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<br />1\. 110'.1'1 (;lJ~ Oil' DElE:D REB'l'RIC'l'IOHS
<br />'j'll'" \lllders.lgned IIndel:stands that: thls p'e,nnl.~ 11I,"l' be: S1\b.leut 1:0 "deed resl:dfJtiolls" l'II,llclt
<br />lilay be IIIOl:e rssl:r,ictive than Cil:y u:\JlI1.aliolls, 'llie undeLslgned aSSUllles r6spollsJb.lltty for'
<br />eornpl lance Hi t:.h allY appLl.cai..Jle deed rest'llcl.:iona.
<br />B. 1/IHdCI!lNBEin CON'l'HAC'l'OHS AIW CO]l'l'Hl\C'l'(,n RmSPOIIS1BILI'I'lF,S
<br />r f lht: OllJ1el: has hl.red a conl:r.actoJ: ur ';ontj:actoLs to \1I1dertaJce 1'lOrle, t:lley nlay be requ:ll:ed
<br />I Lo be IJuellsed in accordance yd.l:h aLa Le and locHI regll.latJ ons. If the contractor- Is lIo!:
<br />].1 Dellsed as req1tJl:ecl by la~/, both the O\'lner and UOlJl:LacLor may be oJl:ed for. a IIIl sdemeal10r
<br />viulation IlIld"n' state Jail, If the OI>JneL or .1.ntElIlded cOlltractor are lll\r.erta.ln as to IIhal:
<br />I j uensJ nyn:!IJldtE:'HIlents way apply 1'01 tile intendfHI \wrk, they are advised to cOIlI:ac:L the
<br />I:U-y of Zephyrh.111s BUilding Department, fl13-'IElEl'6611.
<br />F'lu'Llle1:lllore, if the OHller- has hJJ;ecl a contracto!" or contractors, he .Is advised to have t.he
<br />oOlltracl:or(s) siyn portions of t.Jle "Contractor .Sectiolls" of tlds applioation .for \-IlLlell they
<br />VIlli he l:esponsi hIe. .1 f YOll, as the OHner signs as I:he contractor, you are indl eating t.ha r,
<br />you, raLhel: than the eonl:ractor, are responsible: for the Ylntk. If the conl:t:se\;nr \-I.lshes
<br />ynll La s.l gn as c:ontr:actor that may be an llldJcaLloll that he .Is not: p1:operly 1.1 censed and Is
<br />!lot. entltled Lo penllitting privileges In the elty of Zephyrhi.lls.
<br />c. 'l'RANSPUH'l'A'J' [ON IMPAC'l'FEE:a .AND U'l'ILITY CONt/Be'PION WEBS
<br />D. CUHB'I'RlIC'l'l/JON LIEN LAW (CIIAP'I'ER 'l13, FI,ORIDA S'l'A'l'lJ'I'ES, AS AJ1Jr.N[)JW)
<br />I cart:! fy that: I, the appU.cant, have bean provided \-11th a copy of "P,'lod.da's ConsttllctJon
<br />.1 Jell I,aH .. !IollleO\.mer's Protection Guide" prepared by the E'lorJda Department: of AgrJcu1.t',IIU!l
<br />and Consull\er IU'faJrs. If the appl.lcant 16 someone other that. l:he "oHner", I Cf.ll:1fy that I
<br />have ubtaJned a copy of the above desor:1.bed doculllent and promJse JI1 good fa1th to deliver:
<br />it to the "O\'lller" prJor to COlllrnellcelllelll:,
<br />E:. CON'f'Hl\C'('OH' B!OWHF.R' S AFE'IDAVl'I'
<br />I oert.tfy Lhat all. the JnformaUon 1n Ul1.s appl.lcatJon i8 accurate and t.hal: flU Horle IILI.l
<br />be clone'.l.ll compl.l.allce Il1th aU appl.lcable laylS reglllaU.lIg Gonat.nlCtion, zon1ng, allt! land
<br />development.
