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<br />i\. [iUT lCE: (IF llE:EU RE:.':JTfUCT IU!iS
<br />I'lle IlllrlelSi91led llndersLCinds l~hal tlds permi t may b", suhject to "deed restLic~Li<l[IS" Hhle:h
<br />ilia'}! jj", lllrire lestricljve thalJ t:jty reyuJatinlls, The undelsi']ned aSSllltleS resp()/Isibi lil.y f'ril
<br />(~OJllpJ jan(~e \'/LI~h allY apfJLicable deed restrictions.
<br />B. IJI'lJ.ICE:IISEIJ 'f:UIITRJ,CTOPS AtllJ COtJ'I'RN''l'UR RESI?OtlS1BTLl'J'IES
<br />I f the ("'lIler lIas hired a contractor ur conLractnrs to undertake Hark, t11ey !ltay he regllJ red
<br />l.r) he licensed in ac;cc,rdance liJl:h sLate and Ioca.! regulaLions, If Lhe contract.or is nol'
<br />Jicellsed as required by Jal'!, !Juell the O\'IlJer and contlCictor lllay he clLed fOl a IlIisderllednor
<br />\iulatLun IIlldeI .sLate la\1. If tile O\'lller or intended contlact~or ale 1.lllcerl.aill as tu I-illat
<br />licensillC] requirements Illa)! apply for l-he intended \'1orl;, [:lley are advised [u l~unti:lc[ [he
<br />CiLy of Zepllyrhl lis Bui lding Department, 8L:J-78(J-0020.
<br />FurUlelill'He, if the (j\'mer has flLrer.! a contJ'a,-:;tor or cUlltractors, he 1s advised to Ilai'e ths
<br />c()ntral~t.()l (0'3) slr,1ll portions (,f the "Contractor SecUons" o[ this appl ical:.inri fDl \'Ildch Uley
<br />11111 be rel:ipc))Jsible. If yuu, as I~he Ovll1er signs as the contractor, YOIl are illl.l.!(~al:jI19 IllaL
<br />you, laLher 11Ian the contractor, ale responsible fOl the \'/ork. lf tlle cont.raclul \-d.slles
<br />you to siCjn as contractor that. may be all il)dica~ion tllal. he is not [JLuperlyJ il~ensed and is
<br />not. ellt.!tl ed Lei pennJt-Uny pcl vi1e~les j n L:he CHy of ZefJhylllills.
<br />{-'. TRAtJSPOR'l'/HfUl-I H'lPf\CT f'EES f\ND U'J'lLI'l'Y ('UtIIJECT1UII fE:ES
<br />[I. CUIJSTRIJC'l'UIUtl LJE:II LAI:J (C'HlI_PTE:R 713, FLORIDA STATUTES, AS J\.(V]Et!flf~D)
<br />1. certif}' thai: I, the applicant, have been provlded \-Jith a cupy of "Florida's f'Ullsl:ructlon
<br />l.ien La \-1 HrJlll8o\,lller's Protection Guide" j,Jrepared by the F'l.ori.da fJepi1r:t.llIent: of l\gricu1tule
<br />and ('onslifller J\.ftcdrs, Jf the applicant is someone other that. tile "O\^llll~r", I celify I.hat J
<br />have obta\.ned a (~opy of Lhe above described docLlJl\ent Flnd [Jcomise.in 'Juod faith 1:0 deliver
<br />j I: to I he "o".mer." pri.or to commencement.
<br />E. CUtnRN:'J'UR' S/U\'lIlE:B' S AFFIDA\!I'l'
<br />L cerLify IhaL aLL '-Ile informatiun in this application is aCCllJate and tl1at all \YOlk Hill
<br />he c!olle ill cOlllp1iaJlce \'Ii.LlI all applicab1e la\'1S 1:egu.lating cunstructiof!, zuninCJ, aud land
<br />developmeltl .
<br />!\pplicaLioll is hereh)! made to obtain a pelJllit to do \'Iork and insLalJaUon as jmllcal:ed.
<br />';erLlfV (Ilat rlO 1-lorJ~ or i nstallatloll has conililellced priur 1:0 issuance of a penllll. and Ihal
<br />all HCHk 1,1ill be per.fonned tl) meet standards of all1al'ls regulating constJ:ucllcll1, ('it\1
<br />codes, zr'lIllig regll.1ations, and Janel development regulations if I t.he 'jlulsdjcl:ioll. 1 ilLs"
<br />certify tllal. .J understand I:hat l:he regulal:ions of other governmental a'jenL:.i.es may apply to
<br />LJle intended Hark, alld 1Ilat i L is my l~spunsiblljl:y to idenl:ify \'1haL act lons I IlIust I:a);e to
<br />be ill ,;oifl[1ILance. ,Such aqencies inc.lude bllt are not limited to: *Depart:mel1l ()f
<br />Envil.'uIllHeIltal Re'Ju1atJon-Cypress Bayheads, vJetland l\.r8a5 arid E:Ilviroflllleuta1.1y Sensitive
<br />Lands, \'Jat:er/\'Jasl.el'later Treatment
<br />*SClIlth\lest F'Jol~ida \^later l'lanageJil8nt Distr.ict-vJel1s, C'ypress Bayheads, \'JellarJd Illea'l,
<br />JUt erlllY vJatercUulses
<br />*Army Corps of E:ngllleels--Sea"/alls, Docks, Hav.i.gable Waten'lays
<br />klieparllllent. of HeaJLh [, Hel1abilitative Services, EnvirolJlnenlaJ Health [JIlLl. -\'181 Is,
<br />\'iast:el-lal e1' 'I'reatmenl., Septic 'l'311);S
<br />AlJ. S. F~rJ\7 i r ollIllellLa l Proteci.ion l\gency-Asbestos abatement
<br />1 also (;ertLfy I:llat, jf fi.lllltaterial is to be used 111 F'luocl Ze)(Ie "1'," Cl[ "J\,el-r i( is
<br />unde ['si'ood t.llat a d l aj na'Je pl an addressing a "compensa UI1Y \TI)] 11I11e" l'li 11 l)e SlllJflti L tAd lIhicll
<br />is prepared hV a professional eng.lneer registered ill the State of f"lnrida pril)1 to peUlti t
<br />jssllal\l:~e .
