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<br />,\ 110'i'ICF. (H' DE:Ji:D ::.ESTEICTlm.1S
<br />'Li":'! u:;j..jar&::..gn-ad understa:',d$ t.hSlt t."is PQrr."L:i.t. rr.>.lY be sLibje~t t(J "'det'lo n;!!'ltxi.C':~~C\1!I'1 1-:/'.:, ::tl
<br />may b9 mere ~estrict1V~ thell City r~g~1~tion5. 1h~ und8r3i9~~d assunes r~~pcns1btll~y fo~
<br />C(>"tpli.:!lnCe ~.li7;l'l ~H,): .9.PP~:'.<::ab1.. d.eed :re.!':tri\::ti.::mg.
<br />B . IJNLI CEHSE.D CGl~T :<.AC1 ();:.S ;llW CON'I'FrJ\CTCR RE~S PONS '1 '3 ETl'l E~
<br />If the owner has hired a ccntrac~cr or contractors t~ ~~d5rtake work, t~ev may be xeq~ir~d
<br />~o be ~icensQd 1n accordanca wit~ atat~ a~d 100.1 regula~1o~9. I~ tn~ cont~actcr is ~o~
<br />.lJ..censed as req'..1ired by .;..HI, b:)t.l": the G..in".)' ar.d c:o:nt;:actc::: mar be citga tm,: amit'ide::l'g~oor
<br />'l,i.,;)lat:..on 1.Jn:;lE;):' st~te laH. r f tl":e o\o>'ne~' or ir.tended contr.;tC:tc:t are '.Jnc",rt6:::'. as to ....,-l."t'
<br />l~~~nEino requiramente may apply for t~e i~t8~ded 'I~:k. t~~y are advlsed tc 00n~a~t th~
<br />City 'Jf. Z<?pil~':ch:,U~ Fluild.lll';J; Depart:mmt, e13-18:)-CC'20:
<br />F~rth~nncr~, if tl\~ owner has hirQd Q c~ntrac~or OX ccntrHctc=R, h~ 15 edvi~ed ro h~7~ th~
<br />co~tlactur:~l il~n po=ti~ns o! th~ "Contractor Sectlo~Su cI thi~ ~Fplj.~'tj.8n ~nt whluh th.y
<br />~~11 b~ tO~~0r,!icle. If you, a5 th~ owne~ ~i9n~ a~ th~ :ontrDat~~, you ~r~ ~ndicatinq th~t
<br />yo'.!, X:Cl,ther th''>ln the cCntril~:to:lt, e,.re r~sl:,c';-'l!Iible for: t:~,!l I.mr};. J:~ c:L6! contrCl.::tcr Hi,1hl:'lEi
<br />IO~ to ,Lg~ ~~ contr~ctol th~t ~~y b~ &n ~~dica~ion th~t h~ iM not pr0p~rly :ic~n~~d ~nd is
<br />not entitled ~c permltting Rr1vileQe~ in t~e City o~ Zsphjzhilla.
<br />TRJ.l.NSPO?TA'l':iOH Il1PJl_C? H,ES ~.N::J UTIl.UY r:OHNEC'T:Ot-J FSE"
<br />I:>. CONSIfl.llCrUIOH LIE.;N L.rIH (CHJU'T3':R "7i3, FU;RiD.... s'!'J',nY;"liS, ;c..s Al-')END;;:O~
<br />I cer'tify that I, th~ appJ,ica:lt, ha~e been provided witt, ~ =~p~~ of '~rlorida'3 C0n9tr~~ti~~
<br />.l ~er. l.",'J -. HorneO~'lnoilr' s P.t oteo::ticr, G:1J;lde" preparOld u~, ,"hE> F.' ,y.:::i.;1$_ Det)a::'::l\\9nt .:>f 1\.;;ric\ll tt,J:e
<br />and Consumer P.ffa.1.re. If the applicant. is SGl1;;.,)ne c1:J-.Ql." ':;:::..e.t t:le'~\',.;ner", I c-!:rify the'_ r
<br />h8V~ obtained a ~cpy of the aba?~ desa%lb~d do~umGnt and pro~ise i~ g~0d f~ith to deli'r~r
<br />it t.o tt1e ,. OVin!!r" rr ier to C.O!1l.'l1"r>\::eIT,ent.