<br />ApplJeal.Joll :119 hereby made to obt.aln a permit to do work alld i.llstaJlaU.on as 1lldioated. I
<br />cetU f\, \:hal: 110 Hork or :1.nstallat:Joll has oornmenced pd.or to isslIallcB of a penn.U' allri that
<br />ai 1 ylOrle 1'111.1 he performed to Illeet standards of all laHs regulatillg UOllstnlCltlon, CI ty
<br />codes, zoning regulal:Jons, alld lalld development regnlat10ns JI1 the JUlJscUctj on. I a.1 so
<br />cell:! ty LllatI IHHlelstand that the regulations of other goverTllnental agencies Hlay apply t:o
<br />Ille .1 nl:ended ylOrk, and I.:hat It is my l.'esponsibili.ty to JdenU fy vlhat act.1 OilS I lIIust take 1:0
<br />be ln compliance. SUch a\JencJes lnc:lude bnt are not limited to: *nepartment of
<br />H:nvirollln€lnLal Hegulal:iol\'-CYP1:ess 8ayheads, Wetland AJ:eas alld n:nvi.rolUnelltaLl y SensJl:Jve
<br />Lauds, Wa ler/Was LeiVa Ler 'l'.tea tlllent
<br />"Solltln/esl: F'lod.da ~iatElr Hanagelllent District-Wells, cYPJi.'ess Bayheads, Wetland 1\reas,
<br />^lterll1g Wal:erCOll1:l3eS
<br />"lHiIIY CULpS of E:llyJlleers-BeaHaLl.s, Docks, Navigable Water\1ays
<br />+-]Jepa!:l:menL of Ileal th & RehabJll tat::1.ve Services, n:nvlrollmeul:al Health lJnlt'-Wells,
<br />~iasteHater 'IIJ:eatmElIlt:, Baptle 'Panke
<br />+-11. S. E:UII.I tOlunental 1:'rotec:1:JolI Agency-Asbestos abatement
<br />T al so mHtl fy thai:, if fJ11 llIaterJal :l.a to be used j n F'lood Zone "A" Ot. "A, e\:CJ. ", I.L .1 a
<br />lllHlerstood I:l1at a drai.llage plan addreSSing a "colnpensaLtng vOllllne" Htl1 be submitted I-Ih.l.ch
<br />is pl:epat:ed by a jJl.:ofessiona.l. engl.lIF.1sr. reg.1.st:ered in the SI.:at.e of H'lorida pdot. to pennlt:
<br />isslIanoe.
<br />1\ peuult .Issued shall be construed to be a license to proceed Hith the Hork and not. as
<br />alll.horJl.y to violate, cancel, alter, 01: set aside any p1:ovls.ions of the teolllllcaJ codes,
<br />nor shall i SSIIElllce of a pennll: prevent: the BIIJldJ ng off.1.claJ. from t:hereElftel.: reqllldng a
<br />con:euLj on of errors in pl.ans, conat.tuation, or violations of any aode. Every permlt
<br />JsslIed shall heoome invalJd unless the work author;ized by slloh permit 1.s fJOll1ll1Bnued H.Uld n
<br />silt 1I101ltlulI of lssusnue, or .if \'1<Jrk author.ized hy Lhe petln.lt .i.s slIspencled or abandoned tor a
<br />pedod of S.i.l( m01ll:hs after the t:1.me the \/Orl\ .is commenced. One 90 day e}(tens.ioll of tlllle
<br />may be aOlIDlleel for tile lJermlt \.l.ith fee charge of $Hi.(JO. '1lhe extension shaU be r.eqllested
<br />JlI 111::1.I:Jng to the Bui101.og Offielal. An approved .1.nspeet:Jol1 lIIlIst be logged dur:lng BElch Elll(
<br />ltlOllt:ll period, Ol t.he proj eet \>1111 be considered abandoned.
