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<br />1\. IJOTH'E: OF DEED RE:STRICTIOjjS
<br />l'he l.Irldelsiqlled understands thaL this permit Inay be suhject to "deed restrict!')II"" lildr'l1
<br />IIldY be Wile restricl'iITE:; thall I:ity reyuJations. The undelsiqlled "SSll!lles Le::i!";n,sihj lit \' J",
<br />c:omp.lianr:e \./Lth allV applicable deed restricLions.
<br />8. IJi'lI,ICE:11SEIl 'I":UIITRl\I';TOBS Jl,IIIJ COIJTRl\("I'UR RESI?OllSlBJLITTE;S
<br />.t f the o\mer lidS hired a contlactor ur conlractnrs to undertake \'Iork, tliey may he reglJJ red
<br />tr) be lIcensed in accu1c!ance IIi 1:11 sl:ate and local regulations. If Lhe contract.ol' is nl>!
<br />J icellsed as required by la\'I, buth the O\'iller and contractor may be ciLed for a Ini sdeIll6al((,]'
<br />vJulat Lun Illlder sLate la\!, If the O\'mer or intended contractor are uncel'la in as l u \Ihat
<br />JicensilJg requirements !ila\! apply for the intended I-lOr);, l:hey are advised tu (;Ontdr Ihe
<br />Cily (,f crepllyrhi l.ls BId ldiny iJepartlllenl, 813-78CJ-0020.
<br />FurUlennoJe, if tlJE: OVllleI lias hired a contractor or cuntractors, he is adlJisE:d 1:0 ha'le the
<br />(;(Jntrar.;toJ (s) S.l',J1l portlOlls e)f the "Contract!)r Se,.::t.lons" of t:h.Ls app] icaL~i()n fUI \Ihleh llley
<br />11111 I)e retipo1lsibJe. If you, as the D\lner si<jns as the contractor, YOIl ale illtUcaLill'J Illat
<br />YUil, r.aLher 11Jd1l the cOlllracLol, ale responsiblE:: fOl Ulf= 1'lOr):. 1 f l:lle conl:raclut ",1'-3lle3
<br />'lOll to sirJll as contracLol that may be all illdica~ioll tllat he is not: propelly J icellsed and is
<br />1101: enlHlecJ 1:0 perlllJtting prlviJe(Jesi1l l.he Clry of ~ephYll1ills.
<br />r.. TR1\lISPOR'J'/lTfUl'I H'lPl\C'l' FEE'S MlD U'J'ILITY ('OtHlEC'I' ] 011 fEES
<br />[I, COl18TRUCTlIIUlI LIE:!I LAVI (CHAPTER 713, fLORIDA S'J'l\'J'lJTES, AS l\I'IEtj[)E;[))
<br />I r:ertify that J, the applicanL, have been provided vlith a cupy of "Florida's ('olisl:nlCLion
<br />J Len La \'1 HOll\eotmer's Protect: ion Guide" ],JreparecJ by t.he' Florida fJepartmelit of I\Y1 j euJ ture
<br />allei ('onslilner lUfcdrs. if the applicant is someone other tha\. the "o\'lller", I cellfy Lila\. 1
<br />have obtained a copy of the above described docUlnenl-. and ['.romise .in 'Jt')ocl faiLl1 Lo deljve1
<br />.i t' to tile "U\HIEd." prior to commencement.
<br />E, CUIITR1\Cj'UR' s/uvnJE:F<' S AF'F'LDJW LT
<br />I cell.ify Ihat alL I_he iJlfollliat.ion in this application i.s accnrate ane! (1lat all l'lor); lIill
<br />he dOlie ill cO!l1pliallr'~e I-litil all applicable lah'S regu.lat.ing construetioll, zuning, alld land
<br />developl1181i1 .
<br />TlpplicaticlII is herehy made tu obtain a pennit 10 do I-Iork and installation as illdlcateeJ.
<br />reer-tifi' that 110 \101']; 01 installaLion hqs commenced prior 1:0 issuance of a penni\. alrd I.hat
<br />a LJ I./or); I-Jill be per funned to lIleet standards of all la\'ls regulating construction, l'it\,
<br />codes, 2.1'IJirJq reqlliations, and land develc)pmel1t requlations ill the jur!sclicLj'lll. L alsn
<br />certify that J Illlclerstand that the reguJations of oLher (jovernl11ental dgell<.!ies Iila~' apply to
<br />t jle intended \-/ork, and l.llac it is my responsibility to identify 1'lhaL actions I must take to
<br />L", ill r:rJIrLplLanc:e. ,Such aqencIes inc.lude but are notl1mLted to: f'l1epartmenl flf
<br />!"JIII\r()IIJl\enl'a] P,e'JlllaLion-Cypress Bayheacis, \'leL~Jand 1\r8a,5 and E:llvJrolllllelJtaLJy SensltivE:
<br />L:-illds, Wat:er/\vaSLe\'"atel Treatment
<br />*Sollthl-lest !:"lorida Hater L'I::lI1agewent Distrjct-\Iells, ('ypress Bayheads, \llellalld illeas,
<br />1\11 erLny via l.ercolJl ses
<br />*ArJllY Corps of En9ilJeel:s--Sea\'laJ Is, Docks, I~avjgable vvaLen'lays
<br />*Liepar1nlenc of flea1.Lh & Hel1abilitative Services, Environmental flealth [JnLl"vlells,
<br />vlast:evlat er 'J'reaLlllent, Septic l'anL;s
<br />! IJ - S, EnlJ i r OJl[lIenla 1 t-'rotect Lon llgency-Asbestos abatement
<br />1 also f:eltify t1Jat, jf filllilatelial is to be used in Flood Zf)jJ6 "1\" 0.1 "ll,e\-! it is
<br />IJndersLclrJd i:llat a dlainaqe plan adrJrE:ssing a "compensating vo!ullie" I.lill be sllblll1ltp.d \IILiell
<br />is prepared hy- a !Jl'nfessiona] eng.lneer registered ill the ::1tat:e uf f"1"li,la prtl)l' 10 peUlli L
<br />j SSUallrce.
