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<br />1\. tluTICE; OF llE:E;n RE:STKICTIOllS
<br />rhe unde1s.i<;lllEHJ understands that this permit may bE: suhject to "deed resLcic:L.i()fIS" \'IhLc:h
<br />IlIay be lllUle restricl'iv8 than (~ity regulations, The undelsiqned aSSllllles respcJllsibiLil.y hn
<br />c:omrJ iance l'IJtll allY applicable deed restrictiOTls.
<br />B. lJl'lj,lCF~llSE[) t:Uln'RI\CTOBS AtlIJ COtlTRl\CTOR RESPOtlSlBILITJES
<br />.I f the OIn1er lias hired a contractor or contractors Lo undertake \-Iork, they may he 18CJUj red
<br />to he L:i c;ensed in accunJance Iii 1:l1 sLate and locaJregu I aLions, 1 f the corrt:JacLor is nolo
<br />1 i cellsed as requ ired b}' 1al'" both the 01'1I1er and contlactor may be ci Led f01 a rnl sdemeaTleJl:
<br />viulaLLcJIl \lIlder state lal'. If the (J\.mer or intended contractor are unceL'l.aLIl as Lu vlhat
<br />licensi 119 requi reHlenLs 1I\ay apply for the intended \'lOr);, 1:lley are ael'li sed to contact. the
<br />City of Zeplryrh.i lIs Building Departlllent, 813-78(j-0020.
<br />Furtllennore, if the UI'Il1e1 has hired a contractor or cCJ!ltrac;tors, he is advised to have the
<br />con t rac Lor (s) s i qn pOl't Jons 0 f the "Con t r ac.::t or Se,.::ti ons If of thi s appl i ca Lioll f 0 J vlld ch Llle y
<br />\1111 be re:::>ponsible. If )lUll, as tile o\-l11er si';]ns as Lhe cuntractor, you ale indJcal.L\IIJ Illat
<br />YOIl, raLhel' Ulan t.he conl:ractor, are responsible for the vlork. ] f l:lle coni.ri:lctuL \'lislreE:!
<br />YOIJ to S11JIl as conLractor that lIlay be all indication tllaL he is no!: propelly licensed alld is
<br />not en!:H.led to pennH,ting prllllJe':jes in the City of 7.ephYlhills.
<br />C. TRI\IlSPOR'I'I\TfUN H'lPl\CT FEES MID UTILITY CUIHIEC"I']()II FE:E:S
<br />rl. 1~()118TRUr:'I(JIUll LIEII Ll\f~ (CHAPTER 7lJ, FLORIDA STI\TlJ'J'ES, AS 1\1'IEll[)ED)
<br />r certify Lllat .I, the applicanL, have been provided vlith a copy of "Florida's ('ullsl:rucLlon
<br />J iell Lal'l HrJllleOl'llier'S Protect 1.on Guide" lJrepared by the E'lorida Departlllenl: of l\gr i cul ture
<br />alid ConsulIIer l\ffairs. If tIle applicant is someone other that. the "o\^mer" I I cell fy that 1
<br />have obtaLned a (:opy of Lhe abolJe dE<scribed doclllllellt. and pcornise in IJoocl faiLh 1:0 delive1
<br />j t. to t 118 "OI'lller" prien to commencement.
<br />E. COIJTRI\CJ'UR' S/UVJllE:R' S AFF'LDAV[']'
<br />L cerUfy Ihat a1 I. the LnfonnaLLon in this applicaLion is accural:e and lIlat all \'lor!; \lil1
<br />he clolle in compliance 1'liUI all applicable lal"s regulating constC\1ctioll, zoning, and land
<br />developlIlE<lil ,
<br />l\pplicatioll is herehy madE; to clbtain a pelmit Lo do \,/()lk and installaUoJI as i(HLlcat.ecl.