<br />WARIHIlG '.I'U OvlNmH: YOUR jj'AII,UHEJ '1'0 HElCORD 1.... NO'l'ICE OF COMMIr.NCEHEN'I' Nl\Y HESIlL'I' IN YOlJn
<br />PAYIIW TWICE H'(jH HIPROVEMI!:N'I'S 'I'D YOUR PROpgn'l'Y, IE' YOU IH'['EHD 'J'O OB'I'Anl If'j HAHCIJ.l13, COIl~I/],'I'
<br />WITH YOIIR J,ilJllIJnlR OR AN A'l"l'()RNF~Y BffiIfORR~ RECORDING YOUR NO'I'ICE OF COHI'1E:NCE:I'1EII'II. ,fOBS lI1WE',R
<br />$2,500 Itl VA"". no NO'I' N"'n '1'0 ."COHn ANn P08" A ~" (""""NCE'''''I'I''',
<br />
<br />
<br />"'r'. /:.:.~~-~--:.~' -~.~-~A--~~.~._.-..--- ..__..._._....___.__.___
<br />~- OWNER un AGEtlT
<br />
<br />Lr.).r.).l_)_!_'-'."_LU:~E: ()~ P~:P}~IT l\FB'IDAVlt).1
<br />
<br />-_._--_._~-~--'-._------..._-- _...-....._, "--'--~.
<br />
<br />S I (31-11\'1'lJ HE: :
<br />
<br />CON'l'RA.C'I'on
<br />
<br />BTA'I'E Oli' E'j,ORlIlA
<br />
<br />COil Il'l' Y 0 E' '__ .._...___.._.____._______.________.___
<br />
<br />'J'he f01:ego.tng lnst.rlllnElllt ylaS acknol<lledged
<br />Befol.e lIle tJd s _..__._._ day of__________, I.~_
<br />
<br />I)'y ...._._.___ .... ____... . ..__.__._....___..___________..__..___._. _.__..
<br />(name of person acknOWledged)
<br />[) Ivho is pe1:sona.l.ly known to me, or
<br />
<br />fl'I'A'l'E: 0 F FLORI DA
<br />
<br />cm J N'J'Y U lJ~ ----___.____.____.__._______.._ _...u____.__
<br />
<br />The fOLego.ing .l.llsl:l:\llnEllll.: was ackno\'lledgsd
<br />S"fore me tills .___Jiay of-----.-----__.__, 19
<br />
<br />by _.___..______.________.___....__.___.___,.._._.__.....
<br />(name of person acknow1edy&dl
<br />[kilo .Is personally Imol1n to me, or
<br />
<br />[I Hha has p rOduced_______________._._._
<br />(type of identJf.lcat::l.olll
<br />and \-Jllol] cHd /]dJd not ta];e all oath.
<br />
<br />[J \-o/ho bas prodllof;ld.._______ ____.__...______
<br />(type of .ldaIJLifJCJC;:d.lon)
<br />and v/ho [Jell d []Ud noL t:~ke an oath
<br />
<br />S.I gnat:ure of person taklng acknoylledgement
<br />
<br />.- "..- _.._~_._--_._. ._-'.~-~-----,--- - ---------.-..-.-.-.-----
<br />
<br />Signature of persoll takl.ng ac::lolo\lledgment I
<br />
<br />- ".-.. ~_..._------~~--_.~_._._._.,....-_..._, ..-.--------. ---..---.-------
<br />
<br />Nallle typed, pdli\:ed OJ. stamped
<br />
<br />. .-. .~.. ~._~_..._..-.~___._.__.,.____. .u_... ~'_ .,~..._p______.~___. ..._..._~.._
<br />
<br />-"-.'-"--"'.'-- .._--'-~~-~_._-- .'., .----..---...--.---..-.. .--_.~_._.- ~
<br />
<br />lIallle typed, (>rJnted or sl:amped
<br />
<br />YrvO /~ Y/' ~
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