<br />E, ('ON'TR.j:\_CTCR' s/O~.TUER' S AF?':DA.V:::T
<br />! csrt1!y that all th~ i~fc~n~tion in this applLcaticm i5 &ccurate ~Da th~~ .11 ~crk will
<br />be tiOl~<. in (lc.rlIplii..,::'~e ....'.tn 8_1 a~'Flic.;\::11l~ In..r.'S r"';/I.114t.'lng c<:'.T1C'!'t"rHctH)'1,. :i'.cning. and lar,,j
<br />6evEllopment.,
<br />;1.ppliqatJon is :.ere!:,y il\-5idiEt :0 ,.,btllin .;; pennl,- to dc:. IK,rk .sod lxH,'1tA.,l!lt"ion a~ ind.i..:a<:,~d. I
<br />cBrtlty that no wQrk or instAllation ha~ oommQnc~d prior ~Q i~~uacc~ cr A ~~rmit ~nd that
<br />all rlork wilL b~ pe[f0rme~ ~o meet ~~ftnd~~ds of ali l~WB re~ulatinq cC~8truction. Citj
<br />~Qd~~, zcn1n~ requlati0n~, and l~nd d~velopmcnt r~g~lations ie the iurisdict~on. I alQ0
<br />certify that I UDQ6r~tBnd that th~ ~egulations of oLher gove~nment~~ ng~ncle~ may apply to
<br />th6 intended week, a~d Lhat it is my rGsponsib11i~y to identify ~h8t acti~n8 1 ~d~t t~~. t..
<br />Ce in cornpll.allcoO!. S;.wh agetr.c~.lllS ;,;v::lude bolt er~ n'_'t l.:..rnic:-e(i to: *Oep<trt.ment. ::Jf
<br />E.L'Vircnmen-.:al. RegulatiQn-'::'Yfr~Sg 8ayhe..de, ,'Iet,land Axes.9 and Er.vi..o:):-t:"\~'rlt."llly SQfl,s1t:j,'T'!
<br />Lands, Water!Wastewatsr Tr~atDen~
<br />*Southwest Flgr~d~ Kater Management Dlstrict-Well~, Cyp~e~5 8ay~.~d~. ~etland ArG99,
<br />Alterjng ~atBrc~~rses
<br />.A~my Corps ot ~ngineere-S.aw.l18, Cecks, N.vig~ble Hat.arways
<br />.Depar~nent'0f He~lth i Rehabi!it~ti7e Services, Fn~l~o~mectal ~~gltn lnit-~ells,
<br />WaS~8water TreDtrn8n~. Sept1c Tan\8
<br />.U.8. Environme~~al Prct~ctiGn Agency-A3b~!~cs abat~m~nt
<br />1 alsc cE1:r-.::ify t:...at, i.f Cell m;:o.ttill:ial .),,,. '::Q be USQ,;l :1.n 1'lcod Zo!',a "Fr." cr "A,o;,tc."', it. is
<br />unders'Cood that;; dnl.inacJe t-":,an addres.'5ing ;a "i::l:):;npel'l~,!lting ,:'.;>J.I;.r(le'" will ::'9 e'-1brrdtt&c '.o,h'.C'.r.
<br />i.e pJ:ep/!.l"ed \:'1i!1 p,~of';lsslctlal p.oglnQl;Ir re.q:'!1tF.lrfolr.1 in t~~" S::f.te of r.~()r id~ pr;.cli: tc' peLTJ.t
<br />iSS'll'Hll~e .
