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<br />=........... ~
<br />COUNTY OF
<br />'l'he ~Qr8901Dq J:n~'tJ.t W.~Tlecl9e;c!
<br />Before ~ 1:b1l,1 Y of . l-9 ~e,
<br />by ~
<br />(name of puaoD. acknowl.eclg'ed.)
<br />~1. pe:r:sonall:y kootln ~o me, or
<br />
<br />r::J "Iho has p.c:od.~c:ed
<br />(type of :Lclenti:fiClld.ClDl
<br />OUit.o't. alt~ an Oilt:h
<br />
<br />
<br />s1gnat\lJ:' r. p.,raon U~D' aclalowledqamt:
<br />[J. eo '!a" A (.), f11tarJ ~8OJft.aW~
<br />NiDMI l:yp . p..;i.nud O~ st:lIDpCd \l ~ . ~ COmmI--. DOOOof737
<br />. ~G""" ,ExPll'llS June 01. 200S
<br />
<br />RPR-07-2003 12:22 COX FIRE PROTECTION, INC. 813 980 0631
<br />:; b~-;;;~ ~~_t~~~~i~ - the Cj,'t.y requ.lations. The u.nd.c:lligneC1 lUIsume& tespOZUll-lDl..I.J.1.1 ..VI-
<br />compl~.ace With any app11~le deed ~e"t~~oga.
<br />11. UNtICENSED CON'rAAC'l'OIlS JUlt) CON"1'~CTQR' MSlQltSIBnITIIiS
<br />If tll. Olofller b&:s birm a cont.nc:tor OJ: c:ontJ;actor~ to llnQertake work. they llIaY be ~6quired.
<br />to bl!. lice:Ased in .cc~rdan= wiCh !State ~ local rc9\l.lae.ions. If the ccmt~.ctoJ: is DOt:
<br />l~c=nseA ~s required by la~, both the owner and. cClDe~.ctor may be cited tor a m1SQemeano:c'
<br />V1gJ,iltion ancic::r: .tal:e 1.". If the owner or itltodeci contractor are Ullce.-t.ain a$ to what.
<br />licensing :c'equir~nt~ ~y apply for the intended wor~, they atc advi~ed. to con~a~ t~e
<br />CLey of zephyzhills BU1ld1ng Depar~ent, 813-'B8-&6l1.
<br />fUrthc~re, if t~e owner h.s ~ire~ ~ cont~aetor a~ cont:acto==, he is ~dVised to have the
<br />contr~ctor(sJ aig~ portions of ~he -Cont~.ctor se~ons- of thi. app~ication tor which they
<br />will be respon5ible. Zf you, .8 tne owner signs as the cantracto:, you are in~cat~ng that
<br />yell, rather than the con!:ractor, are rellpoll1l1ble for the wor:Jc. If the c:oJ1trac;to: ",j,lIbes
<br />you eo sign as cDntrou:t:or thilt II\&Y lIe illi itldi"at.ioft tbat he is not prop~rly ~iconsed and 1s
<br />not ent:1tJ.ed to pe.r;m:Ltt1~ pl:'itilege.s 1n the City of Zep~t'Mlls.
<br />C. TAANSl'Ol\'l')lTIOH IMPACT n:2S ~ UTILITY CONN!C'UON FUS
<br />,D. eotIS'fIWCTUION ..t:l!iN LAW 1Q!Atl']!IU\" 713, !'.LORID1\. S"l'ATU'l'ES, 11:1 ~ED)
<br />I certify that: I, the applielnt, have been provided w1,t::h a copy of \\rloJ:~da!. Consttuet.1ol1
<br />lien lAw - Ho:aeowner's 1?rot.eetion G..u.de" prepared by the Florida Depar=-nt of Agr1C\\ltUJ:e
<br />aDei ConllWll8r Atfa1J;1I. Zf the aJ>plicant is aOllll!one ether ~h4t. the "owner-, :[ ce:r:ify that I
<br />have Dbtll.i.ned a C:c:lpy of tbe ~vc d.escr.1:bcd Oo~t and. promise in good faith to 4.:U.VC:~
<br />il: 'to the "'awner"" p,doJ: to c:~~lIlIlen~.
<br />2. CON~llAc-rOR'lI/ot1N&k' II AtrInAVIT
<br />I certify that .11 the ~to%D&tion in this application 1~ .ccurA~e and that all ~rk will
<br />be Qone in c=;.11an~e with all applicable la.ws re~at;i.n!t ccn~t~ction. ;oxdng-, and land.
<br />clevelop.1lll!nt.
