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<br />l\. llll'l' ICE; OF DEED RE:STHICTIOilS
<br />rhe unde1sJ9118d understands that tllis permit Inajl bE; subject to "deed resLricLirl[ls" Hlllch
<br />IIldY be Ulli1e 1.6stricl.i,16 thdnl:ity regulations, The undelsiqned aSSll!lleS .cesllC)llSilllli.t.j' hil.
<br />compl ianr~e \,Jltlt allY applicable deed restrictions,
<br />H, IJI1J.ICE:IISEIl t:UII'['Hl\C;TORS Alii) COll'l'RAC"l'UR RESPOI1SIBTL[TIE;S
<br />.1 f t]18 cJ\'ll1er lias hired a contractu! OJ: ,:::onLracLnrs to undertake Hork, they may be 18qui led
<br />11) helJcensed in accordance \.J.il:ll sLal-.e and local regulaLJons, If Lh8 cont:lact.or i" nul.
<br />Licensed as rEHJuired by lal", buth the 0\-1118):. and contractor may be ciLed ftn a misclelllealllJr
<br />viulaLLun 11Ildel sLate la\I, If the miner or intended contractor are uncel.LaLII as lo \'lhai
<br />1 iCE;IlS i Jig requi reHlenLs lIlay apply for the intended \'1orl;, they are ad'li sed to ,~(J!lta(;t L lie
<br />( i Ly of (,epllyrhi 11 s Sui ldJng Departll1enL, 8U-78CJ-0020,
<br />FurtlleJlI10le, 1.f the (J\'lller has hLred a contractor or contractors, he is adlJised to Ila\le the
<br />(;OntraL:t.O] (s) si9l! portloJls of the "C:ontractor Se,.:;tions" or tilLs application for \'Ildch LIley
<br />lIiJ1lJ81eSpol!sible, If you, as the o\'mer signs as the contractot, you are l.l](jicaLJlllj Illat
<br />you, rather- L1lall rhe contractor, are responsible f01 the 1.lOrk. 1 f l:l,e contractu!. \.d.shes
<br />'yOU to sicjll as conLracLor that. lI\ay be an indicatiol! tllal: he is not PU.iP'illly 1 icellsed and is
<br />not enLJt-jecJ Lu pennil-Ling pL.ivile~les in the I:jty of Ze[JhylllilJs,
<br />(' TRl\lISPOR'j'lIT [UI'I Tl"jpl\CT FEES fIND lJ'J' I LI'l'Y CutHIECT] Otl FEES
<br />II, CUI1STRUC'l1l1UlI LIEII LA V,] ((,H~.PTE:R 713, FLORIDl\ STl\TllT8S, AS f\HEtllJF~D)
<br />J ':ertifv Lllat I, the applicant, haVE: been provlded \'Iith a cupy of "Florida's ('I)f1SLrllctlon
<br />lIen LaH HomeDl.lller's Protect Lon Guide" !,Jrepared by the Florida Uepcntmenl: of 1\<;Ir icultulf,
<br />and C'onsl1Iner l\ftairs. If the applicant is someone other that. the "owner", 1 cerl fy that I
<br />have obtained a copy of the abolJe d8scribed document and promise in (j"ocl faith to deliver
<br />j l: to the "Ol^1Il61." prior to commencement,
<br />E, CUI1TR1\C'J'UR' S/OvJI1E;R' S AFF'LDA\![T
<br />1 cerlify lhat: aLL Ule lnforl1lat.Lon in this appJic:ation is acclll:ate and that all l-IOrk \/ill
<br />he (lrme in compliance vli.LlI all ap!Jlicable lal'ls reguJating constl:uctiorl, Z(J}lJng, allC.I land
<br />developmeril .
<br />l\rJplicatloll is herehy made to ohtain a pennit to do \'IOrk and insLallal_ion as j!l(Llcat:ecl,
<br />l~erLify that no l'lor); or j IlstallaLioll has commenced prior to issuance of a perlld\. and Ulal
<br />aU vlork \-Jil1 he performed to meet standards of all 1a\'ls regu.laLing constluclioll, ('it)!
