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<br />(~():::JJ.'}'10!iS OF' PJ:;;}<IH'I' AE'F'IllAVJ'I'
<br />
<br />A. NCJ'l'ICl1l OF' DliilW kE::;'I'IUC']']OH::l
<br />'I'he unde1::;ignl;d Illlde;l:stands tllat Un:, pt:;ulli t llidY be .:iub:icct to "deed u:i:lt:ric:ticJl1s" ~/ld dl
<br />llIay be more: ,restrictiVb tlli:tn City l':~Jlll",Lions. 'I'IIt:: \lndt::l:signed al::io>lll11l;:,::l rel;lponl;lJbLLity La.)::
<br />complii:lnc:e t,ll tb an~1. applici:lble d",,,,d ]:estr.'ict:il:)ns.
<br />B. 1l1Il,ICJ!iHSED CON'I'RAC'l'ORS AND C:ON'I'HAC'I'UR RES,!:'OHSISILI'l'H:S
<br />I f the OI/lH::J:: has hin::d a culltr:actOl: eJl: contnlct:ou; to uodcrti:lke ~mrk, th",y may be J:o::quin::d
<br />to be liceno>e:d in accul'dalice Id. t:Jl stOlte: and ] oCed regula ti 011.:;1. It thl:: C(Jntntcl:oL j b lIut
<br />11.:.;ensed as l:equir.;.d by laH, both Lilc uI'Wet and contri:lctcH iUdY be: ci t""d tor C:I lid ..delil<:: a llCH
<br />vJ01atiufl under ::ltate len/. If th", millE;t or int/;:;nded contl:actor ell:b llIlCl::l-t<:lill ,Hi to 1~IlOlL
<br />Ii censinlj n:qlli rt:llIellLs IlIdY apply for the intended v/ol:k, they ell',=, i:Hlvi.:.ed lu contdi;l: tile
<br />C.ity of ZepllYlhi 11::; SuiJ dj neJ Dbpa.rtlllbnt, tJ13-'C/8fj'-6611.
<br />jj'urthtHlllo)::e, if the 01JrliiH has Idrl::d Q cOlltracto.r or contractor.:., he il:O advlbcd to hC:lvc tilt::
<br />contn:lcLo).: (::;) tlign portions of tJjt;:: "Contractor Section",," of thi.:. appli cation for ~/hich th<:;y
<br />vli,ll be nf:sponbi bl c. I f you, dO> the ovmer g,i gns a.:. the: contracto1:, you iill:.;; ind1 cati 1'19 Lhiit
<br />YOll, .rather than the cout1:actor, are reo5ponslble for the \VoLk. If the contrOlGtOi: I'Jishbt>
<br />YOll to ::;1g11 Qb contractor that may bt: an indicc:ltion tllat he is Hot prop.;r-],y 11 ceul:iE;d aud il>
<br />HoL enU t1 ed to penni tting pr:i vi It::ge::; in t:he Ci ty of :c,ephytlli Lis.
<br />c. TRAHS 1>OR'j'A'f'I Oil H1f'AC'J' li'EE:S AN n IJ'l'1 LI'J'Y CONNECrl'ION F'H;ES
<br />D. CONS'l'RlJC'rlJTClN LH:U LAW (CHAP'I'Ek '713, l!'LORIDA S'1'A'1'U'l'ES, AS ANENllb:D)
<br />] G.::rti fy that], the a[JpUcant, have been provJded \Iitll a copy of "Jj'lori.da' I:i COnl:itulCl:jon
<br />1 ien Lal-l - BOllleoHIHH'S Protection Gllide" prepart;;d by th.:: l!'] oJ:ida OepeatuII::11L of Agd cllltut'<::
<br />alld Conbluller: Affairs. If tbe: i:lpplicC:lnt is SOlUeone otbE:r thClt thtJ "OI/ili::l.''', I uerity tlii:lt I
<br />lla V 0:: 0bL/il1ntJd a copy of the: above: dt;;scrlbed document and promisE: in gom! fClJtll to delj ver:
<br />it to the "OHIlE:r" l)ri.o1:' to COIiUllenceHlent.