<br />~~Lea~~oD ~. hereby made to obl:ain a per.mit Cg do WCl:'~ and 1nstal1at:ion au indiCAted. I
<br />cer~ify thac DO wo~k or i=sta11ation has commenced prior to is:u~nce of a pe~t aDd that
<br />a.ll WOJ:" will be pf:=:fo~ecl to meet stnndardJs of all lS10lili r09'ulating canatru.ction, City
<br />codc~, ~oninq regul~~1ons. and land develop~t regulat~Dns 1n the jurisdict1on. I also
<br />eertify t~at i understand that the regulations ot other governmental a~encies ~y a~ply to
<br />the 1I\tended work, and that it i8 my responsibility to iliont:1f:t what actiODS I 1ll\1St: take to
<br />be iR ~l~ahee. Such ag~e1es include ~ut are hot l~tQd to: .Depa~t of
<br />EnVitonment~l Regulation-Cypress aaybeads, W@tland Are~3 and. Env1~onme~tally SeD~itive
<br />t,aDds, Waterl.a~~=~ater Tr.a~t
<br />.Sout;!lwest: e-lorida. w.te;c: M~nilli~t: Pi:Jt:-j,et-'Rel~s, eyp~el!ls BayhClacl:l, Wetland ~1II:a.ll,
<br />Alteri~g WatercoUrses
<br />-Azmf corpo of Enqineerll-S~wal13, >>o~, Navi9abls W.~e~aY8 .
<br />.Depart=cDt of Health 5 Reh&b111!:a~ive Services. EnvirOQment~l Sealth Unit-Wellll,
<br />wutewatcr l'::eatmont, Septic Tm~ .
<br />~. s. Env1~Clnmental t:;gteC1::ian Agenc:y-Asklcrstoll abatement
<br />I .&lso certify that, if :t:lll material i:5 to be u"ed in nood Sane "'Ad or "J\.,eec:.', it ill
<br />~rstood that a drainage plan addrcall~lig a "'c~ens~tinq vCll~w ~ill b. .~t:ted which
<br />ill peepared by a professioDal engineer ~e~.tereQ ~n the state of Flo~1da p:i~r to p~:mi~
<br />issuance.
<br />A permit is'!!:ued shall be eon$t1:I.If:ci to be II license tg proceed with' the work omd hot alii
<br />authority to violate, c~eel. a~ter, or lIet alliQe .n~ prov~1l1on8 of the teebnica~ ~ode$,
<br />nor ::hall :.I.uuance of a pc=i1:: prtlvent the 1lW.~d.1Z1l1 Offic1.a.l fralll ehersafter requirill!J (I
<br />ec:rrect1oJ:o ot: en:on in plllnll, construct1Qn, or violat:J.ons ot al:lY code. ~ery pe=it
<br />iS3~ed. shall become inval1d ~es3 ~e wo~k autho~1zed hr sueh pe~t ~s commenced within
<br />uJt DlOnths of iSlluan=e, 01: if wo~k aYoti\c.rJ.:ecl by the p~t ,loa IJuspencleci or aJ)anclo~ed for a
<br />period. of s.1.x months a1:tar the tims the wo.rJc 1. eOllllllelloccd. One 110 day utens1ol\ of "tiJoe
<br />may be all0W9d fo= the ~e~~ witn f~e cha=;e o~ $15.00. The exte1\5~On llhall be requested
<br />in wr1t1.n; to the Ill.l,,ud.ing Official.. An approved. inspection l:J\Un be lO!i9"ed d.udng e;acb dx
<br />1Il.OZltA pll!:.l::I.oci, or t;he project w1.11 be ccms:Lclcred ~anclonccl.
<br />WMNnI'G '1.'0 OWNER: 1'OUI\ FAII.UiU!: TO 1U:CO!Ul A NOTIC13 OF COHMli:NCEHElfT MAY RESULT IN YOUR
<br />PAYING TWICE FOR IMPRoV!H!N"1'1I TO YOUR l'ROi'nT'l. IF ~U nrrEND TO OB'1'AnI ~CINIi, CONSULT
<br />WITll YQUJ\ t.ENDE~ 01\ .!Ul' ATTOflNey 8!:FORt RECORDING YO Iet o!' COIlMENc:EHEN!. JOBS UNIlEP.
<br />$2,500 ZN VALUE DO NOT NEED '1.'0 RtCORD ~~ POST A ~N ICE COHMEN
<br />
<br />
<br />P I'C'S ,
<br />
<br />iICiilQ.TURE: O'lt!I'tR OR ~"I'
<br />
<br />:.
<br />
<br />STATE o:r Ft.ORIOA.
<br />COtntTY or
<br />',l'hll!: foreqoipg 1nstruae~t WIlS a=knowle<:\ged
<br />Befare me this _ day of , lL
<br />by
<br />(Ilou\c of peJ:3on a=owlecl.ged)
<br />C1who 1. per:sonaUy DO'IC to me, 0';-
<br />
<br />r::::J who ha~ p t"odu.ced
<br />(~ype of ;Wentit1c:al;;l.on)
<br />ami loIhoD 4i.d [Jd1d DOl:: talte ~ oaeb-.
<br />
<br />
<br />--
<br />
<br />S~gnatl&re o~ p8~son taking aclmow.lec19e1118:a.t
<br />
<br />N_ l::yped. pr.1:a.~ecl or :51:.:uaped
<br />
<br />t . If
<br />
<br />I ~n I' ON
<br />
<br />S"IHHAHd3Z jO All3
<br />
<br />ftd7S: 1 (aDZ'6' PO
<br />
<br />P.04/09
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