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<br />(~()JIDJ'l'lOljS OF' PEkl1JT AF'FJ DAVI'I'
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<br />A. IW'l'lCIi: Ol!~ DElia) kEI:l'l'RIC'l'IOHS
<br />'J'be llndct::,;iyned lI11dl::rstand;; tllat tlii fj pt::;Lwi t lliay be .:>ubi t;Cl to "det::;d rl::stl.:i.ctions" vitti ell
<br />IllQY be more r'estrictivt:: tllal1 Ci ty raljlll<:ilions. 'l'ht:: l!llcl<n:si gned al:i.:illllll:::.:i l:el;lPOlll;li bi 1J t'l tor
<br />compliance \d th any, applj,calJle d<::",d Lt:::;;tl.'j,ccions.
<br />B. IlNLlnIlISC;D CON'l'RAC'l'ORS AND Cl)I~'l'kjl.C'l'(JR Rb;SI:'ONSIJ3IJ.l'1'IES
<br />1 f the UIIII;;;l ba::; bired a ClJlltractor lJi: contn:lctor.:i to undertake \c/Ork, they may be L'eqllir;;;d
<br />to be Jicen.:ied in accoL'dance Hith aLate and local regulations. ]f the contracl:lH'ib llut
<br />lic;t:;nsed a::; noquired /.Jy laH, both ellc l;\UI",l: and contractor lllay beo c.l ted for a Illi ;:;ddhll:::allor
<br />vIolatiun lllldt::;r I;ltaLe JonL If the miller:, or intendt::d contractor .u:e \IIlcl::,rta1n l'll.> to 1~llaL
<br />Ii ccnsinu requi r"nllell[.:;O lllay apply for the intended \'wl:k, they an" adviSed to conl:anl: the
<br />Cit~i of Z.::phyddll:o buildIng Departll1i:::nt, tl13-'788-6611.
<br />E'urtlltHHlort::, if the- ulmer has Idri:::d a contractor: or contractors, h.. is advi:;oad to hava thl::
<br />conl:1:Olc[.o,l: (s) sign portions of the "Cont,ractor 5..ctions" of tbis OIppl i cation tor Ilhi cb tht;:lY
<br />will bi::: responsibli:::. If you, a.:i the OHnet sign:;o a:o thi::: contractor, you ~re indicating l:hClt
<br />you, rath,u t11c:in the cont!:actor, are rt:;;:;pon;:;iLle for the \'Iol:k. If the cCilltr'l'lctcn VJi;:;llbl;;
<br />you to siyn al;; contrOlctor. that lIlay bt:: an indiccltion tJlaL hi::: is Ilot properl.y liclOnli>Cid and il:l
<br />noL I::ntit.1 c;:d to pi:;l:lIIi tting privilegl::s in the (;,i ty of Zl::pbyrhills.
<br />c. '1'RANS l'OR'l'A'l'J Oil H1PAC'1' }!'EES jl.ND lJ'l'ILI'l'Y CONNEC'I'ION f'E!!;S
<br />n. COHS'l'ROc'rUION Ll!!;H LAW (CIlAP'f'j!;k '713, FLORIDA S'l'A'l'U'l'ES, AS AHENDE:JJ)
<br />I cl;j:rtify that 1, tll\::: al?pUcant, have been provideod Hitll a copy of "li'lorida':;o COlltltulctJOIl
<br />lien Lall - IJoHleOlInI::r:' s Pl:otecti.on Guide" preparl:::d by th.:: Inorida Dep,u:tlllent of Agricllll:urc;:
<br />and COnl:lllll\Cir Affai.rs. It Ulii:: applicant i;:; someone othE:r that the "0111I=1:''', I cerify tll~t I
<br />hOl VCi obtai lH::d a copy of tht:: abOVe descr'ibad document and promise in good tal Lh lo dt::,lj vcr
<br />it to tbe "U\IIH:r(/ {H:iot' to COllllllellC",llient.
