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<br />S'f.A'l' E: OW FLORI DA
<br />\'0UNTY OF __,_
<br />1'11.. r0r",goi,n9 instrl.lfllent was a<.;knoHledged
<br />8"'1:u,.... me t,h~.. __'_._ day of _ l~
<br />
<br />\, Y ---___ - ..____.__
<br />(name ('~:t l"ei:sbn ..cknuwl~ctg<iOc:l)
<br />[] ",l,o is p"L",,-'ni!llly known to '"'''' or
<br />
<br />i:li : : 41 ~:'il; T iiF ZU~irH I LLOlNS OF PERNIT AFF':rOJWIT
<br />-E _~~D RL~~~~'_~~'.)l~~
<br />>1'h.. und'erailJr...d undecBcand", thqt thi:;, permit IlIay b... subject t,o "deed leatL.:l.<::l1 ionl!!" wbi.ell
<br />may 1.>", mOL'" l:eat;riat.ive than Cit;y regulation... The 11nd;!U::Signed aS$'unea rt!oospon.:stbil~ty fOL
<br />comp.lit-nee I'lith 'lilY €lpplic..ble deed re::st.t:icti.0ItS.
<br />B. lJNLICEN8EfJ. i;CJH'l'RA<::''l'(lHB AND l.'ONTR.'-I.C'L'OR RESPOlJS.IBTI.I'L'IES
<br />It tl,e owner haa hired .. ccntt:acto~ Dr contractors to undertake work, they may be required
<br />to )"... Ij ",<>.""ed i.u accr..>.L-dan<:!e ;,J1:"h Btat~.. and looa.1 regula.t::1.01113, If' the l)ont:raol:or i., not:
<br />J icells.::d "'... requJ.LOed by .1....", both Cl,'" Oh'neL and oc>ntrc.ctu.l: may be c:.tl:ed fQr a m1...d""n""'hor
<br />vie,lat.Ion under S1:&t:e li"'1. It: th.., OHn.." C.r In....ended (JOntL/!tctor ...r", lHI(j~rta:1n as to Hhat
<br />J I censJ.ng requ.i rement... may apply tor the int,l'!nded "102 k, they are advisad too .-:JoncZI,ot t.he
<br />C1ty ~f Zephyrhill.. Buildin9 Department, B13-788-6cill_
<br />FlJ.Ltlle.t.-Ulox.:e., Lt:.- the OWnSL- hC!!ls Jll.t.:e.d a QUnt.t.-a.=to.t: or Llontrac.:1:.cra, h~ is ac.ivised to have the
<br />cw"C;r....'.'tOl: (e) ..ign portic.ns of tho;, "Cr~ntractol: Se.cti.oILs" of this appl.lcation for whi,~h 'ch.
<br />l.,i) 1 be "'''''''ponsi hIe. If' you, a.. the ',Wr>er 13ignB <IS the c:ontracto1:', YQI,l a.re lndi,:~t;in9 tha
<br />,'C'L1, l.a._her than t'he cont:raatoi, ar'" L'e"'pon",ible for th"" ~'c>rk, .If' the con1:ractor "iishea
<br />,',," t,:, ...1.<;jn ''is cont:ract;or thac may be an j,ndioat.1.on tbat. he 1." nat prapo;.l'1.y l.:l,oerU",.d and j
<br />",~t ",nt'i.clod to pennitt1.ng pri.vilega" in the. City of Zephyrhi.Il.8.
<br />'I.'RAN,..,PUWl'ATIO)'1 IHP1"CT FEES AND l1TIL1T"{ COHNECTIQN FEES
<br />1'. CONB'I'R\ICTUION LIEN LP.W (CHA.PTEF< 71::l, FLORIDA STATlJTES, AS ANEtH)El'1)
<br />I ceLtify that :r. t:h.. appJ.1cant, have 1"Oll'1) Pl:c>v.tded wl.th a copy of' "E'lo.rJd..'s COllatr\lction
<br />11<5:11 L..~, -- H(>lneO'HI'!:\J:' '" P.t:ot.eDt"ion Guide." prepare.d by tehe FI.orl.da VtlOpaL'tm..nt .;:,f Ag:t:1.cultur....
