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<br />P-.. NO'1'ICt; OF' DliiJW HESrl'klC'1'IOHS
<br />'I'IIt:l Imdeuiigncd Ilndt::.l:stands t1lat Un:, p,",ulli t lliay be:: l:illbjt::cl: to "deed t"t::,:,t:d_ctioIlS" vJld ell
<br />lIIC:iY be more l:estrlctivo:: tllan City u:l\Jul<>.l-ions. '1'ht; lmdO::l:signed al:i:::illlHl:::::i n"l:iponsibLllty tor
<br />complicll1ce Hi th .my, applicabl e de cd J:",S trJ cr:i Oll.':l .
<br />B. U1JLICIt,NSI!;D CO'N'1'RAC'l'OR,:; ,l\UD COUTI{},C;'l'UF\ Rh;Si:'OHSIBll,l'l'Il!:S
<br />If the ol/lH::r has hired a contractor (n contri:lcL:or:;;; to undertake H()rk, tht::Y may be rl::qllill:ld
<br />to be licensed in aeeur.dance Hith stCitc clnd local !:c:::gulali OllS. :I t the contracLor i Q nut
<br />lic.:enl':icd a:;;; l:t:quired by 1<:11'1, both l-he Ollll<::t and contractor way lie: c.i Led for CI Jill.::.delllc:anor
<br />violation und.:::r state] ,HI. If tht:; miller or JnL:l::ndo::d cont:.l:C:\ctor i:l1:<:: IlIlCcl-t,;lill <:II.> to \~hClL.
<br />Ii cellsin0 l:equi n::InenLs llIay apply for: the intended vW1:k, they elLI:> advised tu conLacl: till:::
<br />City of Zephyddl1.:; buUdillU Dcpartlilel1t, !J13-.788-6611.
<br />E'urtherlllore, if the o~mer has hired a contul.ctor or contrClctors, he il::l advl.:>i::d to hdVt::: the:
<br />conLracto,l: (fj) l:Jign portions of the "Contractor Sections" of this Qpplj cation tor \lhich tlll;:;Y
<br />viiI] be l:l::sporll::lible. It 'lOll, a:> the o~mer sign:;; as thl:> contractor, yuu a,re JndicCltirHJ tlHit
<br />you, fathc:r than the contractor, are rc:sponsHJJe fot" tilt:, wOl.-k. If tile c()II1:rac:lcn \'Ji::dlbl>
<br />'lOll to si gn OIQ cOlltrOlctor thOlt mOlY be i:l11 indicc:ltJon that he i::; not prcJperly IJccllo:led and il:J
<br />noL t::ntit:.1",Q La pcrudLting privilt;:ges in the City of ZephyrllUJS.
<br />l;. 'J'RANSlJOR'l'A'l'JDll H1PAc'J' Ii.EIi;S ANn IJ'1'11,1'1'Y CONNEC'I'ION Jj'Ii;Ii;S
<br />n. CONS'l'ROC'rlllON LH:N LAW (CIlAP'I'ILR 7J3, FLORIDA S'l'A'J'U'/'ES, AS A)'1ENIlb;JJ)
<br />I certify tbat 1, tile aLJfdici:lllL, have bebl! provided Hitll a copy of "Inorid"',, con.,t1,lll:tion
<br />licn LoW - lJollleoHw:n;' s Pr.otection Gllide" prepan::d by the I!']orldi:l OepcatmenL of AgrlcII1\:llrc
<br />clIld COOl:lllllll:::r Affairs. It the applicant i oS SOIU.;OIIE: otllfJr thi:lL the "OWlel:", I ucrity that 1
<br />ilavc::: obl:aincu Q copy of tbe:: above descr-ibc:::d document and promisfJ in good taJt:1t to deliVer
<br />it tu tb<:: "ol-mer" prior. to COmUlellCelllent.
