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<br />Vl\~~ ;..,_.'EJ"/r:' _.':..t:D Rr.......-,l !:"\.'_l,_,) J.;,_,:l'~:>
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<br />T h ~ \.~.r.1.j8 J: .'5 i 9ned 1..1 .n,r.:i.8 r'::I t .=,nd 5 t ~-la. t ': l\i s pel-ft~..:. t rna,:,~ be 3 uJ: j e:::' t ::-. (I \\ dee',j r ,":. s t 1: i.:.":". ~ 1') .,:.;'1 ~; i ::,. h
<br />r~,a i:~"~,: :n;:; r e 1.- 8,~3 t. r i c t i ve t ha,t.', C i. t Y r ~q~J 1 a.t. _~_ c1ns ~ Th~ u n<).€.1: ,':.':' qne.rj a:3::: \):n\~0 r e ,'? p(;n'~ l}) i 11 ~ 0/ f ,_,
<br />cc~p~.j_aJl('e ~vit~ 3J1Y aI)pli~a~l:e deeeJ res~rictions.
<br />e . :)[J:' I CE:-;S E D CC);:TRAC'lORS AP(\ Corn :U:\:~":'OR R!:',:=: r'O[,;;:3 I B I LIT::::3
<br />If the 0,,1';.81" h:lS .>:il'8d ,.,. ,,'cntl'a'=to.~_' or c:>ntr':'.ctc,rs t.:' l,ind'Or:tak",: 1-).:'1,;, ':I1",y may b-'.'_-P-Jlllli:'
<br />to 08 licensed i~ accordance wl~h 3tate and ~ocal regu13tio~s. If the CQntracto~ i~ nee
<br />llCensed as requ~~ed by law, both the owner and c0n~ractor may be cited for a r'i3d",mDa~c~
<br />7ioie~ion unde= state law, !f the owner or intended contractor are uncertain as t~;~a-
<br />licensing requirements may apply for the intended work, they are advised to contact tl:e
<br />Clty of Zephyrl1ills Building Department, 813-780-0020.
<br />Furthermore, if the Owner has hired a c~ntrac:or Or cont~actors, he i5 ad~is~d r~ ~~~e rho
<br />contr':lc,tcr (S) SJ.qnocrti<::>n::; of the "Contn:v::r:ol' ::;e'::tion~" ::'1' this3pplic.,~_inn 1'-:'2 ;vh:.ch c.,'
<br />~..;ill be .responsible. J:e :/(YJ, c.!: the OW~1e= si9ns as :_..t~e ::'):;tra(:-t~:Jr, i(:~U. 8.r':1 i~-:,ji,-~.~tln:J ,....
<br />you, r a.t h~ r than the Cor. t ra ct or, a.re ~e s pons j.tl). e :01' t hoe "cl:.k. If ':he c:>" t L. ,-,,~ ~ ': 1_-.':: :::. i:'::
<br />you to sign as contractor that may be ~n indication that he is not properly i:.cen3ed and
<br />not entitled to permitting privileges in the :ity of Zephyrhille.
<br />C. '::'?AJJS'tO~T}:,TI01'1 IMPACT FEE-SAt,JD f;TILITY '~O\lNEr:TI:)N FEE:]
<br />J. CONSTRUCTUrON LIEN LAW (CHAPTER 713, FLORIDA STA~U?ES, AS A~ENCE~:
<br />I certify that I, t~e applicant, have been provided with a copy of "~:ori6a'~ '-r)l'l~;tr'l.lctic!
<br />lien. !"9.'II.e :1omeowner'g ?rctectior: '.::;ljid,,~" prepa.red i)i th.e fj.orida [;el:",rtme'-'T' (>~ ?qri-:.:ltIJ'"
<br />ct:':d CO:lSUr.l91.: Affairs. If the ap!='':'i('ar1t i::o sc'mfO'.:'ne ot').er ,:he.t the "::'\-;l"i.8r'I, ::: c'C'L-ifv ~I>o',
<br />have Qin-ained a (>:'py of the abo'''\? de5cribl;ld (jcclJ:n,=nt ar:d prO/TI),.",e :n good L1:ih ':c' d'O'_:_:-,',:L'
<br />:,t to th<:: '\)"-'mer" prior to cOIT\!",o:'ncement.
<br />E. CO\lTF'ACTC'?" S/Oi'iNE,P' S AFF':JiWIT
<br />~ certify tta: all the in~orrnation ir this application 1S accur:ate a~d ~l1at all wor' w(ll
<br />be ciotl8 in ccmp.1.iance wi':h a.U. applicable J..,,-"'18 r'?!:l"_11ar_inq constr:ucticn, :COrIE;'J, :;n:l ['"",i
<br />(:i;:o'J',:,loPlTcnt_ .
<br />Application is hereby made to obtain a permit to do work and installati8n ~s ~ndi~at~d.
<br />(:e.!'tify that. .f)(,:, viclrk (l.r j,r.u:..d:..:lllation h.a:3 COIT'JT'.enced p,r.'J.(:'.t' ~c iss\Jancq ~)f ,~ re:-J:l.:..t:: <.:l:l,-l ~h,7i~
<br />ail work will be performed to meet standards cf all laws regulating congtruc~i0n, r\~y
<br />cedes, zoni:19 reqlJ.lations, F.U'.d land d,",'\;elopr,l8nt req\.11at__ion.s i:1 the ~\lrl,-;cL;_':~~ic'n. r 3]:""
<br />ce~tlfy that r understand tha: the rQgu.1.atlons of other gover~mental ~gencle3 ~ay 3?ply r
<br />~he inter:d~d w'::,r:~1 a.r\d that it is my resplJnsibU.:Lty ':'J id8ntj.fy what ac:icns J rn:,o,: t:-.':~
<br />be l~ cosp~lance. S~ch agencies include but are not Jimit;:od to: *DQP~rtme0t cf
<br />Environmental Regulation-Cypress Bayheads, Wetland Areas and Environnerltally S~n~it ;;~
<br />~and8. Water/Wastewa':er Treatrnen:
<br />.So~thwest Florida Water Management District-wo:'lls, Cypre~s Bayhead~, Wetland ^r~as.
