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<br />A. NCJ'I'IC!1: Ol!' lJli:J!:D kES'}'IUC'J'IOH.':3
<br />Tht:: unde:rl:iiyncd understands t:11/;\t [ILL:; pt;uui t Ji\.ilY be .:;ub:j",cl: to "deed .l:t::::il:rict:ioIlS" vlld ell
<br />lIIc.Y bE: more u:strictivl:;; t11i:HI City t':::9(1] allan.:;, 'l'he lllldc.l:siuned i:Hi.::;llllles rel:lflOnl:dld.llty tor
<br />complli:lllCe \'lith Clny, applicable det:d LC.5tl:icl:i()iLl:;.
<br />B. UIJLICelllSED COH'l'AAC'l'ORS .lnlD cO:!,'l'W\C'l'UH Rt;Sl:'OJ~SIBIJ,I'l'H:S
<br />I l' the Ollllt::.l: ha:; hir'ed a coulract0r or contractor,:; tu undertake \JC.lrl;, thbY HlClY be l\i::quln::d
<br />to be lict::n.::ied in i:lCCOr:'di:lllCe ,11th sLate <:'Ind local regulalioll.:'J. If t.he C(,nt:rC:luto.l: i l:l not
<br />llcen.:;cd al:i rcquired by .lal'l, both the O,lIlcr anet contracto.L' way be ci ted for a Illi I:iddlli<:::C:lIIOl
<br />vi olati un under ::sLate 1i:HI. If the miller or intended contJ..:actor i:u:e IlIlCe!"t:",Jn <:ll:l to ,~haL
<br />Ii censiulj reqllirelllenLl:l Illay apply for the intended work, they an:: i:idvi.l:led to con Li;Wl: thl:;
<br />C1ty of Zepll~'"'ld11", bunding Dbpar:tlilent, tl13-.eI88-6611,
<br />E'urtlH:LLIllOt'e, if the G\omel: has ldred a coutr:'actor: or c:ontrC;\ctou;, llli;: il::! adv1.l:lli;:d to lli:lve the
<br />contri:lcLo,l:(s) l:iign portions of tllt:: "Contn.ctor Sections" of thl::; i:ippl.1ci:iti.on tor "hieh they
<br />\'/il] be rcspons.i.Lle, It YOll, a,:; the o\omer: l:l.ign;;; <I::; the contrar..:tcn, yuq i:Irt::: .1lidici;ltlng that
<br />YOll, rather tllan lhe cOllt!:i:lL:tor, are respolisible for tilt:: wo:ck. It Lhe cCJlitrlilct(Jl_ vl.il'Jhel:l
<br />}lull to l:l.1yn al:l contri:lctor thi:lt way be an indi.cc:ltion tllat he is 1I0t pt:opel:l.y licelHH::d and il:l
<br />nul t::ntit.1<:::d La peulIitl:ing pr:iviJegel:l in the City of l.ephydlills.
<br />C, ']'R.A.HS l'OR'J'A'I'J 011 H1PAC'1' I!'EES ANn IJ'1'lLI'I')' CONNEC'I'ION F'Et!;S
<br />n. l;ONS'j'f(UC'rUI0N LH;N LAvl (CHAP'f'Ek 713, !I'LORIDA S'j'A'I'U'l'ES, AS AHENllb:D)
<br />I certl fy that: 1, the appUcant, have b",en provided Hitll a copy of "Ji'lor.i.da's Conl:ltl:\lcLion
<br />.1.ien Lenl - HOlllcmlnt::r" s Pr:otection Glli de" pn:pari;:d by th.: l!'] ori.da Depal..twl::nt: at Agri clllture
<br />alld Conl:lllll\e:r Atfair:s. 11' the applicant is sulLleone other that the "ovm.;l:", I ucrify th~t 1
<br />ha vc 01>tai lied a copy of tht:: abOVe dt::.scribcd document and promi.::ie in gout! fi:l.Lth L.0 dclj vcr
<br />it tu the "OllllE:r" vrior' to COIIUllo::UCe:Hlenl:,
<br />11:, COH'I'HAC'I'OR' S/OWHER' S AB'ff'IDAVI'J'
<br />I ccrt.1fy that: al] t:llc intorruat.ion ill thi", applicat.1on.Ls accurate and tlICll:. ,dl I'w.k Hill
<br />be dOIlc in GlJmpliancl:: vd.L-II all i:lpplicable lal'Js regulating constnwtion, zon111lj, and] dnd
<br />developlCIenL.
