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<br />CUJIUI'1'10NS OF' l'ltl-ll'1I'I' AF'FIDAVI'I'
<br />A. NCll'lCl!: Of' llE:JW HES'I'IUC'l'IONS
<br />'I'lltl unde:r::;igfled ll11dt:.!:stands till:lt lids penlli t may be: subject to "deed Lc",trictiolls" ~ild ell
<br />Ill.. y be lUO J::d res t r i eti Vb tbi:ln Ci t Y l"'\JU) a li on", . 'I'h", lllldl:: r s1 glled C:U::i I::i lune::; n::spon s j bLl i t Y tox:
<br />eomplii:lncE: i'dl:h Clny' appli.cC:ible d",<::d Lestr'ict:lons.
<br />B. IJIILIChiHSl!:D CCrH'1'RAC'l'ORS AHD CON'I'HP,C'l'CJR Rl!:SI:'OHSIBlJ,I'l'Jl!:S
<br />If the OiIlH::1: ba::; hi,red i:l cOlltractor or contr"ctorl::i to tmdertake Hr).!:!;, they may Le L;::quin::d
<br />Lo bE: lic<:n::;ed in I:ICCOrdallca \Ji,th ::;tat", and local regulaLiollO:>. If thc C(Jntri:lct:ul.' is 1Iot
<br />licenf>E:d a:::i r.;quired lJY l"Vi, bo.th Lhe U\mer and contractol.' Hiay b", c.i ted for i:I iii] ;;;ctelll\::anor
<br />violation under st.ate laH. If the mllJer: or intendt::d contrl:lctor aJ:e \1I1Cer.t"d.n oil> to I.llal.
<br />licensing requi reme1l1.:::i lIlay apply tor the intended \'>Iork, they al:<; <:Hlvi.:>t:et to cont<:wt tlie
<br />City of Zepllyddl1::; building Departlllent, tlI3-.'188-6611.
<br />E'tu:tlit:l.HlOrc, jf t.he ui'mer ba:> ldl..'cd a contractor or contri:\ctor:>, lie .i/:l adV1:::ied to llCive tht::
<br />contri:lcto.l.' (f>) /:lign portions of the: "Contl.'actor Sections" of thi:> i;lppl.i cation tor \Jld eh tb,=y
<br />will be responsible. If YOII, as the owner :>igns as tbe contractor, you are indi~ating that
<br />you, J:athel.' than the cOlltractor, are responsible for the: Hark. If tlu::: contractol i'J1:>h,,":i
<br />~'ou to :>i gll at> contJ:actor that Inay be an indic",tion 1:l1at h<: i:::i lIot prop.::x:ly Ii cenSed .:lnd ij;:j
<br />HoL t::lltit.1 ed to pe1:'llli tting privil.::ge.:; in the Ci ty or ZciphyrhUl.:;.
<br />C. 'I'RAN S l'OFi'l'A'I'J ON H1PAC'1' }i'EE:S AN n IJ'1'1 LJ'I''f CONNEC'l'ION fEES
<br />n. CONS'I'kllC'rUToN L1JLH LAW (CIlAP'I'Ek '7 J j, E'LORIDA S,l'A'l'U'l'ES, AS AMENlll!:D)
<br />I certify that 1, thl:: appllcant, have been provided with a copy of "li'lor,i.da'ti Conl>tl.ucLJon
<br />I ien Law - HOHleO~ilH::l." s Pl.'otection Guide" prepan::d by l:h<: c'j oridi:t Oepcnt.lIicnt.. of Agri cllltla',;
<br />and Con:::iulIlt::,[ Affairs. It l:he applicant is SOlUo;Olle otber' t.hat the "O~IIIO;:l.'/f, T ()ctify that J
<br />hav<: ubti:tined a copy of Uu::: above descL'ib",d document and promi;:;e in gom! ra.ltll [,0 (j""Uver
<br />it tu the "cJ\JlIE::r;f {Jrior' teJ conUllellceHlent,
<br />c;. CON'fHAC'l'CJk' S/OWI'IER' S A!1'E'IDAVT'l'
<br />J ccrt.ii~1 l:1I..1: a,1} t:llt: JntormaL.Iun ill thi.::; application i.o5 accurate and 1:1I"l: (:.all IH1!k vli]l
<br />be dOIH::: in cUlilpliancl::: ~Ji.lll all applicable laHs rcgul"ting constnlCtion, :l;Onlllg, "nd l"lill
<br />dcvt::loPiClO::lIt,