<br />A perrrit i5~~ej !hall t~ aonetru~d to be a license to proc~ed with tn~ work aTld n~~ 29
<br />authority to violate, =anoel, alter, Qr set ae1de a~y pro~ieion~ of tha t.~hni~~l aoctee,
<br />o,:;,r shall 18g~\3r..:)e af a permit f'rev9n: t.he aui.~difl'~ 0fL:::ill.; ~:rorn tr.er!!o!lftl!r ).'aq1.1J!':'ir,;s 11
<br />:~oI:rec-:ion of e:r:ro:;s in piaoE, ::::cn~t:::l~ction, Ot vioi.at iO:1s of any c{,de. €t'ery f.-end t
<br />1911'.led :shall bee,alne J.nvalid tlr:l~!Il! the ',,'':!'.(k 8.)ttl::lri2(to by S'.l::h p!!I'Z:m.tt 115 ~cmrnenc.e(l ~~~l:h.L.,
<br />3ix rnc>l'lths of iS8',.\~mCe, or if work au-:hcriz~:'i by tf.e permiT. .ta l!l\l$r-e\ld'ld:l,~ a.bl!\ndC:lr.oed ..'nr '!'!.
<br />period of .e!'.K ll'.<:lnths after- t:h'i! t.irnQ tt,e \-Jork is commenced. On'!: 90 da~' exteoEL;;n 0:= t,irne
<br />m~y be allow9d for the permit witt fee oharq~ of $15,00. The exte~5ion shal: ~e recusstect
<br />in wri~ing to the eui1ding Official. An approved ~nspecticn must be logQAd d~ri~g ~a~h ~~x
<br />llIr:>ntb p('ri(',d. ':'r thoG> p~(~ject ,.nll be .:~,)'!"1(.d.:le~'!;:d !lc.~n,:J0r,ed.
<br />;,TARcIlNG 'ro OW~H;:F,t ~'OQR T.tI,~~LCF.E 10 R.~GOP.[' A llOTICE. i)r l:mit,1I:H':::E~1'S~n:' 1:1AY RESUl.'7' II'1 YO!]:<\
<br />PAYH1G nUCE Fe,F. Th~?/)VEI1:i::~lTS TO Yi)lIR PP.O;E'I-.~TY, IF' YO'] INT?ND ~:'() 08T!,IN FUJAN:.ING. CONSULT
<br />\"lI'I'l:i 'i('UR ;:.F;NDEF. UR AN hT'l":)Rt:E, Y BEFCIP.E n2-::0r,C-I ~~r; YOuR NOr ~ CF CCl.j;"Il;;~lC:F.l'IENt. JOBS tnlDE:i'.
<br />$2, S(JO :;~ V~LOE, D') UOT ur:ED '1'0 f<EC'('R[l AND i'~'9'1' A. \\!iOTI~ )~ C")Il!~~~NCE~'lF;rT.".
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<br />3efCl'eTitli..h!-~A~.Z"-J".f18'! 0[.,(/4. U. --I 20 (j~
<br />by - ~..:....-~_.vt-~k__-.._._----
<br />\~ame of person ~c~~cwl.dg9dl
<br />~:.:) .i~ peJ::Booally known t..) mH, or:
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<br />'PhI'; :'':C1-:ce';1'~dn9 i.nstr:uraent was Iil.~kno'.,led.;:ed
<br />B,'?fo.>:l'? (1.\"'. eLls _ clay c)f ____,_., 2,:),_
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<br />lnama ot person acknowledged)
<br />Dwhc is perg~nally knQ~~ to me, or
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<br />Dw~o hes pr0juced
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<br />of idAntjf~~8t~on'
<br />t...kP.' an '.:.at.h.
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<br />Bjq~ature of perSOD -:~ki~? 3~~nowl@dgement
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<br />t.'l.!Im~ tj'"ped, printed cr' stanr;JQc\
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<br />~~[~dCO MISSION NO. 00133550
<br />~~"6r;~~~2 EXPIRES MARCH 18,2005
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