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<br />I\. 11UTICE; of' DEED RE:STIUCTIOIIS
<br />I'lle undelsj ';!lled understands that tllis pernd t may be suhject to "deed restrictinllS" Hhlch
<br />IIlay be 1I1r'1e r.estricl-JITE:; thEdl 1:.itV regulations, The undels.iqlled aSSIlJ\\es respollsihilitj' rcn
<br />c:OJllP.! ialwe I,ll th a}IV applJrcable deed restrictions,
<br />8, lJi'lIdCF~11SEj) 'LUIITRl\.CTOFS AlII) COIITRN"!'UR RESPOtIS1BILI'J'TE,S
<br />.t f tIle O\Hler lIas hired a contractor OJ: conLractors Lo undertake vJOrk, tllel' !Ilal' he requ.i red
<br />try be j.l cellseJ in accurdance \}j th sLat_e and loea.! regul aLions, J f L11e cOldJ actor is llol.
<br />Jicensed as required by lal-/, buth the O\'llIer and contractor lllay he cited fur a misdemeanor
<br />vlulatLull Illlder sLate la\l. If the o\.mer or intended contractor ale ullcerl.alll as In 1,i1lal
<br />Ji.censlllfJ requirements Illay apply for the intended I,orl:, they are advised to ,:olltacL Lhe
<br />(iLy of ZeplIyrhi l.ls Bui Jding Department, 813-78C)-0020,
<br />F'urLhelmole, if the UI'H1er has tlLred a conl~ra,;t:or or contractors, he is advis",d to Ila"e the
<br />c;ontract_oL(S) SirJll portions of the "Contractor Se,.;tions" of this applicaLinll fu) \.Jldch LIley
<br />lIill be redpollsible. If you, as I:he Ol'mer si<jns as the cuntracteH, 'lOll ale illCliealjllfj Illat
<br />you, raLher 1.1,2111 the conlracLor, ate responsible fOl the I-Iorl:. J f l:lle conLracl.ul \'Ji511es
<br />'lOll 1:0 51 'JII as contraclor that Il\ay be all iIldica~ion tllal: he is not: [He'per J y Ii cellsed and is
<br />not: enLi tied 10 pennitting pl'ivileeJesin t:he City of Zephyrl1ilJs.
<br />(-, TRi\t1SPORTl\T[Ul't H'lPl,CT fEES MlD U'j'tLI'I'Y CUlHlEC1'1011 fEE:S
<br />ll. COllSTRIIC'I'lIlUlI L1EJl LA\'J (CHfl.PTER 713, fLORIDl\ S'I'l\TU'l'ES, AS l\I'/IEtllJED)
<br />I certify tilat: .I, the applicant, have been provided Hith a cupy of "Florida's ('lJ!lst:ructJon
<br />llen tali HumeOlmer's Protect Lon Guide" bJrepared by the Florida Department lIf I\<]r Icul turs
<br />ami C'onSlifiler l\fti:drs, If the applicant is someone other that. the "o,^mt~r" I I celi fy Lilat I
<br />have ol.Jt:a tned a r;clpy of l:he above described document and Plomise in <Juod fa 11:h 1:0 de I 1 vel
<br />.it. to tl18 "')VH1Sr." prior to COlllmencement,
<br />E. CUI11'Ri,C'j'UR' S/()vJllE:B' S AFFlDAV.lT
<br />I celli fy Ihat a1 L the information in this appl ication is aCCllrate and that all I'wrl; \..,111
<br />he e1mle in complian'.~e vliUI all apbJlicabl.e lal's regulating constr'llctiofl, zonjrlg, and land
<br />develop1l181Jl ,
<br />l\r,plicat-ioll is herehv made to obtain a permit Lo do \'Iorl; and inslallaLl.on asilllllcal:ecl.
<br />r~ertifv that. no \..I\:)r); or i nstaJ laL1011 has commenced priur to issuance of a permit and I hal
<br />i:l I.J I'Jelrl; I.JiII he pel formed to meet standards of all .lal'Js regulating consLrucl:\cln, ('1 Ly
<br />cudes, znlling regllJatiolls, and lanel development requlatiansiTl the jlulsclicLioll. I aLs"
<br />certIfy thaI. I llnclerstalld that tlle regulat:lons of other Cjovernmental agelll.~Les lIlay af.,ply to
<br />Ule intended l'lor)'., and Lhot iL is my r-esponsibllJI:V to identify \'lliaL actions 1 HillS!: take to
<br />be 111 l;olTtplLallC:e, Such aqencies include but are notl111iited to: *i1epart.menl (If
<br />EnV.l1rllllllellta 1 KequlaL ion-Cypress Bayheads, vvetland i\reas and E:llvirollmellta lly Sens i t i ve
<br />lands, vval:er/v~asle\'later Treatlllent
<br />*Snllthllest Flucida Vvat er l',janagel!\enl: Distrj ct-l'le11s, ('ypress Bal'heacls, Vvel: lalle! i\reas,
<br />A I I. e rill Y vva L e r c; U U1 S e s
<br />*Ihmy Corps u.E En':jineers--Sea\<Jal1s, Docks, l~avigabje Waten.lays
<br />'LJeparfruenl of HeaLLh t( Hel1ahilitative Services, Environmental Health IJIl1L V/e118,
<br />Vvast:ellat er 'J'L-ealll\e;nl, Septic 'I'anl:s
<br />1.1), S. F~nv i I unmenLa l. fJrot8c1:.i on Agency-Asbestos abatement
<br />1 also r:er1: L fy Lila l, if fill IIla1:er ia 1 is to be usecl in Flood Zone "1-\" 01 "1\, e I-r: 11 is
<br />undersf.ood t:llat: a r.!laina(j'e plan addressing a "coll1pensal~illg \loIIlJlie" vii 11 l)e sullllill I-eel Ilhicl1
<br />1s IIJepaled h'/ a p.lr1fessiona] engineer legistered iTI the StaLe of Fcll1rida priol to peuult
<br />issuance.
