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<br />_!.I.I" C1:14";','il Ii vir ~t!--n'II'I')lLL'~'
<br />'~~L~;b vz ~~ED R~~T~:CTIONS
<br />r'1e undexsi9nec!. und€:r9"':ar~d~ ..t~at this p&rp'.ut may be 5u.bject to "d.E:-ect rQstri=t:ions'. '1"'hich
<br />nt!iY J!S! mo~=e rQ2trj_C-:.:.."'-e t.~an Cit:t' ragl:.2.;..tions. The ~ndersigned aS3ume3 =Qsponsibil.:.ty fa
<br />I'::':-"T~p _i;ar_c~~ with a:"1Y ~ppl.i.cat:le deed. rl$st.r:ict l.:>ns.
<br />a. :lI,ICE;NSE!) ::;Oll'I'RACTCRS AND CONT~"::;TOR RES PONS IBILITIES
<br />If ct e ownez. bas h.:.red a contractor or cont,l;'actcre to '~nderta"'e :.,ork, they =y be raquir..,
<br />t(, b~ lice~~ed in accordance wi~h s~ate a~d lOC31 rag~:ativns. If tfi~ contractcr is not
<br />liGer ed as req.J.irQd bj-' lah., :?oth the owner .and cont.raeto~ ma.y be cited for a misd.emeanor
<br />v:i~l~ ~on under sta~~ law. :f the owner or int&oded contracto~ are ~ncsr~ain .$ to wh~t
<br />Ltce!., ,in\l requiremen:5 n-,ay apply for -=he i"tend.ed work, they are advised -::0 contact the
<br />.:::.ty f Z...!=<hyrhil.ls B'Hlding Dep51rtment, 813-780-0020.
<br />Fu~t:l-:. 'rmcx-e,. ::..f tr~Q cwnQ:';:' has hired a contract.o~ or oo.atra~tor!:,. h6 is advi;!;Qd. to ha~"e t:r."
<br /><::<:;)ntr.:. -::tor 'S1 ;!;1g.h port:ions of th~ \'Can-::ractor Section3u of tr~is app2icaticn f':)r which th.~
<br />"'"J.l1 1 d ~e$ponsible~ If ~7CU, 65 the owner- signs a.s the contriSlctor, you ..ce i:'ldicatir~9 the
<br />:J:'cl'U:, "'5.ther than the ~cntre.c"t.or, a.re responsib:"e for tr-.e wc'rk_ !:: the contractor 'rli"he::;
<br />YCu t ".i9n...6 contr<,-ctCr that may be ;on indication that he .:.S not properly lieitnaed ar,d j
<br />nDt at, it.led to perllli€"ting p:dvilegQ" i:t +;~e ~ity of 3ephY':hill",,
<br />C. 'rlU- .:Sl?GR'l'ATION HIPACT E'EES ANI:' IJTI:'IT"i COmlECTION E'EES
<br />D. Ci';:,STRvCTl.1ION LIEN LA.; (~HA.l?TEl'. '113, lfLORlDA STATUTES, AS AI'oJEI,.i:>BD)
<br />I "Art fy th".= :, 1:t.e appJ.ica.,t, hllve be..n provided \<ith a copy of "Florid..' s Ccnstruotior
<br />lien L w - Homeowner'5 ProteQtion Guide" prepared by the Florida Department of Agri:::ultur.
<br />;I;~~ci CC :;'':.lmer Mfaj_:::~. If th€: appj"icant i:=! someone ot htil X' that the \~o,,""r-~e::/I', I cerify that J
<br />ha'Je 0: . ained a copy 0:: -::hs abov" -:lescribEd document and promise in good faith to deli-Jar
<br />it -=0 he "ow,:U!::!':'u prior to ~Omli1-=ncemen":_
<br />E. COt'IRACrOP! S/OWNER' SI'.!'E'IDAVIT
<br />! certi 'y that all the info:nn!ltion in U,is application ia ":::curat~ ano. that alJ. wor" 'dill
<br />bE dCue in c~mplianoe with all applicab1Q lawe regulating constx'uction, zoningr and 14nd
<br />de velcprr ~:1t .
<br />Ap~licatl~n ~s hereby ~de to obtain a permit to do work and installation as indicated. I
<br />oertify ha~ no work or installat~on has cOm{(~nc~d prior to lS$ua~oe of _ per~~t and that
<br />all work ~ill be pe~for~ed t~ MQat standarQS of all laws regulating construction, C.:.ty
<br />eo'~es, 2<. .~inq r"gulation~, and land. -:le-JQlopment regulations in the jur.i"dicticll. I ~lso
<br />e'Htify t.at I under3c;ind t:"il': the regulations of other gov'Brr..r.\ental ",..encia", II"ay "pply to
<br />the i~tenc~d work, and that it is my re"ponl!<ibility to idefitify ~hat actions I mu~t take t
<br />be 1.n CO!l~p_ iance. S'~ch. a.g..".ci.." incl'.lde but are not limited tQ' "OepaO:1:ment of
<br />En-rironnent;l R<;gulation-Cypx.e"s 3e.yneads, Wetland.. Areas ..nd Envircnment...lly Sanl!!itive
<br />Land", Wat.., /WastQ~a1:er Treatnent
<br />.Sout~..;e8t F .orida \'Iatcr Manaqement Distriet-~)ell", Cypres" Bayheads, We,.c~..nd Area",
<br />Al ~:ering Wat". rO.O:Ur3es
<br />"'Army Corps c f Engine"'rs-Sea"al':s, Do::ks, tJavi"..ble Waterways
<br />.Departmer:.t c ,- Health & Rehabilit..t:ive SeJ;'rice", ~nvironrn6ntal Hea.lth Cn~t-ilTQlll!l.