<br />E. CON'1'HP.C'l'Ok' S/OWNER' S At'FIDAVI'l'
<br />I cert,i!y that all tllb information in thil:i applicCltjon 1s aCCllratt;; and that '-tll \IO!,);: i-l1,11
<br />be dOIle in GornplianGe ~d.tb all appllcablc laHs reljUldting constnwtion, :i;onlIl9, i:lnd J aIllI
<br />devl::lopHIl::mt.
<br />ApplJLlatiUI1 j.:; hereby made to obtain a pennit to do \'/Od, and installCltlon OlS Jlldjc~ted. I
<br />ecrU ty thi::lt no Iwrk or In::;ti:llli::lLJon bi::l::l commenced priol to L:iSllanGe of a pt:::nlll t dilll Lllat
<br />all 1'101'1;: iliLl be performed to ml::/;:;l: standanis of all laHS rt;;gu]ating cOfl::lLulct1(;il, City
<br />c0de~""',ltld-j!-I:J r.::gIlJatiolll:i, and lewd devt::lopHlent re:gulations in the :illri:odictJoil. 1 aJt:.io
<br />ct::rLifY~hlt~iQi!j~~r~t,q,1l4 :hi:ll: ~:he regulOlUons o~ otbel', govermnental Ol{Jt:lit.:ie::i Hli:lY dppJ Y to
<br />tile, Jntelldc(iH-/qt}., .' and 'that t~ 105. my !.c::sponsibill ty to, ldeIlLlfy ~/hClt auLl ons I llHH:it Li:llit::: to
<br />IJC 111 cOHlPliJh6t:J,sit,h agellcle::i lncludebut are not lHnited to; A D.;:pa 1. tment of
<br />E;nvirorHnciltal Regulatl.on-CYfJre.:>.:J Baybeacl::;, Wetland Al:t::CiS and EnviroIIIHeni.i:l11y B<::n,~,li tiVl:;
<br />l,;llld::;, Wd1:l;L/WasteiJaLt::J:' 'j'n::atment
<br />.A;julltlH/e:>t: Jj'lorlda WOll:l::r l'1alldgt::lllcot District-Wellb, Cypresl:i Bayllli;dds, W",Ui:llId ArCClo>,
<br />A! tli;l.illg vJaLt:::rcour::'es
<br />'AAnllY Curps ut Jj;ngillcc;l::;-St;i:t\/alls, Docks, Navigable ~vatenJc:lYs
<br />AIJe1J;H'l:llIcnt uf HIi;a1LlI '" RelJabiliLc:ltivc Service.:>, t;nvil:olllHenLi:ll H.::a.1tlJ llidt;--Wl::dls,
<br />Wi:l::;LC::Hal:cr 'I'Lt:::atllll::llt, Bepti,; '1'",n),o5
<br />AU. S. E:nv1r.onlflenta1 l?x:otectlon Agl::iWy'-AsbE:l:ito::l abat:emE:nt
<br />I ",1::;(; certify UJi:ll, jf fill lHaterial 15 to be: used ill }j'.1ood ZonE; "A" or "A,l::tu.", it js
<br />understood that a draina\jt: plall addres::iiny a "ColHpE:n.:.ating VOlllll1e" l'/LlI b~ bllbllli LLcd Hldch
<br />ib [JLepi:llt;;d Ly a fJl'ote.:.si(JjJdl cng.llleer regist.::red in the Stal:t;; of l!']o):,ida pd.OL to plilulliL
<br />is::;Ui:HIC<:: .