<br />Applicatiull is hereby made to obtain a permi.t to do \wrk and installi:tt:lon a:::i 1I1dtc~tcd. J
<br />cerU ty t1lat: no Hod, or 1n::;tal1ation IIi:ls commenced priol.' to i:::i.:manct;: of a penlli L "ud that
<br />all i"01" ~Jill be performed to meet .:;tiwdards of all laHs n::gulating consttllcLioll, City
<br />codes, zonilHJ r.::yu!atiolll>, alld li:llld de\ldloplHent regulations in the juril;:idiction. 'j c,]l:W
<br />Certify t11at J lInder::;tand thC:lt thE:: r<:9ulationo5 of other (jeJvernll1<;ntal ,l(jelH..:iO:::::i lllay C:lpp.I y to
<br />the InLelldcd \wLk, and [hat it is lOY .Ld:>ponsibility to iderd:ify v/h"t actJoll.s 1 llHU:il. tahe 1..0
<br />be ill COlnlJ 1 iancl::. Such agcllcie.:; incl udebut an:: not 1 imi t.o::d to; ^"Depal.t:ll1t::nt. of
<br />E:nvilunw.::lItal Regulatiow'CypLe.s;:; BayhtlQd~, Wetland Al:t::as and EnvirolllHellti:tl1y ,';)blll:d tivt::
<br />Lalld.:;, Water/Wa~t:eHC:ltli:r 'l'l'eatwent
<br />"SulltllllC;:;:il lfloric.lQ Water l'1anagt::lllent lli::;trict-WeIJs, CYPld:::SS Bayheads, W",t.la/ld Area::J,
<br />Al tel.illU vJatt:rcour:::io::s
<br />AAnllY Cor:~.:; ut illllgillC':'l.loi^'Sc.:tlJalls, Docks, NavJCjable Wat.:.r:\JC:ly:::i
<br />AIJ"",~cjr'tlllf:;nt: uf Hli:all:h & Rcllabilil:",tJvo:: Services, t:;nVil'PlUllcntal Health lJll1t-'Wcil1s,
<br />vlC:lo::ltel'iateJ: 'l'rl::aLIII\::lIt, Septic 'l'C:in),s
<br />klJ. tj, li:nvil.omnentOi] I?roti::Gtlon AgO::llCy"Asbeflto:> abatement
<br />I 0110::10 certify that, if fiLl lfIaterial 1:::. to bt:: lIs<:d in E'lood Zone "A" or "A,l;;ll:G.fI, it i:>
<br />undeJ.:::;tood that a drainag\:: plall I:Iddres:::iiny a "compen::;ating VOllllllefl VILli bo:: ::;ublHi LLecl \-lldc:b
<br />i.s [Jlepalt::d lJ\, a fJ1'0tessieJIlal engineer l:'?9ist.ned in till; 'state of c'Jo.l'Jda priol to penult
<br />i.::;.:;illi:lnc:<; ,
<br />A pcrlllit i s:::iu.::d shall bl:: c:onstrlled to bl:: a lico::nso:: to fJ.l:oceed \dtll tht: \Jorl. and !lot a.s
<br />C:luUI01.ity tu violc.tl:::, callcel, a11~cr, 01. st:t af>ide any plovision:::i of tlle tl::cllnici:tl cOdl:::l::l,
<br />nor .shall i::isuance of a pernli L prevent tl1l; Bui leli ng Offici al from tben::cOIfter n::qlLirlng a
<br />correction of error.5 in plans, construction, or violations of C:lny code. Every IJennit
<br />is.::iIl,;;;d ,';illa1l \leGOHl,;;; invalid IJnles.:; tl1e HarK authoL'1~ed Ly such permit: is COllUHbllCi::d \J-itldn
<br />.:>il' monUI.s of i:::il:luance, or if l'>Iork author'ized by the pE:llnit if> su.spcllded 01.- abandcmed fO,1- C:I
<br />pt:.r:iod of si.. montb:::i after the time the vlUrk io:; conmlcnced. One gO day e<(tell.siol1 of tillle
<br />lllay be allcJHed ICJr the permit Hith tel::: chal'l;Je of :ilIS.OO. 'I'he "'<iteli.:;lou .sllall IJC l.eqllbt:it:ed
<br />in ~ni tiug to the Bui ldil1g otfici.al. An ",pproved infipection must be 1 o~.lVt:d dllJ:il1U CC:icl1 .s.i H
<br />month period, or the proj~ct viili be coni:iider-ed abandoned.
