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<br />Ii. tl()'l'ICF~ ()F LJE:ED RIi:STRICTIO!lS
<br />rhe undersigned understands that t.llis permi t ma)/ be suhject to "deed rest.rict iOlls" \'dd.dl
<br />fIIay be !l1(He restricl'jve than ,:itV reyuJations, The llndelsi9118c:1 aSSllll18S ieSpi.,nsihi UI); rOt
<br />comp.! ianr:8 \-/ltl1 aliI' appLicahle deed restrictions,
<br />B. lJi'lJ,H'F~llSE/) ''r:Uln'Rl\CTOPS AlII) (,OIITRl\CTOP RESFOl1SlBILITIE;S
<br />.I f tlle OI-lIler lias hired a contractor or cuntractors t.o undertake I-Iork, they Inay he r8LjuJ reel
<br />t,) helJcenseu in accun:iance \!Jt:h sLal:e and local regulat.ions, Jf Lhe cOIIlJacl.ol' i" llul
<br />J i cellsed as requ ired by la\'" huth Lhe OI'lller and COil tractor Illay be c i Led for a rn i selelllei;HWl'
<br />viula1:Loll \lJlder sLate la\1. If the ()\.mer or int.ended contractor are ullcellalll as [(I \-Ihal'
<br />licells i Jig requi rements IlIa'/ app Ly for the inte]lcled \'101'):, l:lley are ad'll sed \ U l:>mtacL l he
<br />( i Ly of :?epllyrhi II s Bui ldi IIg Departlllent, B13-78CJ-0020.
<br />FurLllelInOlCl, if the U\'lCIer has hired a conlracL:or or cUlltractols, he is adIJlsed to IJave the
<br />contractol'(s) s1911 por-tlons of the "C:ontractor Se,.=t.i01l8" o[ this appl!cat.ioll fo] vlhic!i \'lley
<br />\liJl be re::;pc)lJsibJe. If you, as I:he O\.mer signs as Lhe contractor, 1'011 ale ill<Jlcal:iIH] Illal
<br />ye'\l, rather- Illa!1 the contracLor, are responsiblE-: for the \-!orJ:. 1 E Ule cont.ri:lClrH \"dslles
<br />YOI] to sii]ll as contractor that. Il\ay be all 1lldica~ioll tllaL he is nol: pre,pelly ] icensed and Is
<br />Ilot elll.ll'.led Ie, pp-rlJ1il'.Ung prl'.lilecJes .ill the r:lty of Ze[JhyIldlls.
<br />C. 'I'RAtlSPORT1~'! [UN H"jPl\CT fEES MID UTI LITY CUIII18C'!'] Otl E'8E:S
<br />[I. I~UI1STR'1C:TUIUU LIE:!l LA!'~ (CHP_PTER 713, FLORIDA S'I'l\'l'lJ'f8S, AS I\HF.tIDF~[))
<br />I certify Lhat I, the appLicant, have been prov1ded vlith a cupy of \'F1orida's ('I)[lsl'.ruc;\ion
<br />lLen LaH HomeOl'mer's Protecti.on Gu1de" 1J1:epared by t.he Florida lJepartment: of I\yriculture
<br />ami ('onslllller l\ftalrs. If tIle applicant is someone other thai the "oHner", r l:eLi [y Lhat 1
<br />have obtained a <copy of the aboIJe described documenr. and pcornise .in <]ood faith 1:0 deliIJ81
<br />.il: to Ille "rlV,mer" prior to comnlencenlent.
<br />E. C{)IITRN~'j'UR' S/UvJllER' S AFF'LDAI1LT
<br />I certify IhaL all. I.he information in this app.lication is aectlrate and that all IWIk \Iill
<br />hE3 clone in c;olllpliance vd.Lh all ap1J11cabJe 1a\,s regu.lat.ing construction, zonjllCJ, and land
<br />devel oplflelll .
<br />l'I['plication is herehy made to obtain a permit Lo do vlOrk and insLallal_ion as il\Cllcat:ecl.
<br />';erl~lfy J'hat 110 v/ork or i Ilsta11a\:i01l has commenced priur Lo issuance of d penl\i I and that
<br />aU \'Iorl; l-d.11 be perfouned to Ineet standards of all .1a\'ls regulating const:J:ucl:loll, ('Jty
<br />codes, Z"ILiIICj reCjll.lations, and land development reqlllations .in the jluisdici:ioll. I alsn
<br />cetl~Lfy that I lInder-stand I:hat the regulations of other governmental agenr_:ies IlIay apply 1:0
<br />tile inlem{",r] \'Iork, and Ula!: it. is my responsibility to identify 1'lhaL actions I must ta);e to
<br />be ill ,;omplLallc:e. ,such aqenc1es include but are not Illldted to: *IJepart.menl of
<br />~~lIvlrolllllell La I RelJu1at i oIl-Cypress Bayl1eacls, v~et:land J\reas ami E:n'l irOJl1l1ellta 11 y Sens It i ve
<br />Idllds, v-~ai:er/\'vasl:F.l\'lat8.c TL'eatrnent
<br />*SOllthllest E'loc1da \^lat er ['-!allageJJ\ent Distri ct-I'Jells, (~ypress Bayheads, Vlelland 1\1ea8,
<br />lU le1'i])(J vJal:ercolll ses
<br />*Army Corps uf E;mJilleers-SeaI-IaI1s, Docks, I',]avigable WaLen'lays
<br />'Lieparlrnent. of llealLh [, Fellabilitative Services, Environlllenla.l Health UIIIL. '\'Jells,
<br />\'~asl:e\/al er 'I'r-ealmenl, Septic Tanks
<br />A IJ, S. EI1\7! 1 ollHlental Protection l\yency-AslJestos abatement
<br />I also certify that, if fill material is to be used in Flooc! Z(me "A" Cl[ "1\,81": it. is
<br />understood J.llat a drailla']e plan addressing a "cornpensai:ing 1!()]lllJie" I-Ii 1.1 be sl1ll11d.l.l:ed 1,!lLlcll
<br />is prepared hV a professional engineer registered ill the State of F'lolida pri<ll [0 penlit
<br />jssuanL~e .