<br />1\ penni t issued shalJ be l~OJlstrued to be a licerise 1_0 prc)(;eed vI.i th the "lOr); allrl 1101 ae>
<br />aut h 0 r i t Y t <) \1 J. () 1 ate / can u e.1, a I t e r, 0 r set a sid e any pro vis i 0 II S 0 f the tee h II i c aLl; u des,
<br />nOl shall issuance of a permit prevent tlJe Bullrilnq Official from t1lereafter re(lllilin~1 a
<br />cOlrel~Lion of errors in plans, consLruction, or 1I.LolaLioIls of allY code. E:V8IY pennLi
<br />isslled shall ber:olfle invalid unless thE: vJOrk authorized by StIch pennit is eOllillierlC;ed IJlUJil!
<br />sl:; 1I1onths of issuallc8, or if 1-lOrk authori zed by the permi I:i s suspendecl Of ahandoned for a
<br />f,eLiod of six months after the time the \'/ork is cOllu1\enced. (Jlle 90 day ext:ensioll of Lime
<br />JndY be aUo\'led for Ihe frermiL ''lith fee cnarge of $15.0U. The e:,teIISlun shall be re'dllested
<br />ill l'lriLin<,j tel tIle BuildinCj Official. All approv6d ilJspecLion !IIust be ]('rjr,Jed dlllillq each 5i;;
<br />!II()nLh periud, or the projAct ,.Ii 11 be conSIdered abandoned,
<br />\'Jl\RInlj(j Tn (J{^llJER,: YUIJH f}\ILllRE TO HECORl1 A 11U'J'T(~E ClE' ('(JI'H.1EIlCElJE~tJ'J' [-)I\Y RF:SIJ['j' II] YOIIF(
<br />i:'l\fll.j(~ '!'\tHn: Fr)H. H1PF1JJVEfJEllTS TU Yi)I)P l?ROPE;RTY, IF YUU HI'J'8tll) 'I'U OBTl\lll E'ltIJltIC'JIIU, COtISUL'I'
<br />(<JlTH Y()(JR LElWER OR All hTTORtjE;'{ BEE'URE RECOP[)[JJG YOUR lJO'l'ICF, OF (:()r1tJi'.,lfC~:r]F.:[.JT. rli >BS IllIIJEf<
<br />
<br />
<br />~ 2~5~ V I; e, i; IIEEl'. TO "ECORD_I~ I J) POST ~IOTIC'_:_:':F;"C"::"'~I~~__ ..._
<br />
<br />SIGtlATlJHE:: U\'1llEP OR AGEllT Slr;IIATIJRE: CONTRAI;'['OP
<br />
<br />S 'J'I\ T E ()}<' E'Le)!'u llA
<br />COIJtJTY OE' .._.._..____.______. __._______
<br />The fOl'e'Jolnq insLrumenl: vias acknmiledged
<br />Before 1I1E: this ____ day of _____..__, .211..__.
<br />
<br />11Y ____._.._._. .___ .._________._ ..... .._____ ______.
<br />(name of pelson acknov71edged)
<br />[) 'Tho is personally kIJOI'1n r-r) Irre, 0:-
<br />
<br />S'rl\TE: OF' [iLi)RI DI\
<br />COUIITY ()E _ _.__.... .________._______
<br />The fOlegoing .i nstnUI181Jt \'1as ack/1ClI'lIedged
<br />Be f 0 J: e me I:. his _.. __Jla y () f _ '----___'_'_'_'_ , ,) I)
<br />
<br />by _. _ _.._____ ___'.. __ __ __.,,_ _._.____._...__._ .__......
<br />(name of persoll acl;no\iJedged)
<br />[}Iho j s personally kllOl'l1l t~() me, or
<br />
<br />[} I-Ihu ha s produced.__._._
<br />( type
<br />and \.i!lCrl]dirl [Jdjd not
<br />
<br />of idelltLfication)
<br />takf" an oa th,
<br />
<br />[J \Iho has prodllC8d___.._.______.___ ____._.___.______._
<br />(LYfJe uf i c1ellti fi ca lion)
<br />aJld l'lho []did [J-Jid flot t oJ;e an oatIl
<br />
<br />S.i'JllatIJCe or perSUl1 tCiJ;in(j acknol.rJ.edgement
<br />
<br />----_._,--_._-~--~- -~ ----._--- --------.-.----.---
<br />
<br />oS i 'J I \ a t u r e (l f per 13 0 n t i:l k i I J 'J i:l C k u ()I.d e d <,j III e II t
<br />
<br />llallle L yped, p1 luted 01
<br />
<br />st:all1ped
<br />
<br />---------.--- - -~---__.__ _~_ .u_'__.__~..__ _._____~_
<br />
<br />lIame Lyped, plil1ted or
<br />
<br />st:allLped
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