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<br />lL IJU'l'ICE; (IF DEED RE:STRICTIUIJS
<br />rhe unrlelsl9ned \lnderstanlls that. tllis penni t Inay be suhject to"deedlestdc~ti(jIIS" l,iliJ,:h
<br />11IdY be !li'lle l'estricl-jllE:; thall ':ity regllJations, The llndelsiqned aSSllJlieS It::S['i.>IISihilil.y hJl
<br />camp.! ian(:e \'I! th allY appJical).le deed restrictions,
<br />B, lJl'lLH'f~11SED 'tUII'['Rl,CTORS ALII! (,Oll'I'Rl\CTUR RESPOtlS1BJLITTE'"S
<br />I f the OIHler lias hired a contractor ur contract:r)j:s to undertake le/ork, they Inay he reguj red
<br />1.<) be Ilcellsed in i:lccurdance IJJtll sLate and loca.l regu.lalions, Jf Lhe c()[d.ractor is nul'
<br />licensed as required bj' Jal'/, ]Joth the O\'!Iler and contracl:or may be cited for a In! sdemeallur
<br />viu1i:ltl.un IlJlctel sLate 1al'l, If the m'lDer or intended cont.ractor ale uncertain as lCJ I',hat
<br />1icellsillgrequirelllenls may appLy for L~he intended I~or);, they are advised to (:ontact LI18
<br />CiLy of ?epllyrhills Bld lding lJepartlllenl:, 8Lj-78CJ-0020.
<br />F'UrUlell!IOle, Lf the UI'iller has IILred a conl~ract:or or contractors, he is advised to Ila\le the
<br />c;cJl1tractoJ (s) S.irJIJ portions of the "Contractor Sect.ions" of ULis appl ical:.inn fOl l'lhieh t1ley
<br />\1111 be lesponsible. If you, as tile Ol-Ilier signs as the cunt.ractcn-, YClU ale indlcal:lll!] Illat
<br />YC'u, raLher Illan t'lle C(llllracLol, are responsible for the \'/Ork, j f l:}le contriJctul \"11.51Ies
<br />YOII to SiiJII as I~()nlrdctol that. Il\ay be all .ind.ica~ion tlla!:. he is nol: properly I icensed and is
<br />not enl.ll-Ied 1:0 pp-nl\it:ling pl'.ivile~les in the City of 7.ephyrhills.
<br />I.'. TR!\lISPOR'J'IH rON H1Pl\C'J' FEES lHJD U'J'[ LI'l'Y COIIllEC'I'J on fEE:S
<br />[I. C.'OIIS'l'RllC'J'UIUII LJEJJ LIHv (CHA_PTER 713, FLORIDA STATUTES, AS I\HEIIDElJ)
<br />J certify Lilat: I, the applicant, have been provided I-/ith a copy of "Florida's ('I)I1SLUlc:Lion
<br />1 iell La 1'1 HrJmeOllJler's Protect: Lon Guide" prepared by Lhe Florida Departlllenl: of I\yr i cu1 tine
<br />and C'onsllmer l\ftaJrs. If the applicant. is someone other that the "0\'11181''',1 ,~erify that 1
<br />have obtained a copy of the above described documenl'. and promise in 'JDod fail.h 1:0 deliver
<br />.it. to tIle "oJo.iner." prioe to commencement.
<br />E. CutITRN~'j'UR' S/UvlllE:H' S AFF'LDAVI']'
<br />r cerl.ify Ihat all. I.he information in this application is aCCllraLe and that aU 1'lOrk l/iU
<br />he done in compliance V1itlI a].l app.1icabJe la\~s regu.1at.ing const.n.lctiorl, zonillC:l, and Jand
<br />eJeveJopmeltl .
<br />l\pplJcatioll is herehy made to obtain a permit. lo do l'/ork ane! installation as .illClicatecl. r
<br />',ertlfy that no I-I>)rl; or installation has commenced prior to issuance of a pennit. and Ihat
<br />aU V10rk \.Jill bp- pelformed to meet standards of a111al'Is regulating cons1:rucli(>I1, ('1ty
<br />codes, zr)llillg regulatiorls, and Janel deveiopment regulations iTI t.he 'jurlsdictioll. j also
<br />certify that: J IlTlderstand I'hat l:lle regulations of other 90vernmental agen\.:ies IlIay a~)ply to
<br />IlIE: int.ended l'/ork, and Lhat it is my re.sponsibility to identify l'lhat actions I must: I~a);e to
<br />be ill compliance, 'such aqencies include but are nCJt ]ilnited to: *IJepart.menl i)f
<br />EnvJriJlIJtl811l'a 1 Re'Jula t ilm-Cypress Bayheacls, v]etJ.and Ar eas aml E:IIViuJllmellla l.l y Sens] t i V8
<br />L3nds, vlal:er/v~aSl.el"at8r Treatment
<br />*Sout.hl/est Florida \"Iater l']anagemenl: District-vlells, r"ypress Bayheads, vlelJalll.ll\leas,
<br />A I t e r in y vi aLe u; I JlH S e s
<br />* Army Corps u f E;ni,j inser s -8eal'/a] Is, Doc ks, Ha v i gabl e Wa I. en'1a ys