<br />","d con:;OUmeL.' AffaiJ.:6. If the appl1cAr,t1... I>omeone ot.h"r that the "O\Y(JIiU:". I Gcrit'y that r
<br />havo:. 0bt..Jn..d a copy of the abov= described document' and promise in good fa.1.th to deliv<!Ir
<br />lot. to the '"'c"HrJer'" priDr 1:u c..=OffiIT\enCQnlent.
<br />f:. CON'I'RAC'rofl/ S/OWNEH' B AFH'IDAVIT
<br />I certify that all. the information ~n this appli~~tioh 1s accurate anct tl,at &l.1 WOEk will
<br />be done in Clompliance Hit:h 0111. applioable l.aw~ regulating COl"ll:'t.rllcti':-n, :i:oning, and land
<br />ci.C:::\J~lQpn\ent'_ .
<br />Applioat::1.on is h",reby mIS-de to obt'aj_n Oil .pe.t:rnjt 1:0 do wo:d, and installal-,,1.on as in(~.1oat:ll>d, T
<br />"o",:ti:fy that no "ork or in",tallatj OIl haa Gomq''''l1cl!Od p:t:.1or Co .J.aSl.lanc.e of <lI pe.Lmit and that.
<br />011 ..10 r I\. ~Jj.ll be pc!:feorme.cl to meet Bt'.and~rdlil of' all 10111.6 i:..g\.ll...t'.i'ng OOllaCi:\lClt:Lon, City
<br />codes, ~oning Legulationsr ahd land development regulat~Dns in th~ jlIL1sdiat~on. I al..o
<br />ucetify LhatT understand that th~ Legulations of ather 9ove~r\mental agenciee may apply to
<br />th", :tntended \-'lark, and that it i.oiI If\Y J.:t:lSponai.bi.Lit:.y t,o identity "~ha.t aationZl I InlUit take t
<br />be in c<>lop.Liance - BUell agencies include but a:t:e not limited t,o I "nepar.tlnent nf
<br />ffinvi10nm<5:1.t~l Regulation-cypress 8ayheada, Wetland Areas and Environmentally Senet~iv~
<br />La ..des, Waca t: !W.... t.a\... t:eL T "..lit t.men t
<br />'::;~ut'.bHe..t H"lorilJ", W...ter Han..gement Dist:..ri.ot'-We1-la, Gyp...e",... Bayheads, Wet.1.and .lu....aa,
<br />Al teL.'lng Wat.eL.'courses
<br />..U,lTllY COL'pS 01: Enginee.l..:::s-SeaHalls, D0'-.:ks, 1'.]a,"J.gablc!l. We..t':e.t.:1.Ja!lYs
<br />'[Iefd.,!:'tment:: ,-,f Health & Rebabl.litative S..t:Vl.ce-'S, Envi:t:ontnent.....l Health llnlt-\ooJells,
<br />W~st::ewateL Trea~IlIent, Septic Tanks
<br />.'T).", EnviL'unJnental t'.t:c,t..ctian .A.gencY-Asbes1:.os ab..t.emellt
<br />I 011"'0 ce.t:t1Ey that, if fil.1 materi"l i~ to be uaed in Flood Zone ~An or "A,8tO,u, it ~.
<br />lIn,j".L"tood tllat a dr'd.nage pl,/!lIl add..cessing 1:9. '"colllpensatj1Jg volume" 'ui.ll be suomttted whioh
<br />16 p,-e.pared by a p~of~$slpnal ~ngin~e~ ra9~$teEed in th~ Slate of rlorlda prior to permit
<br />!.:;Isuanc:c.