<br />h:. CON'l'HAC'I'O.k' a/OWNER'S M'FIlJAVI'l'
<br />I c.;rUf'j tlt",t i:ll] tile Jntormeltion ill thi:;;; appliceltion 1.s aCC\lreltl:> and thelt all \'wr.k vliIl
<br />be ch)IJI:> in compliancl;; \,il_th elll applicable lal-Js rogll10ting constnlCtion, ~oni.ng, ,md Jand
<br />dc:::velofJiCili::lll: ,
<br />Applicatiul1 is hereby IHi:lc/e to obtain a penult to do \lOrk and Jnsti:lllCltJon,;l,:, jndic~ted. I
<br />c=rti ty that: lHJ viOrk O.L in:::itallclt:lon hell;:; commenced fJl:ior- to issuance of. Cl pe:nllit i:llld that
<br />ell I l'Iorl. \Ji 11 b.. performed to ITil:>e L titandards of all laHs r..gu.i ating conQtnwLi ()Il, Ci ty
<br />code:>, zoning lli::Yllli:lLion.!:i, cllj(l T,wd devt:::loPlllent r..gulations in tht;: juri::;dictloll. 1 all:lo
<br />ct;:rtify that 1 under::;tand U!aL the regllli:ltions ot other govormnental agdncit::s may apply to
<br />the:: Jnt.::nd.:::d I-JOrk, and that it is my J::csponsibility to iuentif~{ ~Jhat actiollQ I Imll:it Li:lke:: to
<br />be ill COHll) 1 lanct::. Such i:lgcllcies incllldebut C:\re not ] irni led to: kD.:::partlllf:lnt of
<br />h;nvi_J:onlill:lnti:il Ri::gulQti.ow.cYPJ:c.:;.:; baybeadfl, Wetland Ar-ca,s and Ellvironlilellti:llly 80::11Si ti.Vt:l
<br />Lawl.::;;, \fJatl:>r/WQstl:l~JQtt::r. 'J'r'ei::ltwcnt
<br />k::>uIIUHIi:H:jl !florlc.ji:l Water l'1i:lnag(;lllent Ili:>trict-Wells, CYPl.c.:os Baybeads, W..tlel/ld Areal;:;,
<br />J'.] tt::dng \flatercollr:;;;c:>
<br />AAnll~1 Cul:f'.:; ut EI,gillccl.ti-BcC!Halls, Docles, HavJgabTe Wat",n.J",Y.:>
<br />"IJcpc:ll:LllIelll: of HcalLb &. Re:llCibilitativ<:: ServicE::l:i, h:nvil:omlle/lt:0I1 Hdalt:h lJlIit--W.::LI.:o,
<br />vli:l:> t I:llla Le r 'j'l ea Llllcll 1:, Sep l: i c '1'O:In),s
<br />klJ. B. li:nviLomnental I?rote:L:tion Agellcy.-A:;;be.:;tos abat:emfmt
<br />I al",,-, cettit:y tbal, it tiLl H1aterial i.s to be used ill jj'lood Zone "A" or "A,i::Lc.fI, .it is
<br />undcL::ltood L1li:lt a clLainalje pli:w addressi.ny i:l "compen::>ating volUllle" viLli be :mbmitLecl Hb:icb
<br />i.1;:; [.Jl.cparcd LI{ i:l f)l:utt;::::islunal eng.llleer registe:n::d in the State of I!'j o,dda pri 01: to IHHlIIl.l:
<br />1.:Hilj,:IlICC: .
<br />P-. pt::LllIit j st.;ued I::lilall be constrlled to bt;: a licenSe to proceed Vlitl! tlll:l~JOlk i:1I1c/ nol: a::;
<br />authority to violate, callcel, all:er, or s<::t asi.de i:HlY provtsjolll:l of tile teClllliCC:il codCQ,
<br />nor l>balJ issuance ot a pernli L prevent the Buj ldj ng Offici ,,1 from theLI:>Clftt::! ((::(jILi ring i:I
<br />correction of ertors ill pJ ans, constructi.on, 01; violations of Clny code. Every lJenni t
<br />issll!:::d ::;ha]l becom!::: Jnvalid unless tile ,lOrk autho):'Jzed by sllch pennit Jl;; C()jIUllt:lIlO~d ~dtldn
<br />~ix l\\ontlll:l of i.:;~uancc, or. if \'Iork C:\utlwrized by the peunll: j::l SIlSpclldcd 0.1.- abi:lndoned fo.i- a
<br />period of o9i... montbs ,dter the time tilt:: vlDr!> i::; conullenced. One 9() day 8:;,1:.,n::lioll ot tJlIle
<br />may be alJoHed for till:> permit Hitl! fee charge of $15.00. '1'hl::: (:::;;tensJon :>bi:ll1 be H:qIH::l:it:ed
<br />in I'ni tlng to the Buj lding Otfici.a1. An approved inspect:i.on must be jogged dU.i--inU eaell l:d H
<br />month period, or the proje:ct Hill be conQidered abandoned.