<br />A pennJ I~ j ssued silal J be COIISt rued to be a I icelise Lo proL:eed I.d tll the I-Ior); alld not. as
<br />authority to \)iolate, canue.I, alter, OJ: set. aside any pro17isiollS of Llle l-echl1ica.L ,codes,
<br />IIO! shall issuaIlce uf a permit prevent 11le Building Official frorn thereaFter rer]llllln~j a
<br />cOITe,;I.Lon uf errOlS ill plans, C(l!lsLruct:Jon, 01- "JolaLions of any code. F;V81Y permi I
<br />isslled shed I l.)er;Ollle illllalLd \mless the \'/ork authorized by s\lch perndt is cOllllllenced \'IJ.Lllill
<br />8.1)( 1II0111:11S of Jssuallce, or if I'wrle authorized by the pernilt is s\lspended or abandoned For a
<br />period of six months after the time the \'Iork is conunenced. OIle 90 day e>;tensiOl1 of Lillie
<br />may be aUo\'/ed for the pernliL l'Iil:h fee charr;Je of $15,OU, The exLensiull shaLl he re(l\lested
<br />ill vlriLillq to tJle BuildjllCJ Official, An approvedillspecUOft III\1sl- I)e J()(j(Jed dllrillq eacll sJ);
<br />mOIlth peli uel, or [he project \,,]l.L be considereel abandoned.
<br />~'IARIJJIj(J 'I'n Ul'iIJE:R: YUIJR FI\.ILUR.E: TO HECORll A Il(ITICE ClE' ('U[vll'1[i',llCE[JEIJ'1' HAY HE:SU[,'l' III YOflR
<br />Pllnl\Jc:; 'l'\'HCE FIll< H1PHO\lE~]E.llTS '1'U YUUH PROPERTY. IF YOU 1tl'J'EilD TU OBTJ\lil FIIJl\t1CIIII" C:1)118UL'I'
<br />vJlTfI YOUR LF:llUEH OR All l\TTOR[JE'( BEFJRE RECORIlIlIG YOUR. IJU'l'Ii:E OF C:Or,lHE:IICE:tlE:nT. ,lll!:lS IJIWE:f<
<br />$~, 5UO ] l-l V!\.L,UE DO t'JOT IIEEll TO f<ECORD AllD POST A "llOTICE: (IF ("UI'Jl'mtJC:E:I'iIc',II'i'''.
<br />
<br />---~_.__._--_._-----------._------._-
<br />
<br />SJr;llATlIJU: :
<br />
<br />ownER OR N;EI1'1'
<br />
<br />---~---- ------ --~_._-----_..._-_._- --------- ----..--.-
<br />
<br />SH,tlATIJPE::
<br />
<br />CONTRAI :'I'UP
<br />
<br />STATE OF ELORIflA
<br />C()(HJ'I'Y OE' _____________ ._____._____
<br />'1'l1e toregol.ng ins Lrumenl: vias acknovlledged
<br />Before lIIe Ud.s _____ day of ___._, 2IL_u.
<br />
<br />by .------______._______. _.._.._______ ..__ ____u_______._.
<br />(name of person ackno\'lledged)
<br />[Juho is personally knolll1 to Ille, 0r
<br />
<br />STII1'E: OF FLORI D!I
<br />er.l IJ ll'J' Y Ii F ____._ _ ._____________________
<br />The foregoing i nstrllfl1elll \'Ias ackrlOl'I) edged
<br />Before me I:his_....___day of----.------,-, 21i
<br />
<br />by. _ ______.. _ ___ ,__ _.____._.._._. __________.____._ ..__.. __,__ __._...
<br />(nallle of person ackllo\'!l edged)
<br />CJlho j s personally kilOI'm 1:0 rne, or
<br />
<br />[J vilw has produced__________.___,____
<br />(type of idenLification)
<br />a!ld \'lllO[j d.1 e! [] elj d not take an oa th_
<br />
<br />[J \'lho has prorhwsd__,__ __.____'__.___.__._,______,_
<br />(type of .1delllifir:atir)n)
<br />alld vilw [J dl d CjHe! !lul I a):e all oa t II
<br />
<br />Siljllat1lre ot person tal:in(J ackno\'!ledgement
<br />
<br />---._.__._.._--_._-----_._-~~--------_.._-----..__._-
<br />
<br />---.-----...--------. - --._-- ------------....---. -------
<br />
<br />Si'Jllat:ure of person l.aldll(J aCkIIO\-,lecJIJlHent
<br />
<br />---.- - '. -_.~'-'--- ".-.--------~_. '0
<br />
<br />lJallie typed, prillted or st:amped
<br />
<br />. -~_. ---_._.~----..,._-_._,---------
<br />
<br />iJame I_yped, plinLecl or slalilp""j
<br />
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