<br />Appllcation .1.:; hereby made to obtain a peUld_t to do Hork and in.:;tallaUon al:l illdjc~tt::d. I
<br />ecrU ty that: no \o/Orl;. or: in.::;ta]lat:ion Ili::l::; commenced priot. to iSi;lHcHICd of a p,:::ulli l and that
<br />all l'Iork will be perfoulled to meet ::;tandards of all laws regulating con::;t:ruution, (~ity
<br />codes, zonin<j r.:::yu] aLion.;;, alld land deve::loplIlent r:egulation.s in tlle juri I;:jdictJon. I ed::so
<br />certify tlH..t I llnder::;tand lhat the regulation::> of other govenuilental a(JenCid::i may i:ipply to
<br />the 1nti;lnd.:d ViOLk, and thaL it is my l.i:ll;iponsibility to ideutifi' Vlhi:lt i:ictJonl:l I lIlU::;L LC:lJit:: to
<br />be in cOlClplianct::, Such i:igencii:ll:l include but ar'e not. limited to:A'j)epartment of
<br />8nvil.onmentaJ ReguIati.on-Cypres.:i Baybeact.:!, Wetland AI.:ci:ls and li:nvirolllllellli:lU.y ,'3l;;;lJ::si t.lv.;
<br />Lalld:;;, Water/Wast.;,JaLer 'J'reatlnenL
<br />~t:iuiltlMi:l:lL Iflorlda Wi:lter l'1anagelH<::nt D1strict-Wella, Cypresl:l Bayhei:id:;, W<::tli:llld Area.::;,
<br />AI ter:l11~ vlat<:::rCOllrscS
<br />.AAnnll Curps ut h:11g-illc.::l.;;-SeaIJalls, Docks, NavJgi:lbl", Wat':::J..:Hc:lY;;
<br />^UelJc:ll."LlHellt uE HeCjlt:h I:< RdlabililcltJve ServJce;;, {!;nvir:olllllent,d Health UlJit-'Well.::;,
<br />W",:;1:.;Vla-ccr 't'rcatlLlellt, S.;ptic 'l'anl,s
<br />'~lJ, t;. Ji:nvil.orHllcnti:l1 I?rotection AgeIlCy'-Asbe.::;tos i:lbat:e:rnent
<br />I a1.::;0 certify t:hi:lt, jf till materia] is to be used ill flood Zone "A" OJ.: "A,eLc.", it: is
<br />und<::r:>tuod that a dLi:lina(j'=' plall addrc::;:;iny a "cCJmpensat:ing volUlne" I'JiII h<::: .::;lIbud LLed Hldch
<br />i.l:l [.llepan:::d I.-y a fJI.'ote.::;slcillc:ll engiueer n,gist.;.red in the Sti:ite of I!'Jorlda pLiol. to pb.t:lnit
<br />i:;'':;(Ii:lIlc.:e,
<br />A pe:i:llIit i sSlled shall b<::: c.:onstrned to bt:: a licen.se to proc.:::e:d vdtll till:: \'Jol.k i:md lIot al:l
<br />author:lty to violate, cOlllcel, alt.;r, or set asidE: any prov.i.::;.1on::; of th<::: t<:::chnic..l cod<::l:l,
<br />nor /:illal} l:isl1ance of a p.;nnit prevent tbe build.ing Official from thereclrtt:::t rel}ldrJng a
<br />correction of error.:! ill plans, construction, or violationl:l of ",uy code. t!;very permit
<br />ll;i.:;\led i;ihi:dJ b!;COille Invcdid unlesl;i tile v/Or!\: authot'i~cd by such per'mit lb COIlUJlt.:liI\..J<:ld' Idtldn
<br />::Jix month:> of i:Sl:Hli:UlCe:, or if ,,,ork authori.zed by the penllil is suspended ell: ..band(mt:d f.o~ a
<br />pl:riod of si.. filontlll:l after the time the 1'10.1:], i.:; conuuencad. Dne gO di:iy e<etensioll 01' UIlIt::
<br />may be CI] lo\H:c! t(.lr the pe:rmi t. vii th fee chal"lje of $15.00. 'l'he .:::..te:l""i on /;illi:i11 j,o:. reqlH::I:it:cd
<br />in wrl ting to the Bui Iding Official. An approved inspection must be .J oVVo:.d dilri IlV I::i:lcb pi"
<br />month pcritid, or t:he project v~il1 bl:: con",idered abandoned.
