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<br />(;()JIUI'i'lONS OF' Pl!;kl'1IT AI1'FIDAVI'r
<br />j!." NCJ'i'IC~ UJ!' 1J[!:JW kES'l'IUC'l'IOHS
<br />'I'JIl:l llndcl.:/:;igncd ll11dt::l:stands tbClt this plHruit lIlay be subjt::ct to "deed rt::l:ltl.:ictiCJllS" vllddl
<br />way be more l:estrictive tban City l:egulationb. 'l'he undf::l:signed a::;::;Ulllt;:::; 1-'eSpOIHdbllJty for
<br />compliance \oJi tb any, appU,caule deed restd,ctions,
<br />B, \J11I,ICI!:NSJ!:D CoH'l'AAC'l'ORS AHD CON'l'Me'l'oR RESI:'OHSIBILI'l'II!:S
<br />I f the OIIlJtH bas hired a contractor or contnwtou; to undertake Helrk, they may be rli:;quin"d
<br />to be lict;:n.::;ed in acCUr'di:lllCe vl.i.th state and local regulatiolls, ] t the C(Jjjt:ractol: i::; not
<br />licensed as required 0y 1avl, both Lbe Olwer and contractor !nay be c1 ted tor a rulSdc:llllt::anOl:
<br />violation ullde:r I:ltate LHJ. If the OlmeJ:: or intended Gontractor ,u:e \lllCel-t"dll s:lS to Ilha!.
<br />li censin(j requiremellt:;; lIlClY apply for the intended work, they <:In:: Cldvi:;;ed to contcwt tilt::
<br />City of Zt':phydli 11::; building Dt::par:Llll<::nt, tl13--788-6611,
<br />E'Ul-t1IC:HIllOU::, if the GwneJ: has lli,Led a contractor: or contrC:lctor:;;, he i:::> C:ldvt:;;t::d to bColve til.::
<br />contractol: (:;;) 1:11'.111 porti ons of tile "Contractor: Sections" ot tili::; i::IPP] i cation tOl.: ~Illich tlll;;Y
<br />~Iill be n:sponsible, I f you, a::; the ovmeJ:: tiigrH:i as the contract(H, 'lOll iHe indi cAti ng Lhat
<br />you, rather than the contJ::Clctor, are respon::;ible for the wOJ::]~, 1 f tile contr:c:lCtol ~Jibhel:i
<br />YOll to :;;i gll ab contnwtor that may be an i nd1cation that h.: is not properly li celltied and il:i
<br />llut entit1 ed to penlli tting pr1vilege,(:i 1n the City of ~ephyrhi 11s,
<br />C, 'I'RAHSPOR'l'A'nOH H1PAC'1' !i'EIi:S ANn IJ'rILI'I'" CONHEC'I'ION v'Et;S
<br />Ii, CONS'I'RUc'rmON LnH LAW (CHAP'f'EH '713, h"'LORIDA S'i'A'l'U'I'ES, AS AI'1ENllJi:D)
<br />1 ecrU fy that 1, the appUcanl, bave been provided Hitll a copy of "li'lorida's COntitlllcLi on
<br />lien LClH - HOllleO~lIH::l:' s Pl'otect.ion Guide" pr<::pared by lht: J!']orida DepaJ:tull;nt of AgdcIlll:un:
<br />alld Conl:lllmer AtfaLrs, It the applicant is SOIllc:lOnE:: other tllClt lhf:: "ollller,lI, 1 ce:rity thcat J
<br />hd Ve ubl:ii1ineu a cupy of tilt:: Clbove described document and promiliie in guud falth to dc:llJ vcr:
<br />j t to the "uIlller" [Jri,or t:0 COllllllellcelllent,
<br />t:. CONTHAC'i'OH' S/OWNER' S M'FIDAVI'l'
<br />J c<::rt.iiy tllat all t:II'" information ill th1:;; applicCltJon 1.5 accunll:e and tllClt i:lll ''''Hk Ilill
<br />be dOIlI; in compliancf;: IIJlh all <lpplicable la~ls rcguldtin'.1 c(jnstnlclioll, zon1.nl), alld ]Cllld
<br />devclopinenl.