<br />E. CON'i'HAC'I'OH' S/OWNER' S At'h~IDAVI'l'
<br />I cert.ify tll"d: a]] tile intormation ill this appliCation 1.s accurate and t:Jlclt a.11 vw!l;: vdl1
<br />be dOIIl::: i.n c.:ompliallC{;; HiLlI ali applicable Ialls n:lgulclting constulctl,on, :.:on1119, and land
<br />de:velopllienL,
<br />Appli t;ation j:;o her::eby made to obtain a pennit to do Iwr);: and installation as IlId! c~ted_ I
<br />cerLi ty that no 110,1:1;: Ot illstaliatj,ol1 lias commenced pric'L' to is::l\Ianci::: of a {lli::ulIit c:ind that
<br />all 1>0/01'1;: I,i 11 bl::: performed to IHl:::I::L ~tandards of all laHs rt:lgul Clting constnlUl:ion, City
<br />codes, zonilHj r"::(Juli:tLiolll;, alld laud devl:::l1opwent rc;:gulation:;; 1.n tilt; juri",d1.ctJolI. 'I a]/::iio
<br />certify tJlat J linder-stand lh"d: the regulations ot otber govii::rmnental agc::::lwi c::::1::i !Hay <;lPP.1 y to
<br />the intf::nJed VIOLk, cllld that it is my .Lesponsibility to ide-oLify vlhat actiolll;l I IlIUl:;\, t<;lhe to
<br />be ill cOlnpliallCe. Such "gencie:;o includebut an: not limited to:^'Department of
<br />Bnvi.r:onmental Regulation-Cypre:o.:i Baybeac.ls, WeLl cHid Ar'eas anu I!;nvirollmentol.l,Jy /:""n:;oi tive
<br />Lewd:>, Water/Wasti:;~'al:t::r 'j'r'eatment
<br />ASulltlll'lfH.t li'loLldii WC:tt=r l1anag~llIent lli:;;t:r:ict-Wells, Cypl.ess BClyhead:;o, Wt::t1cwd An:a..,
<br />Al tt:::r-illg vlalt::rcolll.:::;es
<br />^jl.nLIY Curpo:; ut li:llgillceL",-Seallalls, Docks, Navigable WiitcnJays
<br />AlJ,::pl'lr'l:llIl::nt of l1eodth &. RdlabilitaU,ve ServicC:I::i, EuvirOHllIE:ntal Hea.1th Ilnit-,w..l1:;,
<br />Wa.;>t:eHatcL 'l'Lt::aLmt:::llt, Septic '1'0111)'5
<br />'AU. S. E:nviLCJnWE:ntc:a.1 Protection Ageucy'-At>bcf;ltos abat.:::wE:nt
<br />1 also certify that, jf fill material is to bE: u;:;ed in Flood Zone "A" or "A,etc,", it is
<br />under.::ltooJ that a clr"inaVi::: plall addu:::s:;oiny a "culllpE:n.-:;ati IIg volmllc" viLli bt:: .;>llbud l.ted Hide!.
<br />i,:o f)tepared l)~' a f)L'C.tesSi(illcll engilleer Leg.i::>te.Led in the state of h'loctd<l ptiol, to [ib!:lllil:
<br />i:>l::illi:lIlCe.
