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<br />II. tlll'l'ICF; (IF LJEED RESTlUCTICillS
<br />I'lle undersiqlled understands thaL t.hIs pennit may be subject to "deed lesL(i(~li(jIIS" \lhldl
<br />IIldY be 1ll'ir8 l:estrlcI-.LvE: than l:ity r8CjuJatIons, The undelsiqned '1SSlllt18S leSP('IISihil.i.Lj' f"j
<br />c:oJl1p.ljan(~e \.,Ltll allY appLi'~;at)le deed restrIctions.
<br />13. IJIHdCE:11SEII 'CUIITRl\CTOHS Alii) COllTRN"l'OR RESP(111S1BTLITIES
<br />.1 f Ule Ol-mel. lias hired a contractor or contractors to undertake Ilork, they may be regui red
<br />h; he 1.1 censed In at;(~(~n:Jance lij i:h state and loea.! regu.1 atJons. 1 f the cOllh aeLor is llul
<br />J i censed as required b'l' ] al", both the O\-Iller' aneJ cont1actor !lIay be cIted for a roi SderIl8i:lIl('"
<br />vlolatLuf1 Ilnder sLat.e lelll, If the O\'lDer or intended contractor are unced.aiII as lu \Ihat
<br />Licensing requirements IIlay appLy for the int.ended \'Iorl~, Uley are advised 10 contact lite
<br />( i Ly of ?epllyrhill s Bui ldi ng Departlllent, 813-78()-0020.
<br />F'urUle1InOre, .i f the lJ\'lfler hOtS hired a contractor 0r cOIlt.ractors, he Is aclvised t.O lia\le the
<br />COli t r a c; to] ( s) s .i q 11 po r t j 0 I IS (J f tit e "c Q n t r act 0 r S e '..c t j 0 n s" 0 [ t h 1 oS a p pile a I: i () II f () 1 Vi t d c h II J e Y
<br />\ 1111 bel e s pOll sib! e . T f Y () u , a s I: he () vlll e r s I 9 n s as the con t r act 0 t , Y (J II a] e ill (lJ C ci l:i II 'J I II a L
<br />y()U, raLher IIlan rhe corJi:racLor, are responsible fOl the I"orl~. I f the conlracl UL \'Ii.'3118S
<br />YOll to SI')ll as conLractlH that. lI\ay be all indicat.joll tk:ll: he is not prope11y licensed ane! is
<br />not entHJed 10 pprli\itting pLivUeCjesin the City (If 7,e[JhYlhills.
<br />(-. TRANSPOR'I'IITTml HIPl\C'I' FEES MID U'J'ILI'l'Y CUtHIE:C"I'lOH f8ES
<br />[I, CUIJS'I'RIJC'['UIUll LIE,ll LA\v (CHfl_PTE;P 713, FLORIDA STATUTES, AS lW1F.tIDED)
<br />J certify that I, the applicant, have been provided vlit.h a copy of "F1odda's C"!llsl:t\lC(jon
<br />J ten Lavl HOllleOllller's Protect ion GuIde" ]Jrepared by the Florida Uepart!nent of I\Cjr JeuJ ture
<br />and C'onsliIller l\ffalrs. 1.f tlle applicant is someone otller that. the "ell'lIler", I ,~erify that J
<br />have ohtained a copy of tile above rlescrlbed document'. and promise in 'Jood faith 1:0 delive1
<br />J l: to l tie "(l\'olller" prlo L t.o commencement.
<br />E. CU[ITRlIr:'J'UR' S/UvJI1E:P' S AFFiDAVIT
<br />I certify Ihat aiL I.he Jnfc'lIlIaLlon in thIs application Is aCCllrate and that all l'IOlk \1111
<br />he c!ulle in complian';e Hith all ap[Jllcable 1a\,s regulating constructjoll, zoning, and Land
<br />deve10plnelIt .
<br />l\rJpllcat:lon is helehy made to obtain a pellni.t to do l'lork and installation as Jmllcatecl. I
<br />certify thd\ no \'Iork or illstallation has COllnnerlcecl prior to issuance of a penni t and I-hat
<br />aU. HCJrk \-Jill he pe1formed to Ineet. standards of al11a\'/s regulating constr:ucliclll, ('it)/
<br />codes, zc;lllrlg r:eguJi3tioflS, and land development regulatIons in the :jurisdjction. J aJsu
<br />certLfy Ulat J lmeler'stand I.hat the regulations of other govel:nmenlal agent_lles IIlay apply to
<br />tlle intended I-Iork, and that it is my responsibIlity to idenlify HhaL a(;tions I must I:ake to
<br />be ill cOIfl['l Lance. Such aqencles Inc.l ucle but are not: I imL ted tu: "11eparLm6ni () F
<br />~~nvil'()lllIlelll'al Re<ju1atjon-Cypress Bayl1eads, \"]et.land l\reas '1nei E:nvlrojjJllelltally Sensitive
<br />lands, Wai:er/~~astel"ater Treatment
<br />*80ut'hllesl: f'Joclda I'vat er l-jallagelllerIt: District-IJells, Cypress Bayheads, vJelland 1\leaS,
<br />Al [ering vJal:ercourses
<br />*Army Corps of E;n9ineers-Se:lI-lalls, Docks, I~avigable Walen'lays
<br />'Liepar1rllent of HealLh [, Hel1abilit3tive Services, EnvironmentaJ Health UnLL-\,1ells/
<br />\^Jaste\/al er Treatll\",nl, Septic Tanks
<br />IlJ. S. EnvlJ OJllllent:a I Protection l\gency-Asbest.os abatement
<br />1 also certlfy 1:l1at, if fill IIla1:e1ial is to be used in Floud Zone "/\" rll "1\,61-(:.", II is
<br />undersl'ood t.hat a dlainage plan addressing a "compensatiflCj \Toluille" 1.1i 11 be SUllllllil'erJ \Ilticlt
<br />is prepared hy a professIonal engineer legistered lLI Ule State of l"1"r'i<13 pri()l 10 perllli l
<br />jssuanc:e.