<br />WARNING 'PO OWNER: 'tOUk ff'AlLlJR8 TO RECORD A HO'rICE OJ!' COIVJl'1ENCEl'1hiN'r l'1AY khiSUW' IN YOOk
<br />PAYING T\liICE jfC)R H1PROVEMhiN'l'S 'j'O YOUR PROPERf'Y. It!' YOU IN'i'EHD ']'0 Oh'I'AIN J!'lNANCJNG, CONSlIL'i'
<br />Wl'1'H 'tOUR LEIWER OR AH Ni''l'ORNEY BI!:E'ORE RECORDING YOUR NO'l'ICE DI!' CUIVJlvlEHCEM!!;H'I', ;JOBS lJ}Wt!;k
<br />$2,500 HI VALUE: DO NOT NEED '1'0 RECORD AND POS'I' A "HO'elCE CW COIVJNE~NCElvJEN'I'I/.
<br />
<br />(~UflfJ1'L'IOIiS OF' PEkllIT AlTFI DAVJ'J'
<br />
<br />
<br />---.--.,-------.-... -_._-----,._._-_.~----,._,~ . "-'-'~--~"---'----
<br />
<br />S I GNA'f'URE l CON'I'I<AC'I'OR
<br />
<br />S'j'ATE Ol!' fLORID.1>,
<br />COUN'i' 'f OF ____~___._._._.__m___
<br />'l'bt: toregoing irl/;,trurnent: v"i:l1:l acknoVlledyed
<br />Before me ttlis e_....__ day ut ._______, 19_
<br />
<br />by ...___._.______..__....__ ______... .__ ____.__.__..._.._._.._.
<br />(name ot per::lon acknol'oil.;dged)
<br />o I'~ho i::; persona.1ly knol'JIl to file, or
<br />
<br />S'f'A'I'E OF IfLORIDA
<br />
<br />COlJN'I'Y OE' .--.--.____'.e..._.____...______._____
<br />
<br />'l'lle foregoing instrUHlf:ln t: Hal:l acknovoi.1 t::dgi:::d
<br />Before me this ....._-----1ji;jy ot..---.--.-.-, 19
<br />
<br />by ___.._.______...._._.._..__.... _._._.__..._...__ ... . ... .......________._ _...___.
<br />(nam<::: of persun acknowlt::dVE:d)
<br />rJJho is personally Imown tu me, 0.1.'
<br />
<br />[J ,~ho has prodllced_____
<br />( Lypb
<br />and vlho[]did []diJ nolo
<br />
<br />of idli;:nti.fication)
<br />tab: i:ln uath.
<br />
<br />[J Hila has. produced .___ _._....._._.
<br />(type of jdenli ricaUoll)
<br />and vlho (]did [}:Hd IIU! lab:: i:ln ui:lth
<br />
<br />._._---_..~-~~._"-- -----.---------..-.. .-. -,~-...- _. -'-'-'---'-'-'-'~'-"~'-~_._---
<br />
<br />Signi::ltul.t:: uf fH:lrSOn ti:iking acknovJl.edge:filent
<br />
<br />Signature: of perl:lun t..ld ny aCkllOI'Jli::ldU1jli;::nL
<br />
<br />li~~~~" t y fJ c d~-;r i ;~t~~i-Z~.._~-t:.~~.l~=-';:;::i- ...-
<br />
<br />..--------.-------.-.------- -----_._---"...-.,._."_._-,."_.....__._._---~---,.,._.- ---------
<br />
<br />Name: typed, lil:Lntt::d or .:;l:aHl}J\.::d
<br />
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