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<br />IL IIO'I'ICE: (If llE:E:D RE:STRICTIOllS
<br />rile undelsJ9l1ed understands l~haL this permi L ITIa)! be suhject to "deed restrict l'>IIS" Hld,~h
<br />llloy be 1l1(lle I.estricl~ille thalll:ity regulations, The undelsiqnec:l dSSllIlies respr.>lisibilily h:~
<br />comp] ianl:e \'Iitll allY applicable deed restrictions.
<br />13. 1J/'ILICE:I1SED 't:U/I'['RI\CTClPS Alii) COtlTRN"l'l)R RESI?UtlSlBJLI'I'1 E;S
<br />.I f the olmer lias hired a contractor ur conLracLnrs to undertake Hurk, tlley may he 1eglli red
<br />t,) be 1 j censeo in accordance I)i I:h sLal:e and locaJ regul aLions. 1 f Lhe cOllh actor is nut.
<br />1 icensed as requ ired by 1a\'I, buth the 0\-1I18r and contraci:o]' !!lay be ci Led Ll] a mi sdelileanlll
<br />violati.ull under sLate la\l. Jf the rwmer or intended contractor are Ilncerl~aill as lo Hhat
<br />.1icensillg 1eqllireillents Inay apply for the intended \"or);, LIley are advised ICJ (;ontac:L Lhe
<br />1 iLl' of Zepllyrhi lIs Building DepartlnenL, 813-78()-0020.
<br />F'u:rt.henn()re, if the uI'lIle1 /las IILred a contractor or CCJlltractors, he is advised to Ilave the
<br />l;ontractol (5) sL ':In port ions (J f the "Contractor Se,.::l:i OilS" of I:his appJi ca t inn fo! Illjj ch tlley
<br />Ilili be ret:ipollsible. If you, as the ovmer signs as Lhe contractor, you dIe illllJcal:ill'j Illat
<br />ye'Il, raLher ,.jldn rhe cOflLracLol, are responsible for thf= IFHk, ] f l:lle contracl.U! \.I1.."lle5
<br />YOIl tu sigll as cOllLracLo1 that. lI\ai' be an indica~ioll UlaL he is nol: propel/Y I icenserl and is
<br />Ilot ellLi t'led to pp.lInj Iling pliviie~lesin the I:U'y of ZephYlhi Us.
<br />(.. TRAtISPORTi\T rUN H'lP/\CT E'EES MID L1'l'[ LI'l'Y CUIH1ECTJ 011 E'8E:S
<br />II. C:OIJS'J'RllC'l'lIlUlI LJ E:tl LA\1 (CHAPTER 713, FLORIDA STATUTES, AS 1\.lilEIlllED)
<br />J certify that I, the appiicanL, have been provided vlith a copy of "Florida's ('unst:ruction
<br />J lell LavI HomeOlnler's Protection Guide" prepared by the F'lorida Uepartmelll: of l\yr j cul lure
<br />and ConslHller l\ffaJrs. If tile applicant is someone other that. tile "ovmer", i l:e1j[y that I
<br />have obtained a (:opy of the above rlesr:ribed document. and promise .in 'Y'Oc] faith 1:0 deliver
<br />.I L to tIle "(ll^1l1e1-" P1ior to commencement ~
<br />E:. CUtJTRN~'J'UR' S/CMlJE:R' S AffiDAVIT
<br />I cerljfy Ihat all. tile Jnfolmat.Lon in this applicaLion is aCCllrate and that al) Iwrk \1111
<br />he c!eJ}le in compliance l'lith all applicable 1al"s 1egl]IatLng constructioll, Z(,nj\lg, and land
<br />developlllelt\ .
<br />IIPplicatlon .Is helehy made to obtain a pellll1.t Lo do v/ork and insLallaLlon as JncLLcated.
<br />,:erLifV that 110 HorJ; or illstaJ lalloll has commenced prior to issuance of a pel'lld t. and that
<br />a LJ Hork \'Jili he pel formed to meet standards of allla\.Js regulating constl:ucl:iclll, ('i1:y
<br />codes, zoning re9uJatinns, and lanel development reguiations ifl the 'jurlsdictioll, I also
<br />certify IllaL J llf1clersLand that the regulal:ions of other goverllmental a(jenl~~les Illay apply 1:0
<br />tIle illtended \-Iork, alld Lltal: iL is my responsibiU~I:y to idenl:ify \'/hat actions .I IIlUS!: take Lo
<br />be ill ':()mf'JLal\C~e, ,Such aqencles Inc.lude but are notlillllted to: *1)eparl~lllelll. (If
<br />Fnvlrl llllllellLa] Re'Jula t i 1m-Cypress Bayheacls, \Jet land Au':as and E:nvirolllllellta 1.i y Sens It i 11e
<br />lands, vJai:er/\'vaslel'lab::i.. Tceatment
<br />~S':llltllllesl: Flurida i.1atec l-JaliageJl\ent District-\Je1ls, C'Yf1l8SS Baj'heads, vJellallcl i\leas,
<br />/\1 LerlllCj \;.)al:en:iJ\Jrses
<br />*Army COlpS of Enyineel:s-Seal-laJls, Docks, l~avigable v~aLen.lays
<br />*Departrllent of Health & Hehabllitative Services, Ellvlronmental Health UlllL'dV1el1s,
<br />\1aste\lal er 'J'reaLmenL, Septic Tanl:s
<br />/.1). S. F~nv j I Oll\llenl:a i Protecti on Agency-Asbes tos abatement
<br />1 also ':ertify thaL, jf filllllalerial is to be used ill Flood Z'JIle "1\" 01 "i\fel'(~ it. is
<br />under.stoorl that a draina']e plan addressing a "compensating u()Lulile" ViiI] be sulJlllilted 1/ILIcli
<br />is prepared h,,! a professional engineer registered ill the State of Iil(lrIrla priol to peulli l
<br />issuance.
