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<br />\.~().\\~JJ:ll.11Ul'~::3 Of' p}i~Hl"rIT AF'FJ DA'VIT
<br />
<br />P.. N0'1'lCtl OJ!' lJt;EDr HES'l'JUC:'l'lOH::>
<br />'I'll.. IlndeJ:l:iigncd IHldcl:st~nds tll<lt LIi:L;::i p~;l:mi t lilii\' b,,, .:ilIVj ccL to "deed l:c.">trietiollS" ~lltJ cll
<br />way lie more Lestl:ictive tllan City r'=(jlll~llion.">. 'l'he llild'::.:rsigned ea::;",lllHe::> rE;;::;ponsll.,jlJty; tor
<br />compllomcc I.JJ th any, <lpplicClvle d",cd restd.cl:iun::;.
<br />B. UI1LICI!iNSIW coN'I'AAC'l'ORS AHD CCJl\ITJ'tAC'l'OH RESI:'OHSIBl1,I'l'IES
<br />If the Ollller b~s hired a contr<lctor or contractor", to llndel:take Hork, they Hlay be J:i;quin:,d
<br />to be licen::led in QecoL.dance ~Iith sLeate and local .ceglllaliolls. It the C(JUtractor il:i nut
<br />lic:elHHH.t a", l:equir.:d Ly 1 ClI'I, both Llle o~Jjjer and contrdCL:Or way lit:: cl tcd for i;l wi ::;d<:llll<=anor
<br />violation Ullder ::>tate Lnl. If the O~Jller or intended uontnlctor eal:e IIlICbl.t<lin I<lS to lihi:d.
<br />li censinlj reqlli rcllienLs lliay apply ror the intended \~ol:k, they i:ll:t:: advlscd Lo conl:<I(;t tltb
<br />City of Z.::pll~'!m1dl1Q buLldIng Dcpartlllt:nt, ~13-'7BEl--6611.
<br />E'urtlltlrmorcj if thE< 0\-JrHH has lilr-cd Ci cOlltractor or contn;\ctou:i, h;;; 11;; adVl::ied to IIQve till::
<br />contrQcloJ.: (s) sign port1.01ls of tile "Contractor Section::l/! of tllis appl.i cation for Hldch tllt<l,/
<br />~lil1 be respoll:dble. If you, as the o~mer s1gns as the contra<.:tor, you cH'~ indicClt:1ng that
<br />you, father: than the cOlltl:aGtor, are responsible for tile \-Jol:k. If the cC)lItractor I'Jishes
<br />'lOll to .:11 gll Cil:i contrOlctor that lnay Ub Oln i ndiccd:ion that ht: i."> not pnJped.y lJ c\:,;;lIl:ied and is
<br />nul. I::nti tl c::d to pend tting privileg-e.:l in the C.i ty of Zcpbydlills.
<br />C. 'l'RANSl'OR'I'A'T'!OIl H1PAC'1' J!'EH;S ANn IJ'l'IL!,}'Y CONHEC'I'ION F'EES
<br />n. CONS'l'kllC'rUTON Llf;i'I LAW (CHAP'f'li,k '713, - E'LORIDA S'I'A'l'U'I'ES, AS AlvJENllhal)
<br />1 Gertlfy that 1, tile appUcant, have been provided Hitll a copy uf "v'lorida's COIl.\:ltr:uctlon
<br />liell Lenl - JjolUeo~mt::r' S Pr:otection Guide" prepan:d by the InoridCl llepartlllellt of Agdcllltur",
<br />alld Conl:HlIl\et AtfaiLs. It tile appli cC:lnt 1 s someone oLller that thr::: "OIJllli::r.'", I Ui:::rit'l lhQt 1
<br />haV<:l vbl/;lined a copy of the above de:sc.r-ibed document and promi::le in good taJtll Lo dli:llver
<br />it tu tbe "mlller'/ I;1'ior- tv C::OlIUllt::IICelllent~.
<br />B. CON'llHAC'I'Ok' S/OWNER' S At'E'IDAVI'i'
<br />I cer~.Jty l:hat all t:I1<= informaU.ol1 ill this applicatJon is aGcurate and t11i:lt ,,11 ~J(Hk Hill
<br />be d(jc!e in c.:omplianc:l; ~liU! ali Olpplicable lonl.:> H:lguldting constnlCtion, :Gonillg, and land
<br />dcveloplCl",uL,
<br />AppliGation Js heJ.:eby made to obtain Q penn1t to do \-JOrl;: and installation al> illd1c~ted. I
<br />certi fy tbdt nu \lOrl> or in::;talldti.Ol1 hal::! cOllimenced prior- to iSl::!llanc<:l of Cl [H::uni land thdt
<br />all I.Hn\( ~Jill be performed to mt::eL standards of all laHl> n:gulating consLU1UU(in, CIty
<br />codes, zoninlj r.:.::glllaLJonl>, dlld lalj(j devt:lopment regulations in the jlld.::;dictJoll, 1 ,'1.1::;0
<br />certify that I llnder::;tand thClt the regulations of other goverwnental oHJelll:.:1<:l::l Hlt:iy app.l y t.o
<br />the inte:nded ~IOLk, t:ind that it 1s my .c:espons1biliLy to idecdify ~Ihat action::> I lm,sL t,die to
<br />be in cOlilpliancl=. Such Clgencies include but aL-e not limited to: ),-Dcpartment of
<br />Envil.omnentid Hegulali_on-Cyp:r:-eso:> BQyIH::ael.:i, Wetland Ar:t:aS and Envi-rolllllelltally 8 ",II::; i t.iV<:l
<br />],iwds, Watet/Waste~Jat=r' 'l'rei::ltlllent
<br />";:>ulltll\lc::;t JJ'loricla Watl;;J:- IvJ"llIagement lJil>trJct-Wells, Cyp.t:esl> Baybcad,;;, Wetli;llld Area:;,
<br />Al ter-illY viat=r-collr::;r;;S
<br />"AnllY Corf's ut li:ljgille.;r.:;--Se~\Jalls, Docks, Navigable watenJi::lYs
<br />A!J.;:par-tlllent vf Health 6< Hdlc:lbilitat1ve Serv1cC:l;:i, t;nvironmental Health Unit-.\"iel1s,
<br />Wa:;telun:er 'J'rcatllll;;lIt, Septic 'l'Olnl,s
<br />"U. s. h:nviromne:nt~l I?rotcc.:t.ion Agellcy'-A::>be:fJtos abat:ement
<br />1011;;;;0 certify that, if fill Hlate:rial i... to tJe used ill Inood Zone "A" or "A,etc.//, .it: i:o
<br />under.::ltood that a dra.inagc plall addres/:d.ny a "cumpE:nsating vollllne:'/ "ILl! bl:: ::I(l\.llld Ll:flej \olldch
<br />1::; [;LepaLcd Ly a [;l-Gfe::lsic'lIal engIneer regist<::red in the State of B'lorJda pdor. to l'bullit
<br />i S.::llliH1C....