<br />jl. pe:cmit i SS\I.:::u shaJl bt:: conotl:lled LO be a license Lo proceed Idtll the VIO!]; i:llld not as
<br />autho,dty to viole,.t:t::, callcel, alt{;;.l, or set: aside any provisiolll::l uf tilt:: technicC:ll COdt::b,
<br />nor shall i.:isuaoce of a pentiL prevent the Building ofticied frolll L:l1ere<ltter reqlllrlng a
<br />correction of err01S ill plans, construction, OJ: violations of Clny code. EVery ljerll1it
<br />i:;osued sh,d] become inv,llid unless the Hork authori~ed by such permit 11'; COIIUllbllUcd Hitldn
<br />::Ii" monllt.::l of i:S::luemce, 0): jf \>%rk authorized by the per-mi.t is sU::Jpended OL' ,dll'lndoncd fo!: Q
<br />pt:itiod of six montbl:l aftcr tht::; timti: the vlOr); il;; COllUlLc:IICti:d. Oni::: 9!l dl'lY t:;KL"msion of tlWti:
<br />may be c:iJ J ('lied fe)): tbb Fermi t \>o/i th fee charge 0f $15. O(). 'l'he (::..tti:lI",i on l;lllal1 be rf:CjI!bl:it:cd
<br />in In1t1ng to tbe: Building Official. An'l'lpproved inspection must: be .Jogged d1ldng cacll l:ii,{
<br />mOllth per::1od, or the projti:ct l,i11 be conl:dder::ed abandoned.
<br />WAR1HNG '1'0 OWNER; YOUH E'AILllRh: TO RECORD A HO'1'IcE Ol!' COIVJMENCEI'1EN'l' HAY HESUL'l' HI YOUR
<br />fAYING '!'VilCE h'uR I1vJPROVE:MEN'j'S 'I'D YOUR PROPER'f'Y. JI:f' YOlJ IN'I'END '1'0 Oh'l'ATN li'HIANCJNG, CONSl/L'l'
<br />WI'1'!i YOUR I.EIWER OR AN A'r'l'OHNE;Y BEIi'ORE RECORDING YOUR NO'l'ICI!; OJ!" COlvJNENCEMh:H'l'. (fObS IJIW!!;H
<br />$2,5UO IN V}~LlJl!: DO NO'I' NEED '1'0 RECORD AND POST A "NOTICE OJ!' COlvn'1E~NCEI'1EN'I"'.
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<br />SIGNATURE; OWNER OR AGEH'I'
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<br />--.-.-----,--.-.. -_.----_._-_._~_._- .'--- - -.--.--.----.----
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<br />SIGNA'rURE: CON'l'HAC'I'OH
<br />
<br />s'rATE OE' H'LORI DA
<br />COUN'l'Y Of' -.----__._.__.___
<br />The foregoing j,nstr:urlI..nt, \hlS acknolllE:dgf::d
<br />Before me this _.____,_ day ot __. , 19_
<br />
<br />by ".__ h_____._'__h__ ,__,"_____,..____
<br />(n<:illle of pE:nJOn ackno\'lledged)
<br />o I,ho is personc:ally knol'i11 to me, or
<br />
<br />S'rA'l'E OF h'LORUlA
<br />
<br />COUN'I'Y OE' .___'__________......,_,_________.______
<br />
<br />The: foregoiny instrulllbnt: was aclmol,/J bdgl::ld
<br />b.:::fol:C: me this ._____day ot-------, 19
<br />
<br />by -'___,.__..____._'__"..___....__,__.,_____"..._______,_ '_h____
<br />(name of pe~~on aCknOHll:::dUc:d)
<br />Olho is pe:rsonally kno\'ln to me, or
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<br />[J who has prodllced_.____
<br />(tYpf:::
<br />and ~lllol]c.lid []did nol:
<br />
<br />of identification)
<br />tal;i;; an oath.
<br />
<br />l~who has p~oduced
<br />, (t yp", ~-rT,l~;)lhi Tl~~~ l:J 011)
<br />and Ilho [] did [lhd II(; t La ].e ",II Oa tll
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<br />Signaturt:: uf per::;on tclking acknoHledge:mellt
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<br />SignOltllre of pe-rl:lon taJ;i)j(J ackuolil dd'JJJlC:lnt.:
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<br />lJ<.\llle typ..d, jJri nti:::d Cd_ :>l:allljli:::U
<br />
<br />HaHl'" typ<;:;d, jlcinted or .:it"'llipt;;d
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