<br />A ~~rmit jssued shbll be construed to b.. a 1~cdns@ to pLDceed with the HOEk and not a$
<br />outl'Dr~ty to violate. cancel, alteL, or 8~t aside any proviBipns of the technical cDdeo,
<br />no" sh.Lll ~Bsuanc", of: .. pcrmi t_ prevent the Building Offici..l f:r:oln th",r.eaft.EiL l:ceq\.,\j.ri.ll9 iO.
<br />COJ:,l.'e<.::t:1.on ot errorB in plans, pon"'t.Luution~ or vio,l;o,'\;tone of any oode. E1v.r:y peqn1t
<br />1 ",sued eoha11 beoome l.nva.ti.d un 1 e,!Ul thl;i ~'Jo!>:h: aut".horized by auch permit j S <::IallDlloenaad H.tt:hin
<br />G1>{ ""-'11th... of i....llanc<=, or if HDrk authorized by the permi.t i.l:l ~uapended "r G1handoqlil.:i fQ.r
<br />p..riud of >::Illt month.. after I:he time the Hnrk is <onrnn1en(~ed, One 90 day 6Kt;ensiofl of \::,11116
<br />rll"'Y be al.1DHed, fCJr the peunit: wit:h fee charge of ~l5,CJO, The extentJ1.on ",heLL be 1:til<]ue_\:e.q
<br />j Cl \..r~t1..ng to th.. BUildi"trJ Ofeil'lial. An apf>J:ulI..d irHsp..ot1.uh must b... lugged dLl.cing ..aoh - liIi..
<br />",,-,nth p"".L'ic.d, wI Lha pEojeGt wiLl be conl!lldered abandonect.
<br />.~ARJnNG TO OWIH!lRI YOUR IlAILUf<l!l TO RECORD A No'rICE Olr COMMENCEMENT MAY RI!l8UL'1' IN YOUR
<br />PAYiNG TWICE FOR IME;'ROVEHEN'l'S TO YOUR PROJ;'ElR'l'Y, If!' YOU INTEND '1.'0 .OIH'AIN EINANl:;Il\Hi, ~(lll~lJL
<br />WITH YOIHi LENDER OR AN A'I"I'ORNEY BItFORE R!JCORDTNG YOUR NOTICE OF CO!'1HENCEI"IElH'I', -.JOB8 Ul~/)eR
<br />~1, SUD IN VALUE PO NOT NEED TO RECORD ANL> POST A "NOTICE OF (:()Ml'IJENCEl'1EN'r".
<br />
<br />d~... nud1~
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<br />SIGNATURE I CON'rI<ACTOk
<br />
<br />.9'I'ATE Oir ~M'd
<br />COUNTY or-rv{~" .' . '__
<br />The foregoing inst~~lIrnent W-,5 aq~noHled\,J...d
<br />8et:ore Ill.. t.his ..l:i~J"j"'!I or:~L,_, ~ ~;..__
<br />by ___.-. ~
<br />
<br />~J " , >i 4 1', r,
<br />
<br />~' ,
<br />
<br />1/1
<br />
<br />S 1 ONATUH.E I
<br />
<br />OWNER OR 1>.GEWf'
<br />
<br />
<br />(name of per~on aoknowledgedl
<br />1$ per8c.nally known to mar or
<br />
<br />o \lh,) h..", prodlloed.____ .
<br />(type of identjfi.cationl
<br />dnd 'Jhc.CJ ctl.d Odict not take: an '~ath.
<br />
<br />an
<br />
<br />R.i.gnatul:"e or piS.! son tak~J1g a.~::.knOt/_t-=ctgelnent
<br />
<br />lJaIl\~ tYtJ~d( pL.:j.rlt:~d uL" ~tallllped
<br />
<br />e!:,son taki.t1g Ii nowl",,JYlOenr:
<br />
<br />~ - g~AA/~.______~______._
<br />,.' J..Hi.nted ~~I1P..d
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