<br />codes, znniflg regulations, and land development regulations in the jur.i.sdicl:iul1, I also
<br />certify that: T understand I.hat the regulations of other governmental agelll.:ies may appLy to
<br />t l1e intended \'/ork, and that iL is my re.sponsibil.il:y to idelll:ify \'ihat actions l must l:al:e 1:0
<br />be ill ';omplLance, Such aqencles include but are notlilldted to: *lJepart_menl e)f
<br />~~llvjrl)llllleIII.a 1 Reljula Li nn-Cypr'ess Bayheads, Het land Areas arid E:nv ir Olllllelil. a l.J y Sens.1 t i ve
<br />Lands, VJal:er/v~asLel.later Treatment
<br />,. SOllthlles t Flo cida \"Jat 81' t'Janagement Distr I ct-I'Je 11s, ('ypress Bayheads, vJell and III eas,
<br />fI.ll 81 LIlY vJa l.err;lJlH ses
<br />*Auuy Corf>s "f E;n(jillE::elS-Seal'laJ1s, Docks, HavigabLE: vJaLen'iays
<br />kl)epartrlll:::lll. of: HeaJLh E, l~eltabilitative Services, Environmental Health 1111\.I.-.\'lells,
<br />vJaste\Jat 81- Tr'ealmenl, Septlcl'anJ:s
<br />A IJ, S. F~nv 1 J Ulllllenta 1 Protection l\gency-Asbestos abatement
<br />I also certlfy tllaL, if fl..! 1 mate1ial is to be useu ill F;loocl Zone "l-I" OL "1\, el-" , it. ] s
<br />undersl:oor! tilde a dra.inage plan addressing a "colllpensa~~ing vo]ullle" \.Ji 11 be SulHllLited \lh1cl1
<br />is [Heparecl hy a plofessiona1 engineer Iegistered ill t:he StaLe "f fil"r1da pri')1 II) piHllli l:
<br />issuance,
<br />f\ penni t issued shalJ be l:onstrued to be a Licelise Lr, proceed 1,1i 1:11 t.lle \-Iorl; BIIl.1 IIO[ a~
<br />au L h 0 r i t Y I: 0 'i 1. 0 1 ate, can u e J, a 1 t e r, l) r set as ide any pro 1j j s L () II S 0 f tile 1- e chi Ii c a J l: 1)11 e s ,
<br />[lor shall issuallce (If a pennit prevent tile Bullcilnq Official trorn Llleleafi.er H,'fjllirlny a
<br />correlction of errCllS ill p13ns, cOllsLruc\:.ion, O.L u.lo1ations (If allY code, F;V81Y peuult.
<br />issued sha] 1 become illllalicJ unless the \'lOrk authorized by s\lch pennit is conll\\enced 111.1:I1]n
<br />s.i;( IlIonl.-hs of is sua lice, or if \'-IOrk authorized by the pernLi l: is suspended or ahandoned for a
<br />period of six lllonths after the tillle the \'/ork is commenced, Olle 90 day ezl:ens;oII of Lillie
<br />may be aLJOI'led for Ihe permil: l'Iil:h fee c11ar98 of $15.00, The e)(1:ellsioll sha] L he requested
<br />ill l/IiLJllfj 1:0 the BuildiIlCj Official, An approved illspection IIIIJSt l,e lOljyed dluinq eac:ll sj);
<br />month ~h::r.i()d, or Lhe pIoject \,/11] be considered abdncloned,
<br />\'I!\Rt1Tllf, TO Cl\^JllER.: YUI)H F11l I,URE TO RECORLl A 11UTT(~E elF' ('OlvjHE',llCE1IE1JT 1']I\Y R.F:SIJI:l I I) YOIJH
<br />i:'l\{llli; TVilC'E: FI)}1 IHFHO\lEJ1EllTS TU YUUH PHOPERTY, IF YOU lll'J'E;IHl 'j'() OB']'f\111 Fttll\IICIIIl:;, C'OIISULT
<br />l-H'J'II YUUR LEIIIJER. Of( All l\TTClRtlE'( BEF'ORE HE('ORJ)[l!G YOUR 11U'l'ICF, OF C~()rJrIEtl('E:IlF:n'1', ,lIiBS IltllJEF
<br />$:2, SUU J II 1//\1,1)8 DO l'jOT 11EE!.1 '1'0 FEe'OFf) AllD POST A "!10TICE: (IF (-'UI'nJEW;j;:I'IF',1I'I"',
<br />
<br />SIGtlA'I'lnu:: O\'mER OF [11:;[<;11'1'
<br />
<br />----- -.-----------..----- .--..------------- ~_._. .---. .",---_.. - "-"-"--~~-". .,-
<br />
<br />S I Gl IA'I'IJFE:: COtJ'l'FAC'I'Og
<br />
<br />8'I'}\TE ()F FLORI llA
<br />COlllJ'J''! OF' .~-_ ..__.________ n_____~____
<br />The foreCjolnlj instrument lias ackno\'iledged
<br />Before IIle t:hi s __.__. _~ day of _____________, .2IL_
<br />
<br />)) Y -.--.-- --- _ un. _ _.. ._____m__ . _ _ _____.nnm_ _______
<br />(Ilarlle of person ackno\'lledged)
<br />[] Ilho is personally kllo\l\l t_o me, or
<br />
<br />S'fIITE~ OF FLORID1I
<br />COIJl-l'J'Y OF' . ._._m~___________
<br />The foregoing i nstrlHllelll. \-Ias acknC>l-lI edged
<br />Before me I:hi.s _____.slay of------.---.n__-u-, ){I
<br />
<br />h"-r'
<br />
<br />(name of persoll ac:klluviJedyed)
<br />[J,ho j s personally klIO\1ll t.o IIle, or
<br />
<br />[] I'Ihu h3 s produced___.________
<br />(type of idelltification)
<br />d II d \'1110 LI d i cI [] d j cl Il 0 L t: a ); e an 0 a t h ,
<br />
<br />[J who has produ nee! __~._____..__..____.____._._____...
<br />(LYfJe uf jdenllfi(~<3Uon)
<br />alld \-lho []clid LlJicl not laJ:e all oatil
<br />
<br />Si<JllatlHe of person tal;lnq ac~l:n()\.11edgemellt
<br />
<br />Si'Jllature uf person Li:lkillCJ ackIIOI'lIed(,lIll811t
<br />
<br />tJallle l. Yl'ed, ['r inted or s l:amped
<br />
<br />name typed, pIll)!.e;] en sLalllped
<br />
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