<br />*Depar1nlent. oJ: HealLh [, F<.ehahilitative Services, Environmental Health UnLL'v.Jells,
<br />\t<last:e\'1al e1' Treatmenl, Septic '1'8n):s
<br />AI),S. En\liruJ\1l1enLaL Protectjon I\gency-Asbestos abatement
<br />I also certify I:hat, if fill IlIaterial is to be used in Flood ZeJli8 "/\" 0.1 "l~,el.(: il is
<br />ulldershlod t:llat a cJraina']e plan addressing a "compensal:JnCj volume" \.ti 11 be sllhlllll.tecJ Ii/ilch
<br />is prepared hV a professional engineer registered 1u the ~)tal:e of 1<'ll1rida JHiiJl tu penlllt
<br />i.ssuance,
<br />1\ penn.1 t .1 ssued sllalJ be cOJlslrued to be a Ii.ce!ise Lo prc)I:eed I,d l:h t.lle l'lork arid nol as
<br />auLhoLi.ty to 'Ji.ola1:e, lcanuel, alter, OJ: set aside any pro11.1.s10115 of the techllicaL l:odes,
<br />no.! shall .1.ssuarICe of a permit prevent the Building Official from thereafter reijllirinq a
<br />cOl.re\ction of erlors in plans, construction, or 1I.lo.lations of allY code. EvelY permit
<br />issner! shaJI become illllalid unless the \'Iork authorizerl by SllCh perndt is COnlfl\ellCed 1111hin
<br />s.1:: lllonl.-hs of issuance, or if \~ork authorized by the perlllJ.tis sllspended or ahalldoned for a
<br />f>erlod of six lllonths after the time the. \'lork is cornmenceu, One 90 da)' e};t:ension of Lillie
<br />lllay be aUm'/ed for the pennil \~ith fee cnarge of $15.00. The extensiun slla] 1 he requesj..ed
<br />in I/ril.iJl9 to Ule Building Official. An approved irlspecL.ion lllIlSt: IJe J()(J'J8d durin'] aaell si:;
<br />mOTlth pelJud, or the projer:t \~ill be considered abandoned.
<br />Hf\Rll! t.I(, Tn OIi>JI1ER.: Y(Jlm fl\J LURE 'T'O HECORl1 A llUTI(~E OF C(Jlvj['1EIJCE[lEtJ'l' r'll\.Y RE:SUt.'l' III YOllk
<br />/:'11i'J IJI~ 'l'vIlCE f( 1)1 H1PRO\lErJE1lTS TU YUUF PROPERTY, [F YOU ItJ'J'EIHl 'I'U 08'1'/\1 II FI tll\IICllm, ('OIISULT
<br />vETil YUtJR LEtlDER UR All lIT1'ORI1E'{ BEE'ORE REC'OPDllIG YOUR tlU'l'ICE Of c:or.nJE:III'E:11E;[.J']'. ,JilES IIIJDE:fl
<br />$:2, SUO] 11 Vl~J,I)E; DC! IIO'J' IJEELJ TO PECORD AllD POST A "nOTICE: (If 1"Ul1~mtJC:E:I'II;~II'I"'.
<br />
<br />SIUIJA'J'URE: :
<br />
<br />i)vmER OR !\I:;EllT
<br />
<br />---_. _'_'___'_n__~__.....___,_ ._~ __~_________'_'__~__~ ._."_.___
<br />
<br />Slr;llA'l'UBE: COll'I'RAI:TUF<
<br />
<br />STATE OF FLORIDA
<br />C()IJI-J'i'Y OE' ..______._______. _________
<br />'J'he fore'JoLng instrument: I-Ias acknovlleciged
<br />Before me this __... day of __~..__, 211-..._
<br />
<br />by .---..--___ ...___...........__._.... ---..-.____...u...._ ___'__"_."__'___.
<br />(l1alllB of person ackno\'J.ledged)
<br />[) I/ho is personally kIIOI/11 t.O IIle, or
<br />
<br />STI\TE: OF' F],URIDII
<br />
<br />CO U II T Y () f _...___... '.__'_' ... _. '_... ... .__......___.._ _._.____.
<br />
<br />The for egolng .i ns t rIH11811l 1'138 acJal(l\vl edged
<br />Be fo 1.'e me I: h.i. s . ____ria y (J f ...---.....-....___... , ,) I)
<br />
<br />by __ '.. _....._._...___. .... ...._.__..._._.... .__.__.....__..__.._. .._...
<br />(name of person ackJlol-iledged)
<br />[j,ho is per-soJlally kl10VIlI [0 me, or
<br />
<br />[J I,}lro lias produced__________________
<br />(type of identification)
<br />alld l'illO[Jrlid r)d.1rj l10t take an oath.
<br />
<br />[J who has prOdll(~ecl..._ _'_._'''''_' _.._._.. h.___._.__
<br />(tYf)e uf Jdellllfi':aLioll)
<br />alld ",ho []djd LJJiclllo! lake 311 C1atll
<br />
<br />SilJllatllIe or perSOl1 t.akinC] acknol-iledqement
<br />
<br />.' ---------..--------.-..-.---.----.-------------..--
<br />
<br />oS i '.J I \ a t u reo f per son I a k i I I iJ i:l C k IJ 01./1 e c1 ':I m e Il t
<br />
<br />tJallle Lyped, pL1.nted or stamped
<br />
<br />llame I.yped, plilltecl or sl:alllpI,;r'!
<br />
<br />. .---_..~---,_.- .-.~- .~'--~--------.-
<br />
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