<br />I\. pennit .Issued shalJ be I::ollstrued to be a licelise IJJ prcll~:eed I.dt:h tile l)e)l'k allllllot as
<br />authority 1:0 'lJ.olate, conue.l, alter, or set aside any provisl.{)Ils of tile l:echlJicaL l:odes,
<br />1101 shall issuance of a permit prevent the Builrllnq Official from thereaFter re(julrJng a
<br />c01rel~tion of erlOIS in plans, construction, OJ v,ic)lalions elf any code. F:1J8ry perfllit
<br />issued shall be(~olfle illval id unless the \'Jork authorized by SllClr permit is COIIH1l8nced 111Lhi \1
<br />sj){ IlIontlrs of .issuance, or jf \"ork authorized by the permit is sllspended or ahandoned for a
<br />f,eLiod of six months after the time the \'Iork is COIlUl\ellced. One 90 day ext:en8ion of Lillie
<br />may be aUm/eel for the penll11 \"ith fee cllarqe of $15.00. The exte\lsioll shall be recjuested
<br />in IIrJtJIJrJ 1:0 Ule Building Official. An approved IllspecLion IIIUSt lie loq'Jed dlnlJlq each 8i;:
<br />fIIonth period, or the [llOjAct l'lill be considered abandoned.
<br />~'}I\Rtlllj(J 'l'n OWJER: '{(JIJH FI\.ILURF, Tn HECORl1 A [lUTr(~E OF ('(JlvJt.1EtICEI1EIJ'l' Hi\Y RF',SU[.'J' III YOIIE
<br />Pi\fHli~ nlleE: rUH H1PROVEI,1E:IlTS TO YUUF PROPERTY. [F YUU Wl'EIl[) TO OB'l'I\IIJ F'III/\IICllli" CUIIS!IL'I'
<br />vHTII Y{)lJR LEIJUER OR All Nl''l'ORlIE:'{ BEE'ORE RE('c)Fr)[tI(~ YOllR IlU't'ICF, OF r:OfltJE..IICE:IlE:t.JT. ,j(I!:3S IJlIlJE.f<
<br />$~, 5UU ] 1,1 lJi\LlJE: DO 110'1' 11EElI TO 8ECORD AllD POST A "110TICE: (IF 1'(lt1tH;:llC:E:I'lt~IIT".
<br />
<br />-- --------------------------.-------..----..-----
<br />
<br />SIGI1A'l'lJRE:; UWIIER OR l\GEIl!'
<br />
<br />------ --,--_.. ------------- .--------.----..---.-.. -_._- ....--.-.- .-. .
<br />
<br />SIGtlA'J'1J8E',:
<br />
<br />CON'!' kAI :'1'01<
<br />
<br />STJ\.TE OF' ELClRT llA
<br />CotJtl'l'Y ()E'~-, .___~____.____________
<br />'l'he fore'joLng insL1umenl: Has acknovJledged
<br />Before me !:Iii s____ .. day of _~____~~_...__,' 21.1.._.
<br />
<br />by '____,_.__,~ __, ~_~~~____, _. .. .,.______.~ , '~_____~_,
<br />(nallle of person ar:knouledged)
<br />[] \1110 is personally kllO\1l1 to IlIe, or
<br />
<br />STirn: OF fI,URI/)i\
<br />COUllTY OF
<br />The tor egc>i.ng .i ns trllfllellt l)a8
<br />Be f co). '" In e I h is _.._-,"1 a Y {J f ,~_._
<br />
<br />acl:n('\'Ill':;cJged
<br />-, 2(/
<br />
<br />by
<br />
<br />--.,.- --_.._.. '._.'._- .----------.---..-------. -".-----.-..,. '_,-_...' -"-"'- _..
<br />
<br />(name of persoll acklloHJedqed)
<br />[Jlltn is personally knovJn l:o me, or
<br />
<br />Ll \'1110 lias procJllced__u__,__~
<br />(t.ype
<br />awl \,,110[1 eli d n di (j liot
<br />
<br />of idelltLfication)
<br />t.ak8 an oath.
<br />
<br />[] VJho has prodllC)ed,___u__.___~_..___.._____,___~
<br />(type I)f jclellLlfi':alion)
<br />ami "ho C]did []jirj !lO! I al:e all Datil
<br />
<br />Si'Jllatlil.e ot ['ersoll taJ:in'j acknol./ledgemellt
<br />
<br />S i 'J 1 \ a 1: u r e u.f per son L i:l ki Jl 'J a c k 11 U IJ 1 e (1<,:11\\ e 111:
<br />
<br />lJall!E: L yped, pr illted or stamped
<br />
<br />------ ._-_._----._---~-_._-_.. - .-._-. ----..----------------
<br />
<br />tlamE: Lyperl, fJl illLed or sLalllped
<br />
<br />- '-~------.-.- --------._--_._-._-- -- _._-~--._.- ....- ---------------
<br />
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