<br />Wswtewater Tr",ltment, S"'ptic. Tanks
<br />*0. S. E:wiron:n. ntal.: Pru.""ction AQency-A"bestos abate:nent
<br />I ells:: r~er,=ify ."hat, if. fi11 ~~'at&ria.l i..s to be used in Flood Zone ,.,A..... 0: ""'A, etc. u, it is
<br />'m:lELstcod :hat ' drains.... pl.m aCldr..seing a "compen..!Itln.. volume" will be submitted >lhieh
<br />is prep~r~d by professional engineer regi..tered ir.. the Sta~e or Flcr~da prior to permit
<br />is~uar.Lce"
<br />!\ permit iS3UQd ,h~l.l be con"trued to be a li ::..nse te proceed 'nth the work and not a5
<br />au~h~~~ty ~o vie &~e, canoEl, al~er! or set aside any p.c~i~ions of the t~chni=al code$,
<br />nor shall is..uar.~9 o~ a perm~t prevsnt the Buildinq Offiei..l frc~ thereatter rQquirinQ a
<br />correc,ion of err'rs in plans. co~st~uction, or vio~atio:ts of any cede. Every permit
<br />iss~:ed shilll becor".. invalid ur:..":.es" the '''or~ aut.horized b;>. suc1J. permit i.. commenced within.
<br />six mc'nth.. of iss"aI.te, Or it work authorized t.y the permit is $Uspend.ed er ab..ndoned for's
<br />periou of si>: month:! ..',fter the "tlllle the wor:{ is COllUEenced. One 90 aaJ' exter:."ion of time
<br />-may be allowQQ fo= the "errr~t >lith tea c~arqe of S15.0J. 7he extension sh~ll be reque..tec
<br />in .1Iri1:l.nq to the Build.L.go ort'ici...l. An ,,-pprovad inspection must be ~yq..ed Quring eaon Sill
<br />month periOd, cr the p~.cj.. ~t will be oon..ida:::ed aba:ldoned.
<br />WARNJ.~jG ~O OWNER: YOOR FAl_eRE TO RECORD A NOTIC~ OF C~IENCE~ENT !~.Y RESOL'I :N YOUR
<br />FAY:N3 TWICE FOR rMPROVEMENT~ ~O YOUR PROPERTY, IF YOu :~rEND 10 OBTAIN F!~A~CINC, COKSULT
<br />\lIT"- YOUR LENDER OR .~ A'ITQ~1E_ BE~RE RECORDING YOUR NOT!C~ OF COMMENCEL~ENT. _OSS UNDER
<br />$2, see n,VALUE DO Nor NEED TO -,""':CORD AND POST ~ "NOTICE OE' COMMENCEt"lENT"_
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<br /><d~A1 .w)~ ~7 A, ""J~
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<br />SIGlt';Tl'R. O\'f~lE:? QR AGENT sr AfURE' CONTRACTOR
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<br />..)ll
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<br />1'.(,....
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<br />S7A't' OF k.LORICh
<br />COUL.~ .:~: O~...
<br />Th~ ~oregoiny ins~rum~nt was ackn~~ledged
<br />Bef".::e me this _ day of __, 2rL.
<br />J:;y
<br />(name of perso~ acknowledged)
<br />o "ho is personally know:1 to I\le, 'r
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<br />STATE. Of' FLORIDA
<br />COUNT: OF ...
<br />The foregoing instrument was
<br />Befor.. me thi.s __-Payor
<br />by
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<br />acknowledged
<br />r 2Q_
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<br />:n~~e OT. person ack:towled;ed)
<br />~ho is personally k~own t~ m~,. or
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<br />o "h" has produced__
<br />(type of ide~tj '.:.ca,ionl
<br /><L10 whoO did Odid no:>t take an t ,tn,
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<br />. -J who he.s produced
<br />(type cf ide~tification)
<br />a~.d ~ho Odio. oc.~d ,not tak.. an cate.
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<br />Sig:r..att..;re of person taking Qckncw .)~ !em~.l:'.t
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<br />Sign!lt1.: -.. of person takil:g "cknc)v;l"dyment
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<br />Nan\e t~~. -0, p.cin't~d or stamped.
<br />
<br />Namm typed, prin~ed o~ stamped
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