<br />1\ pennl1: issued shall be reOllslrued to be a Iicerise tCJ proceed \-Ji th the \"lOrk alld Ilot as
<br />authority 1:0 ',Jolate, canu8l, alter, or set aside any provisj(Jlls of the I'echllical. \;udes,
<br />110t shall issuallce of a permit prevellt tile Bu11ciJng Official from thereafter reiju!.lin'J a
<br />correr~tl(Jn of erroJ:s in plans, cOllsLruction, or' violatiolls of allY code. F:V81Y permit
<br />.lsslled shal I beCOll18 i llual 1 d IHlless the \'101' k authorized by s\lch pe rmi t is cOllimel]ced 1/1.1. h i)l
<br />sl): 11101l1:[IS of Jssuallce, or if \,ork authorized by the perndt is suspended or aballCloneu for a
<br />period of six Illontlls after the time Lhe \-Iork is conunellced. Olle 90 day ezl:ellsioll of LIme
<br />Itlay be aL.!o\'led for Ihe permit \,il:l1 fee cllarge of $15.00, The extellsioll sllall he rerj\lested
<br />in v/riLill(] 1:0 tlle BuildillCj Off1cial. All approved illspecLlon IIIUst l)e lil(Jf]8d rim'Lng each sJ);
<br />month perJ od, or the EHnjer;t IIi 11 be cons1de'ced abandoned.
<br />~'Jl\Rm 11(; TO UI.-Jm-:R: 'fUIJR flU LURF. TO RECORD A I.! I)']' l(~E UF' CI JI'Il-1E'.IlC'ElIEt1'l' [,]I\Y RI;:SII l,T III YOIIH
<br />P]\{Illl; 'I'V~H'E FIJI< THPROVEIJE:llTS '1'1) ':{I)UP PPOPERTY. iF 'fUll 111TE;tHl 'j'I) 08'1'1\111 FIIll\tICItIG, COIISIII.'I
<br />vHTII Y()UR LF;IIDER OR AI! 1\.T']'(JRI1E,"{ BEE'ORE RECORI1[JIG YOUR ]IOTICF, OF r:OI,HIEIICF:IIE:t.J'!'. ,j(>BS Illlj)E..[<
<br />$:~, 5UU 111 Vl\LlJE DO tlOT llESt' TO PECOP.D Aim POST A "llOTICE: (IF 1"Ui1tlE:lICi<:I'IEIIT".
<br />
<br />S 1 l;tlATUHE::
<br />
<br />O\tnJER OR AGF.llT
<br />
<br />SIGtlATIJPE:: CON'I'RA(:'I'(JR
<br />
<br />STl\TE: OF FLOHI [lA
<br />C()[JtJ'I"i Of ..---____.._.___
<br />The fOl'egoillCj insL.rument \-Jas acknoviledged
<br />Before 1118 this ______. day of __.__.____1 2IL_.
<br />
<br />l) Y --.---_ _ . __. .. .__ _ _.... _'.. ____.._. ._ . __...__..._.___...
<br />(nallle of person ar:kno\"lledged)
<br />[] Ilho 1s personally klIO\111 to IIle, or
<br />
<br />ST1\TE OF' FUmI DI\
<br />COUl],],Y Of .....____.._..._._._..__.._.______
<br />The f01.eg01ng ! nstrlHl1ellt \'/as acl;no\'/1 edged
<br />Before me Ihis .__day of..-..-.-..- -""-'-''', ;~I!
<br />
<br />by n....___.....___ ...-_.____...........___._._.u..._._ ._..... ........ u......_
<br />(nallle of perSOl1 ackJ\ovI J edged)
<br />[Jlho is personally kllOVlII 1.0 me, en
<br />
<br />[] 1.i!lU lia s pr odllced... '....... . ____.__.____
<br />(LYE)e of identification)
<br />i:lJld l'I!H>lJdjd [)elld not t.ake an oath.
<br />
<br />[J vlho has proell1(;ed..._ .._.___...._.._..._....__.__._._..
<br />(tYFJe of Irlellllfi':aU on)
<br />and vlho [ldid LJiid not 1 a);e an oatil
<br />
<br />S.i']]lat\He ot persulI tal~llHJ acl:nu\dedCjement
<br />
<br />Si'.Jnature of pel: son Lakin'] acklJol-J] edgmeJ\t
<br />
<br />tJollle I. }!ped, pr lilted or sl:amped
<br />
<br />tlame l.yperJ, [.Jlint:ed or st:alllperJ
<br />
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