<br />I, pennit- issued sllall be COIIstrued to b,e a licelise Lo proceed \,.i\:h tile \'Iork allrlllOI as
<br />authurity to 'Ilolate, conue], alter, or set aside anv provisiollS of the [-echllical l~odes,
<br />1101 shall issuance of a pennit prevent tlle Builriinr::1 Official from l:llereafter rerjllil.lnq a
<br />cOJ.Tel~t.ion of errors in plans, construction, or v.iolaL.ions of any code, EveLY permit.
<br />.lsslled slla1 I ber~olJie illvai. ie:! Imless the vlork authorized by Sllch permi t is cOlllmenced l.dUd II
<br />sjJ; IIlontlls of [ssuallc8, or if I,ork authorized by the permitis sllspencled or ahandoned for a
<br />I,eriot! of six Illontl1s after 1:he time the \'Iark is commenced, One 90 day ext:ensioll of l_lme
<br />may be aLJc!\'led for lire f,enuit "ith fee charr;;e of $15.00, The e;;tens.ion sllall he request-ed
<br />in v'lrjLillf] Lo tIle Building Official. An appro\;ed lllspection IIIUSt- IJe JrJCJljed riurlllq eaell si);
<br />month per.iud, or the project l'lill be considered aboncloned.
<br />\'Il\RtllW, TO OI'illlT:R,: YUlJH FlU LURE '1'0 RECORU A t]OTI(~E UF C(Jlvlt'1EIIC'EllEIJ'l' H/\Y RE:SUI,T I tl jOfJR
<br />P!IYll.]I; 'l'vHCE FI)[1 H1PRI)VEHE:llTS TU .:{UUH PROPP.WI''i. IF iOU 1l1'J'EtW '1'(1 OBTiilll FltlllllCTI "
<br />vHTfI YOU1<- LElJDER OR All l\T'J'CiRllE;'{ BEE'ClRE Rs('rmrlIl'lG YOUR 110'l'ICF, OF c:or,jtlEIICE:IJE;t,lT:.,../,)(iBS
<br />$:2,5UU 111 VI\LlJE; [iu l,jO'I' 11EEU TO PEC'ORD AllD POST A "IJOTICE: (IF 1-'UI'lllE:llCE:I'IE',II'i'''...
<br />
<br />
<br />S I GtlATtJRE:: OWl'lER OR i\GE:ll'f'
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<br />
<br />__u_ __ ._._ .__________ _n_ __.___ _. __._._.___; -;Ij.._.;_ __
<br />SH,IIATIJBE:: COl']'I'RAI:'j'OP ~(/~:>
<br />
<br />8'1'1\1'E OF FI))1<-1 [lA
<br />COIH1'l'Y OF .----__________.___.______
<br />The foregoinCJ ins Lrument Has aCkllOlJledged
<br />Before lIie Ud s _____ __ cia',' of ________, 21)
<br />
<br />1) V ------- - -.___ ____.____._. __.___.__.__ .. _. ____.._____.__
<br />(liame of per-5on acknouledged)
<br />[) uho ls personally kno\Jn to lIie, or
<br />
<br />STI\TE OF FLORI DI\
<br />C:OlJtlTY Clf_.___._ __.__________
<br />The foregoIng InstnHl1ellt I'J:35 acknul'lledged
<br />Be fo t-e me I:hi s ._.. ___da y (l f _.___.__u_ ---------, ;! Ii
<br />
<br />b V -- . -- -.--. ____ ._... _____ _.___.__ __ . .uu_.____._
<br />(name of persoll ac:kllcJl-/Jedgecl)
<br />[jlfJO is personally knovlll 1-0 me, or
<br />
<br />[J I'lllO has pr oduced______.____________
<br />(lYI,e of identLficatIon)
<br />allr] \'Iho[l dj r.I [] elj d not tah" an oa th,
<br />
<br />[) \"iho has prodll ceel __ _.. ._.. __._______.__n______..____
<br />(LYIJ8 uf JdelllIfir;aL.ion)
<br />amI vlhe: [Jdid LJ]jd not lol:e all oath
<br />
<br />SHJlla1:llr.e or persoli tal:inCJ acl:nouledgement
<br />
<br />,Si'::1llature of per son I.a k Lng ackllOul edgment
<br />
<br />[lallie l. yped, pr lilted or stamped
<br />
<br />l1am6 1_"T'ecl, printed en slalllperl
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