<br />WARNING '1'0 OWi'JER. YOUH Ji'$>.nURl!: '1'0 HECORD A NOTICE OJ!' COIYJl'1ENCEJvlEWl' NAY REtlUlil' IN 'fOOk
<br />PAYING TWICE !1'OR IMPROVE:NH:lj'l'S 'J'O YOUR l"HOPER'rY. I f YOU IN'fEND '1'0 Ob'l'A IN li'IHANCJJW, CONSlIL'l'
<br />WI'rU YOUR LENVER OR AN AT'l'ORNEY BI!~mR}!; RECORDING YOUR NO'J'ICE Of C01YJlvlENCH:MEII'l'. .-foBS IHWEH
<br />$2,500 IN VALli!!; DO NOT NEED '1'0 RECORD AND 1'013'1' , ICE Of C01'1l'1E~NCElvJEN'fN.
<br />
<br />
<br />-, ., ,OR .......
<br />COUNTY Of _. -+-R UJ....!________.~-_.--...--
<br />'l'llt: ton::'.Joi!lg in.strurnent Vias acknoviledged
<br />Before 1lIt:. til1:> __~..CL. ~A1=\fOFt~..tr ' ~fJ~1
<br />by ,._______.J.Q\::Il:i_._______.__.__._._____"_____
<br />.....-+rraml::: of per.son cocknoHlcdged)
<br />er;,/ho is personally kllCJi,m to me, or
<br />
<br />[J HIIO has produced...____ _...._._._..______.___
<br />(type of identific~t.ion)
<br />
<br />~:1~~ lKWl' ~~ (Jat11~__._...
<br />
<br />SignatuLI:: ur p<:'!::iun ti:lldng ackno~J1edgement
<br />
<br />ll~i~l::;h- ypc~;L1mr~~~1~mE s't~0'.'
<br />Notary Public, Slate of Florida - t
<br />My comm, Eixpires Sept. 4. 2004 ,
<br />_____s'.sr:;m. No. CC9f:5032
<br />
<br />
<br />'LORTDA
<br />COlJH'l"f OE' .._~ -:1'/0<. "~p.._!<./ ".___..____________
<br />The foregoing inslruHli::::n l: Wi:tl> a cJi.rlO~.l cdgi::::d
<br />Boi::fore me thi.. ,_~.ti..Jlay of.-L!!:t~--f ..g~:,-_
<br />by ----.".----.-.dOHN-MAFffB:RANA-":"---,--.-..- ,.
<br />.----\-frame of person acknovdedVli::d)
<br />~ i.. person&lly knoWl1 to mt::, or
<br />
<br />[] iiho has pr-oduced
<br />. -----.-.---.---.---.--., "'.'--. '.-
<br />(type of Jd"JI!li riccOItJou)
<br />
<br />an71J:;; ~d ~~~I o~th
<br />
<br />.-..--- '-.------,~---~.---,.-...--.- -~-,-..- _ -..,..-___._.,.~..~'"_'N___.
<br />Signature: '01' person taking ackllo~Jll:llhJlIIt::nl:
<br />
<br />_u__ _~.__ _ _ ,-::;-'_= ::::_-.._\". __"__ " . "___
<br />NC:iIl\e: t\i~i)ltltla.rBna1cd 01 ~~l::l
<br />I nrLORIS i:\NN NAT!l,~, \
<br />I ",., Pllbi;" ::;1:"" (Of n. nda \
<br />'\ ! 1 d 1 - ..., ~ t",' n4 '
<br />" l .ff! r ),.-~ 'v _
<br />
<br />1,_.._.... _"... ."....- --..-.... .
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