<br />A pl;;rlllit i sS\I.;d shOlll b<= COl1.::itrlled to bt:: a lJcens.:: to proceed I'litb th= ~Jorl, and not iHi
<br />autbority to vio1Cilte, Cancel, alter, or ::let a.\:lid€: any provtsion:::; of tb... technical codt::s,
<br />nor sball issuance ut a penHi t prevent the Bui lelJ ng Offici a1 from t\1erei:lftcr rcqllirj ng a
<br />correction of error::> in plan::>, construction, or violettions of <:Iny cod",. EVerY}JI:H:lOit
<br />il:islled ..11t:ilJ becollle inValid unless tile HorK author'i~t::d by.sIlCh per'wtt Ji:i COIlUlIl:lllUed IJitldn
<br />.:ii-x montlll;l of ii:il:iui:tnce, (H if I~ork authorized by the penllit: 1:0 suspended Ol.. al1dlldoned for I<l
<br />f!;;;riod of 131". montl!::> C:lfter the time the \olod. i", cOllullt:':nced. One 90 day eKlension ot tillle
<br />may be allolJed tc;r tile permit Hith fe:e charge of $15.00. '1'\1e b..,tl=lI::>ion ::II1Ci111,.:: rflqubl;itl::d
<br />in ~Iri 1:1n9 to the Bui lding Official. An approved inspectJon must v.. loggt::d dln-Jng eaell ..i"
<br />month period, or tile pr:ojflct Hill be: consi-dered abandoned.
<br />WARNING 'f'O OWNER; 'fOUl-{ E'AILURH; TU RECOHD A NOTICE OE' C OIvJ111 EN C ElvJEN'I' NAY HESD!.'l' IN "{OUH
<br />PAYING TWICE t'UR IHPROVEMEH/l'S '1'0 YOUR PROPER'ry. H' YOll IN'rEND '1'0 O{:)/I'AIN b'iNANCiNG, CON8\iL'!'
<br />WI'I'1i YOUR LEIWER OR AN AT'l'OHNEY BEfORE RECORDING YOUR NO'I'ICE OE' CDlv)1vIENCEMt!;N'I'. ,fObS \IlWH;H
<br />$2,500 IN VALlJH: IJO NUl' NEED '1'0 Rf;CORD AND POS'I' A "NO'!'} eE Ot' COlv)lvJE~NCE:Jv:lBN'I"'.
<br />
<br />SIGNATURE; OWlmR OR AGEH'!,
<br />
<br />___d~_::<~~G'~_
<br />
<br />S I GNA'i'URE: CON'l'HAc'roH
<br />
<br />S'I'ATE OJ!' fj'LOHTDA
<br />COlm'1't Of -- --------.-.-_________
<br />The tOl:eyoing instrument ~~as acknoVJledyed
<br />Before Hie thi", __.__. day ot _____ , 19~
<br />
<br />Ly _.._____ _______________ .__.______.,____
<br />(Ilallle ot person i:lcknoyJledged)
<br />o ~Iho is pen;onally knol'Jn to rue, or
<br />
<br />S'rA'l'E OF l!'LORIDA
<br />
<br />COU N'l'Y 0 E' ._________...____________________
<br />
<br />'I'lle foregoJng instrument Vias Qclmow:t cdgt:d
<br />Before lIle thil> ______JlC:ly of---------, 1'J
<br />
<br />by _ .____..___._______.___...__.___.______..__"___..__________._______
<br />(name of person ~cknowlbdVed)
<br />[Jlbo i::; personally Imowll to In<:l, or-
<br />
<br />[J Hila ha::> prodllced_______
<br />( type
<br />and \'jho[] did l]did nul
<br />
<br />of id<=ntificCltion)
<br />talic an (;ath.
<br />
<br />[] Hha has. produced______________ ___________. . __
<br />(type uf Jdt::nli-ficCltloll)
<br />and \Iho LJ d iLl [lhd 11(; t: Ii;}; c clll ua tl1
<br />
<br />.-.--..---.--------~~_._--..-._.~.-_.__ ..._ _ _..____~.,_._.w_____
<br />
<br />SJ gnatuie of person taking ackno~Jledgernent
<br />
<br />Signature of person taldng OlCkllOVI] edument
<br />
<br />Name typ<=d, Vel nted or stamped
<br />
<br />-- -----_.----~._------- .._.__.__.,----_._--_._.._._-+-_.__.._-~_._-".,.._._.----,-~
<br />
<br />Name typed, printed or ::;tC:;\llipt;;cl
<br />
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