<br />1, penl\i t issued shall be construed to be a I ieerise L(J proceed I.d th tJle l'lork alld rlol as
<br />a u !:tic) r 1 t Y I: 0 IJ i <) 1 ate, can u e 1, a 1 t e r, 0 r set as ide any pro 11 i s i () II S 0 f the tee h Iii c a J ,; Il des,
<br />nOl shall issuance of a permit prevent the Building OfficIal trorn thereafter re'jlJiLing a
<br />cOlrectlon uf errors in plans, consLruct.Lon, QJ: idolaLions of allY code. Elfer y penni!-
<br />isslled shall become IIll/alle! Imless the \'Iork authorlzerl by Sitch pennit 15 cOllimenced IliLhill
<br />sj:; IIlonl-118 of .issuance, or if \'lark authorized by the perntit is suspended or abalHluned for a
<br />[/er:iod of six months aJ'ter the time the \'Iork Is COllul1enced. Cine 90 dal' exl:ensioll of tillle
<br />lIlay be aLlo\'led for Ihe f,eLnlit \'lith fee cl'large of $15.00. The exlension shall lie rerjllSsLed
<br />in vlrjtilHJ to tile Buildj!lCJ Official. An appro'Jed illspection must I,e lu(]']ed dllrillfj eaell sL(
<br />lIIllnth per joel, or the proj eet \,d 11 be consIdered abandoned,
<br />~'mRllTl](; TO O~vlJE:R: '{UIJH FlU LURE '1'0 RECORD A ll<yncE OF ('(JHI-1Elj('EllE~ln I'll\Y RE',SIJ[ '1' III YOUR
<br />E'1\YlIJI; '1'\tHeE; FUP H1PR.OVEI'lE:lll'S TO ':{IJI.m PROPERTY. iF YOU lJI'j'E[lll 'I'U OB'I'}\111 FIIII\IICIIJr" (:(lllSUL'I'
<br />vHTlI YUUR LEIIIJER OR AllllTTORJ1E;'( BEF'URE RECOFUlIlIG YOUR IlU'l'ICf: OF C:Or,nlEIICF.:11F.:rrr. ,JiibS IJII!JE:fi
<br />$2,5UU ] 11 Vl\LlJF~ [ICI 110'1' 11EELI TO PECORD AIlD POST A "]jOTICE: UF 1-'Ul1~lEtlCF:lilf;~II'l'''.
<br />
<br />S 1 GI1A'l'lJHE:: i)VJllER OR l\I.~h~1 IT
<br />
<br />~---~- -- --.---.------..---.- ---_. ----_._..~-----_._.
<br />
<br />SH;IIATIJBE::
<br />
<br />COt'l'[' RAI. :'l'f)f{
<br />
<br />S'/'l\TE OF FLOHl DA
<br />cor JIlT Y 0 f'-- _ .__u_______.______ __________.___
<br />The tOLe'JoLnCj inslrLlmelll: vias acknmJ1edged
<br />Before 1IIe I'his ____ m day of --__.____f 2IL__.
<br />
<br />l)y ___._____ _ ___. _.________.__.__ .__.____________
<br />(name of pel.son arckno\'lledged)
<br />[) II1Io Is personally blolln 1:0 IlIe, or
<br />
<br />STIITE: Of' ElnRIU1I
<br />C:OUIJTY liF . ..u__._.__._______
<br />The foregcdng j nstriHl1elll: \'Ias acJ;no\'iJedged
<br />Be [0 r e me I: h i. s '_u' ___Jla Y (l f -----.--. --.---.- f 2 ()
<br />
<br />by __. _. _________.. _ _._____.___. _..___._____._._._______.
<br />(name of persoll ac:klloVlJedyed)
<br />[jlho j s personally knovm t'.l) me, or
<br />
<br />[] 1,1110 iI,s S pIodllced____.____.________.____
<br />(lYIJe of idelltificatIon)
<br />and HllOl]clir! []djl1 not: take an oath.
<br />
<br />[J "litO has produced.___ __.______.._.___.____._______
<br />(Lype uf Idellllfi';alion)
<br />aJld vlho [Jdjd [JUri nol: lake all oatil
<br />
<br />8j 'Jllat \] Ie () t perSOll ta l~ll1CJ ackno\lledgement
<br />
<br />,gj'Jllature uf person l.akLIl'j dCKIIUI'Ilec](:J1l1ellt
<br />
<br />llallle l. yped, p1 lilted or stamped
<br />
<br />[lame I_yped, [..JLilltecl or sl:alli}-lE=d
<br />
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