<br />A permit i sl:illed shedl b<:: con.:;tr\led to bb a license to proc.::ed ~dtb the VIOL I, and llot a::;
<br />authori ty to violate, ci:wcel, a1tl::L, or set: a::;id", any provisi on.:> of tlll:: It:::chni cCil codc::::;,
<br />nClr shall issuance ot a pend t prev<-nt tilt: Bui 1ding Offici i:ll from l:hcn::after (<::llILl.rj ng Ol
<br />correction of E:rr01l. in p]i;ifIS, cCJflstrucl:i.on, 01: violations of ClOy code. Every llel:'lHit
<br />i sl:i\!ed ,:;;IH:d 1 \;t:;collle j nvcdid Holes.:l tbe ,/Ql:k authorized by :stICb peJ:wi t~ il:i COllUllbliUdd Id tldn
<br />::Iix !llonl1J::I of i,:;;::luaucc, OL' if \'lOrk authorized by the penniL is suspend",d OL i;abandolH:d for d
<br />pbriud of 151.. monl:l)b aftt;;l' the time: till;:: VIlJ1:k io> conulll::nced. On.:: 9(J day c.,tt::nl:iiOil ot tJwt::
<br />may be: a]!ol/t:r! tor tbt:: permit Hith fee cl~i:ll'ye uf $15.00. 'l'he e:.,tel)bi.oil blliill b"" reqllt:l:ited
<br />in l'/1:i ting to tbf: Bu11ding Official. An approved lnspection must be j O~HJed dlldnU edch I;:iJ K
<br />mOjlth period, or the project VILlI bb COnl:iJdl;1:ed abandoned.
<br />WARNING 'NJ OWNER: YOUH E'AILlJRt; TO RECORD A NOTICE OI!' C OJvlN EN C El'1 E: WI' NAY RH:Sur/l' III YOOk
<br />PAYING 'l'vHCE t'CJR I1'4PROVEl>1J1:N'l'S '1'0 YOUR l?ROPER'rY. IE' YOll 1N'i'END '1'0 Ob'1'AlH Ji'INANCJNG, CONSllW'
<br />wn'u YOUR LEIWER OR AH AT'l'OHNEY BEE'ORE RECORDING YOUR NO'I'ICE 011' Cm'llvIEHCEI'1EN'I'. ,JObS UlWEH
<br />$2,500 IN VALllE: VO NO'1' NE:ED ']'0 RECORD AND 1'OS'l' A "HO'rICE OF COI"ll'1li~NCEI'4EN'r".
<br />
<br />
<br />,~
<br />E ; - ---(:)Wi~ ER--()Re5---.....---------
<br />
<br />S'jIN1'E OE' li'I,ORJDA
<br />COUN'l'l.' OE' -- __~________
<br />The foreVoing instrument was acknoHledged
<br />BefoLe me thl::; ____.. day ot ____ , 19_
<br />
<br />by ..____ ___'___._____._____________.".____~
<br />(name of peri:lon aclmovJledged)
<br />o v~ho is perbonal1y knol.m to llIe, ox:
<br />
<br />[j ~/ho ha::; puJdllced________"
<br />(Lype
<br />anel I'JhofJ did []did nolo
<br />
<br />of identific~tiou)
<br />
<br />t~kc an ()ath.
<br />
<br />Signature of penson tc:ddng Olckoo~/ledgE;llIent
<br />
<br />ti~~~;~h-t YfJc;j~~r j II t__~~i-;~--.-,,-l:-~;;~;-~-J--.
<br />
<br />
<br />,_.-.. ' ~ )--_...__.----~---
<br />CON'l'HAc'rciIZ- ....----l-~...~
<br />
<br />.s'l'Nl'E OF IfLORInA
<br />
<br />COIIN'j'" OE' __.______'___..__._.________.___,,________.____
<br />
<br />The fore:goil1g instJ:\lHlcnt: wa::l ac]mo~dcdg..d
<br />b.::!o:re me thil:i __._day of------, 1~
<br />
<br />by ~______.___.._._______'___,__.__"______,_____.______________
<br />(namd of p~J:son acknowledged)
<br />[]Jbo is pbr:>oned.ly Imown tu we, or.-
<br />
<br />[] Hlto lli:ls. produc;ed___,___________,
<br />(type: of id<::nU fJcal:!oll)
<br />and ~/ho C1did []:iid not Lab:: ail oi:ltb
<br />
<br />._._----'-_._------_._---_._-_.-.._...._--,-~...- .,- -.--------.p.---...-.----
<br />
<br />Signat\lre of person teddng ackllcJWl bd91HcnL
<br />
<br />..._-----"--_.__._._-~--- ... ---'.-. ----"_..._-_.._...__._~._._.~.,.~._-->._-.._,.,._-_.__..-.-.-
<br />
<br />HalliE: typed, pr1ntbd or stallll'cd
<br />
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