<br />,~ertif\1 that no \-lOll: 01 illstallation has commenced prior to issuance of a permit and I'hat
<br />aU \-Iork 1'li11. be performed to Hleet standards of all la\'ls regulal:ing constIuclioll, ('ity
<br />cudes, zoning regll.!ations, and land development regulations ifl the jurlsclicLioll. J also
<br />certify I'hat I Ilflclerstand I'hat the 1'egu1 al:ions of other CJovernll\ental agenc.:ies Il\dY appl y to
<br />jllE: intended I'/ork, and Lllal: il. is IllY responsibility to identify \"haL actions I IIIUSt I:ake La
<br />be ill ,;omplLance, Such agencieE:! include but are nol:limited to: *llepart.lIlenl. (Jf
<br />~~llvjr()rllllE:Ill'a] Re'Jllial.ion-Cypt'ess Bayheads, vletland Areas and En'lium\l\elltally Sensitive
<br />Lands, vJal:er/v~asLe\'later Treatment
<br />*SOllth\1E:st F'Jorlda \'iater l"lanageJt\ent Distrlct-Ilelis, (ypress Ba\'heads, VJellallCll\reas,
<br />AtlerlllY ItJaterclJurses
<br />*l\UIIY Corps uf F;nyineeJ:s"Seaqalls, Docks, l'lavigable VoJaLel\'lays
<br />kLiepartfll8fi1. of Health & Fehabilitati'le Services, EnvironmentaL Health IJnIL..f'lells,
<br />\~asl:ellal e1: 'J'rea Lillen I , Septic Tanks
<br />'11, S. F;IJIJ 1 J Ulllllental Protecl.i on Agency-Asbestos abaLernerJt
<br />1 also certify t11aL, if fillmate1ial j.s to be used ill F'luod Zone "AU or "1\,81'(:.", it. is
<br />undersl'ood t:llat a drainage plan addressing a "compensatLng UolUlileU ~Jill t)e Sllblldl.t'ed l'lhiclt
<br />is ['Hepal eel hy a professiona] eng.i.neer legi stared ill the State uf F'lorida pI il)l l:o perllli I
<br />issuance,
<br />1\ penni t j ssueJ sllal.! be construed to be a I icerise to proceed I,d th tile l'lork alld IlOl. as
<br />a u L h 0 r i t Y t 0 IJ 1 0 1 ate, can u e.1, a 1 t e r I 0 J: set a sid e any p 1 0 vis i () Il S () f the t. e Chili c ale 0 des,
<br />1101 shall issuaflce of a permit prevent tlle BuildJnr,j Offici a] tlorn t:hereafter re'jll1L\ng a
<br />correct. ion of errors in plans, cOflsLruct:Lon, 01.' v.lc)latiofls of any code. Every penll11
<br />issued sha]1 become illvalid \mless the l'IOlk authorized by sllch permit is COlllll18ncecl \IILllill
<br />Sl), Illonths of issuance, or if ",ark authorized by the perml t: is suspended or ahandoned for a
<br />peLiod of six months after the time the l'lork is conullenced, One 90 day e>;lension of UlIle
<br />Illay be allo\'led for I.he f>ernliL l"i1:h fee cnarr,je of $15.00, The extensiull shal l he reqllesled
<br />in vlriUnr,j to tIle Building Official, An approved illspectiofl must lie JC)(JrJed ,jurill'] eacll sj);
<br />month periud, or the project: 1'1111 be considered abandoned,
<br />l'IARllHH; TO UI'iIlf,R,: 'fUIJH Fl\ILURE TO RECORD A 1l0TI(~E OF' C()J'-1l'1EIK'EIJEtn' ['Il\'f R!':SU[,'I'lll '{orJH
<br />PI\lI Ni~ 't'vilCE F'UH H1PROVEI1ElJTS ']'0 ''-UUR PROPERTY. [F YUU III'I'EIIll 'I'D OB'I'I\lll FIIIl\lICllln, C:CltISUL'l'
<br />voJITlI '{OUR LEIWER OR All llTTORl,lEY BEFORE REC'ORnHIG YOUR 110'l'II:F, OF COr'lIJE:tICF:rlEIJT. ,I()BS lJlltlEF,
<br />$2,50(1 ] II VIILUE [)() 110T 11EELJ 'I'O BECORD AIm POST A "tlO1'ICE: (IF 1:'UlJJ~lEllCE:I"t~II'I"'.
<br />
<br />SH,llATlJRE: :
<br />
<br />I)W\'lER OR I\GEllT
<br />
<br />S IrJllATIJB E::
<br />
<br />conTRAI :'!'OR
<br />
<br />STATE: OF ELOHI[lA
<br />COIlll'l'Y OE' ----__,_ ._ _____
<br />The fOl"egollJg instrument was acknov,ledged
<br />Befole me tht s __._ ._ day of __,____._~_, 2ft__.
<br />
<br />JJY .___..____ ___._ .___..... __"'_'__'_,..... ,_________.____,
<br />(nallle of peLson acknOl'l1edged)
<br />[) \lito 1s personally ):IIO\/l1 to lite, or
<br />
<br />STl\TE: OF' FI,r)RI[)J\
<br />C:OUllTY OF'm___. ..,-__._h__H'_OO.____.___..__.___
<br />The fOlegoing j nstr\lfl\enl' \'Ias acl;nolvl ed'Jsd
<br />Be fore me L his ... _ ___da y (J f -------'..---...---, 211
<br />
<br />by _.__ __"______ ____ __"'m __""_m'... ..
<br />(namE< of pe1sol1 acklloviJ edged)
<br />[J,ho is personally knol-ln r.() me, or
<br />
<br />[) 1,lllO has pr odllced__._u_..___.______.____
<br />(LY[Je of icielltLficaUon)
<br />a II d l'lllO LJ did [j d i (j n (; L t a k e an () a t h ,
<br />
<br />[J who has prodllnsc\n._ 'nno_...___..__
<br />(Lype uf L,hmUfi':alJon)
<br />awl v,ho []did LJUrI not t al;e all oath
<br />
<br />Si'Jllatll1.e ot persoll ta);ing acknov-1ledgement
<br />
<br />---_.__.__._-~._- -- --- .-.-._-_._-~---_._._-----_.. ..- ..._---~-- --.---.--.----
<br />
<br />Si'-:)llature of person takLIlfJ acknoldedgmellt
<br />
<br />IIdllle L yped, pr inted or stamped
<br />
<br />llame l.yperJ, pI i lilec! or sLallq.J8d
<br />
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