<br />WARNiNG '1'0 OWNER: YOUR FAILURE; '1'0 RECORD A NOTICE OJ!' CO)VJl'1ENCEHIWrf' HAY HI!:SUL'J' Hi YOUk
<br />PAYING TWICE If OR IMPROVEMEN'I'S '1'0 YOUR l'ROPER'rY. I I:!' YOU IN'fEND '1'0 Ob'I'A TN l!'lNANCJNG, CONSUL'!'
<br />WI'rH YOUk LENDER OR AN Nr'l'OHNEY Bl!~F'ORE RECORDING YOUR NO'I'ICll: Of CUIVJl'IEI~CE;)'1h:II'l'. ,10b8 UNfJli;k
<br />$2,500 III VALUli: IJO NO'!, I~EED ')'0 RECORD AND 1:'OS'1' A "HO'neE OF COI'1lV1li~NCElvjEN'J"'.
<br />
<br />'~()lJl)l'j'IONS OF' PH:Rl'H'I' AF'E'IDAVI'I'
<br />
<br />SIGNATURE; OWNER OR AGEH'l'
<br />
<br />-----ct~~~~~~2___
<br />
<br />S I GNA'1'URE: COH'1'HAc'fOH
<br />
<br />s 'rAT Ii: 0 F' F'LO H I DA
<br />COUN'1'Y Of -- '__
<br />'l'be tor=going instrllfnent Has acknoVlledged
<br />Befort:: m.. this ________ day ut _._______, 19___
<br />
<br />by ..__._____ ._______.__.____ _._____ _M___.~.__.~___..4_.____
<br />(nCillit:l or per SOH acknowledged)
<br />o \-Jho is pl:>rl'wnal1y k1101'In to liIe, or
<br />
<br />S'rA'l'E OF fLORIflA
<br />
<br />COllH'l'Y Of' ._________....___.________.______ ____._______
<br />
<br />'l'h", foregoi.ny instruHlbnL Has acknovJIt:dgad
<br />fj e for t:; me t h i::l ._____d i:l Y 0 f ..----.----- --.--- , 1 ~
<br />
<br />by __ ___.___."___.____., ____ ._.__ ____.._.._,_.___.._.__._.___.._______ _____._ ._____.____
<br />(name of pctson acknowledVe:d)
<br />OJho is pbrl:lonally known to Illl:l, or
<br />
<br />[J vJho bas prodllced______._
<br />(type
<br />ami YJhorJ did l] did no t
<br />
<br />of idenLificHtiol1)
<br />take an oath.
<br />
<br />I] \lho \!C:\,S. produced___________.__.. ..__._____0_._
<br />(type uf idl:>nli ricCllioll)
<br />Cind vJho Lldid LlHd nol La)ie all oCltb
<br />
<br />._._______.4.___________ ___..___......___ __'._ _.__._._..._~_...__...___.
<br />
<br />Signature ()f pl:!rl::lon taking acknovJledge:ment
<br />
<br />SignC:\tllr:8 ot pel:son tc:lk.iny CicklloV/.l t::d(JfHc;nt.:
<br />
<br />ii~.l;-l~---t y p e':i~-l~-J: i ;~t-':';~i-~ ~--~-t~-~;;~~-~-d--u-.
<br />
<br />..---.---.-------..-.---.-- -...-.. ... ...____.._.M_,___...._..____._ ..'__.___..__. ._...u..._~.___..__.___
<br />
<br />Naill<:: typed, \Jl:i nte::d or Stcllll)H.:d
<br />
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