<br />Al,:ering Watercourses
<br />~A!my Corps of Engineers-Seawa.lls, Dncks, Navigable Waterways
<br />*Department of Health & Rehabilitative Services, Envircnm~ntal Health Unit-Wsl1s.
<br />'~1}9:3te.(H te r l' rea tment, Sept), C T,:\nks
<br />*U.S. Envlron~ental Protection Agency-Asbestos abatement
<br />J aI.s':"' ::.ertify that, if fj_1J. rnateri'3:" .is t.<) be I_:s~:?d in Floor:i Z'.")ne H,A" or \'A,'8ts.", It i~"?
<br />understcod th,3.t a drainage plan a,ld.ressinq a "c<Jmp8ns,9tlr:9 'iolum,," ,,,_'1.]_ be ';'~(,\l"1itte,-; "r,_-_'i
<br />is prepared by a p~ofessional engineer registered in t~e State of Florida pri0r t~ p~~n::
<br />:'. ~:;Suc,nc~.
<br />
<br />A permit iss~ed shall be constrlled to be a li.cense to o=oCQ~d \~ith th~ work a~o l~~)~ ~s
<br />authority to violate, cance~, alter, or set aside ary provisions of the techni~al C~d~5,
<br />nor shall issuance of a per~it prevent the Building Official from ther",afto:'r reguiriG] a
<br />correc:ion of errOrs in plans, constr:uction, or violations of any code. E~Qry pe~mlt
<br />issued shodl oecome j.nvalid unless the work authorLz!?d by such peri'Jit i5,:,0"-,..,'':1-::n'::8,-2 ':"_~h.'r.
<br />S1X months o~ issuance, or if work authorized by th" permit IS susp~nded or aba~d0ned fsL'
<br />periocl of :six months af<::er the ttrr'.e the work i5 cOH'Jnenced. Cne 9:1 (1,3/ ext,:,n5io:, ,:f ti,I'''-
<br />~aj be ailowe6 for the permit with fee charge of S15.~a. The exten3icn 5hall be ve~JP~':e
<br />2C wri<::ing to the Building Orficie':'. An approved inspection must be loggGd dll~~ng ea~~ "
<br />month periodl or the project will be co~~idered abando~ed.
<br />v.JARNI.\!G TO C~',lN2R: 'iOt'R FAILURE: TO FEC~'.:)RD A l'lO'I'!C~ OF i~Ot--JtJD)CE~1F,N'T ~':M'" FESUL':' I;' .fr::rF
<br />PAYING TWICE FOR IMPROVEMENTS TO ~OCR PROPERTY. IF YOU INTEND TO OBTAIN ~INA~CING. ~O~S~:
<br />vnTH YOUR LENDER OR AN ATTORNEY BEFORE RECO?DIt'lG YOUR NO:-ICE C:F CO;'1;>,1El:CSH::tJT. -"~:)BS :):,1Crr:
<br />$2.500 IN VALUE DO NOr I~EED TO RE'.Corw AND ?O~Tr A. "1'10T!CE: (IF cm1r1SNc~=r'lE))T/(.
<br />
<br />~~ lkuJ~_
<br />
<br />SIGNA ~);:.:r : CONT BACTC P
<br />
<br />:3IGt':ATUR~: C0-'1~ Of/. AGSHT
<br />
<br />STKTE I.}: :LORIDA
<br />I~' 0 cn,; T Y C! i?
<br />The foregoing instrument WdS acknowledged
<br />Before ~e this _ da'l of ___ 2iL
<br />I) ,,_,
<br />(na~e of person acknowledged\
<br />Owho is persona:ly known to me, or
<br />
<br />STA;;::' OF FLC?IVA J J . n
<br />::::(If)i'JTY OF' ~_____________,
<br />~h: f,.:n:B']Oll;9 i nst l'un,;;'nt ;.~"'~ ::'.1:.kn ~'ld =.-d':;~:-I
<br />
<br />~~tor~\r:re.~l~~ ~t.~~~_~'~',_~
<br />
<br />rvI (~c,me IJ f pe l~ S (\f1 .:1 ~~' knl':;l,'! 1 e.i:i9;?G :"
<br />".,:-.0 ':"'9 p~rsor.'.aJ.ly k:lown t:.8 :T\~" (-n~
<br />
<br />o ',~llr) h.:\s prc:luced
<br />(type
<br />"l.r:.d. ""hoO dilj OdJd not
<br />
<br />o "Ihc h.:\s [>1'0::111'-::8'.::', '___.._m___
<br />(ty~e :~lf j.(~Jer';';::ficati;:.
<br />Odi ~cI tt"t t:-.ke 2'.r. ',r-,
<br />
<br />
<br />,"<, : ~ "'. ~{tcli t'r~--------' -" , -- .-
<br />S ~ qna t iJr~ ,_~, ~ l S OG'. :_~a- (. ~ '-"t'RR'ili, ~Ekp~ESl ~ It,,!,:, "':-. ':.
<br />'~~l ' il> <'(-'3
<br />
<br />
<br />of identific~~~on)
<br />t,:>k8 a.n (-,90th.
<br />
<br />Signat~re of cerson taklng aCKnowledge~ent
<br />
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