIJ OF (;(>MMENCEHIllN'l'. JOBS UNDER
<br />$2, Suo HI V/\LIJ.l!l 1)0 NO'l' Nlllllll> 'J'O RECORD AIiID POST A " OTI\.:E UI!' (;OMMJi:NCEMll1N'1'''.
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<br />Il'J'A'I'l!l ()Jj' FLORI J)I>.
<br />C()UN'I'Y OF __"~_.___.__
<br />'l'he tCH;'egolng j nstr:U1nt!lIL WaB I\nknowledged
<br />BeforE> roE! thJ.1;; _.__~_ day of __..___..__..__, lL,
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<br />by ~__.___.._.. __.________
<br />(lIallllll of pet'sou Aoknowl.dqed)
<br />[j who Is personally known to 11le, or
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<br />CI wh() has produo@ri._._. __._~__
<br />(type of identiflcat.ion)
<br />and whoDdld [JdJ.d not take ah oath.
<br />
<br />sr ~'b: OF FLORIDA
<br />CO\JN'I'Y OF __._____
<br />'I'he foreQo.1ng ilHI h:tlrnlllllt Wi"l al:lknowledged
<br />lJl!1fore me tld ~ ...._._JJay of--___, 19 _:_.
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<br />by ._.'____,_..
<br />(nanu!! ot l''''l:I.JDll iloknc>wledg.c.l)
<br />f-1ho :l. pe.rsollally known to me, tJt;"
<br />
<br />n who has pJ:oc~l.Iced_ , ..___
<br />(type of id.ntifiQationj
<br />and who Odld OUd not t.ska an o~th
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<br />----------.--....----,-.--....
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<br />8.i gnature I)f. p.r.on til~1llg ...,.,know~eclgemEoII\:
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<br />8igl'ult:ureo oJ! pel.:lilnn t.t1kiIl9 aoknowl..dgRlelnt
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<br />'I~-;;iiie-ty'i~~';i:.'p~i~;l t ;d~-~~ l~;;~p'~d~---'-
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<br />-N am;- t YJle=(r,--~~irl t8d~'~:.-;.tilJnpf1fj---""'.'._'----
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