<br />Appli cation i.::; llereby made to obtain a peuuit to do ~wrk and installat1.on ati llldlc~tcd, I
<br />certi fy tllat no vwd; or inliitall aLion lIas commenced prior' to ifH:l\li:Hlcf:: of a p<::uui Land l:hat
<br /><:Ill 1-101')( ~/i 1:1 be performed to filf::et standards of all 1al/s n:gul aUng conl:llnwl:l on, Ci ty
<br />codeS, zon111tj J:.;\Julationl;, <llId land development J:'egulations in tile jud:;dictioll. 1 ,dl:lo
<br />cer:lify tllat J understand that the regulations of atller govermnental agenc:j e::i llIayaP1J.1 y to
<br />eh<:: intended vlO1:k, and Lhal: it is my .lcspon~ilbility to identify vlllat acUonl:l I llnll:iL LA hI; Lo
<br />Le ill cOlClpliallc<::, Such agellciE:1ii include but ar'e not limitt;:d to;^'Pepi:lrtment of
<br />Envilonmclltal Reguli:lti,on-Cl'pres;:; Bayhc<eld.:>, WeLland Ar'eas alld ElIvirolllUdllLi:ll1y S"'IH..i UVe
<br />Laud;:;, WiiI te I/Wastl;;lla tel.: 'J'1--eiilt!nent
<br />A'sulllilHe:::;t jj'l(Hlda Wc.tt;t' l'1anClgclUl;;nt D1:>trlct-Wells, CYP.LbSS Bc.yhe:ad:;;, W",ll~lld Al'ei:l:;;,
<br />Al te:r1ng v/ii1Lercollrs.:s
<br />'AnllY Corps ot EngilleeX:::;-Se:;alfal1s, Docks, Navi.gable Wat.::rvli:lYs
<br />A!JeparLlUent of HealLh I< ReJIClbiliL"tJve ServJces, I!;nvironlllental Health !Jlllt--Wells,
<br />Wast:eHal:eJ:: 'i'rt;atlliellt, Sepl:1c '1'anks
<br />^'U, s, Ji:nviu,mnental l?rote:Gti on AgenGy'-A:;;bestos abatement
<br />I a1::;0 certify that, i.f fiLl material is to be: used ill ii'lood ~one "A" OJ: "A,tltG,", it is
<br />unde.t:<:ltooJ tbat a c1J:ainagt:: pIal1 addre::;::;iny a "compen::;aling VOlllllit:" Vlil1 be slllllniLLed Hldch
<br />i::; f)li:;pan,d Ll' a f)l"...f"'.:.isi"lliill e:ngilleel: rcgistf::ri:;d 1n th<:: StClte of li'loJ:Jda pLica to (lIHlIIil:
<br />i S,;, II i:l II co; ,
<br />A perllli t i Stilled ::;lIa11 be con.::;tnled to be a license to proc.:ed IIJth the ~JOrI~ and not Ai:I
<br />C:lulhor1t'l to VJolC:lte:, ci:lilccl, a]tel:, or set aside: any provl:;;ions of tile Li:;Cllllical code::;,
<br />uor sl1<elU l.:.i.5uance of a pend t preVt;llt the Bui ldi ng Of ticial froIII theJ:eafter r"'C}ldrl ng a
<br />correction of eU:on; ill pl i:HlS, constructi,on, or vi olations of any code. I!:very permit:
<br />i:;;sued i:lhall bt;colllc invaUd unless tl1e ~~ork author-ized by sllCh permit it> COIIUllduat;d Hitldn
<br />sll> 1lI0nlh.::l of i;:;SUi:lllCI:, OJ:' if Hork authorized by tile penlllt is s\lspelldcd Ol' al;andoned for' a
<br />pt::riod of sil> month:;; after tbt:: time the lien-!;: il;:i COllullcnced, One 90 day f:;4Ctension of time
<br />llIay be a]] oHed f(Jr the permit Iii tl1 fee clliilrge of :,>15. O(J, '1'he 1':::.<.tcq:;;10n ;:;1101 11 \;c:l rE:qIH::l:itli:d
<br />1n In1 ting to thE: Bui hUng ottJc1al, An approved inbpectJoll must be:; ] oggt:d dlld llU t:Clcil ::;i l(
<br />lfiollth period, or the pro)<::ct vlill be con.:oJdered abandoned,
<br />WARNING 'ro OWNER; YOUH E'AILUkJ1: '1'0 RECORD A HOTTeE O~' C01VJl'1ENCElvfEN'f' 1l1AY HillSUI.'l' IN YOOR
<br />E'AnNG TWICE IfCJR IMI:'ROVEMI!:N'i'S '1'0 YOUR PROPE:R'ry, H' YOU IN'fEND '1'0 Ob'l'A IN li'INAHClNG, CONSl/L'l'
<br />WI'1'H YOUR LENTJEH OR AH AT'l'ORHEY BEE'ORE RECORDING YOUR NO'l'ICE Of COI'1lvlEHCl1:MEN'l'. ,lObS lJjffJl!;k
<br />$2, SuO lN VALUE: 1)0 NOT NEE:n 'm RECORD AND 1:'08'1' A "HO'rICE OF COlvJJYlli:NCElvJEN'P".
<br />
<br />SIGNATURE; OWNER OR AGEN'I'
<br />
<br />
<br />--''----- .~~'b'__
<br />~; CON'i'HAC'1'(H{------r--'-~ -0---
<br />
<br />STATE OE' v'LORI DA
<br />COON'i'Y OF ~Sc.o .'________
<br />'j'bt: foregoing instrument wal; acknoVlledged
<br />Before llle.this____c?~ ot__~ .' -HdOO3
<br />
<br />by -'-~~:~~J~~ ~Oll m;~~~o~l-~d~~'d)------'-~-
<br />
<br />[Y('v~ho is personally I;:nol'lll to me, or
<br />
<br />S'rA'I'E Of E'LORIDA
<br />COUN'i'Y OE' ,j)~~CO _'_______________________
<br />The foreg01ng 1nstrum..nt: HCll> Clcl\fIO~I1l::dgt;d
<br />Before me this ,_~DiilY of-1r\~___, ~,_;!~3
<br />
<br />by-----~-'~-~;~~:.~-;Ji;:l~~;i'~d(J=d)------
<br />
<br />~ho i.::; pl::rsonally ),no\oJll to me, 01-'
<br />
<br />[J Ilha has produced______
<br />(type
<br />alld \olllOr] did l~id nut
<br />
<br />of id~nlific~tion)
<br />tai;", an ()ath,
<br />
<br />[] Hila bas, produced___________,___,____
<br />(t:YPi:i of id.,ldi ficatliJll)
<br />and 1'1110 C1did l~jd not: lal;., all o<eltll
<br />
<br />-.,--T----...~--~--.--.---
<br />
<br />.-.--.--.-------------------.---..- -.'-,---.-.....- ._._.._---,._.~---_.
<br />
<br />Signature of fH::rson tC:lldng acknoVlledg.::ment
<br />
<br />Sign<:itul'':: ,of person ti:lJd!ICJ aCIOlOvJl \::ld(JlJIClnl:
<br />
<br />'ii:'~:';~"- t YP ~d-;-~r i n t~~i--;;'~'--,,;t~~;~;p.;,;d------
<br />
<br />.. ------.-------.--.-.----- - -------..-..---..-.-..---- -------~._---_..._." --.------.--
<br />
<br />Nallle typ.::d, pcl.ntl::d 01' Sl:<llllpt::d
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