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<br />P.. NOTICE or OCtD 1l.ES'1'lUC'l':tONS
<br />The under~i;n.d UQderatands th~t this pftrMit may be sQbj.ct to ~deed z..tr1ctionc" which
<br />o1lay be IIlOre l:QllItrict.l.ve than City requbt.:lonl. Th. undl!!!I;s1qn.~ lI!UIUI'I.e. re~onsib111ty ~or
<br />=~l~Ance with ~ny .ppliaa~lQ dQQd ree~~iotionl.
<br />a. UNLICENSED COlUMCTORS AND CONr~p' RBSPONSIBILITIES
<br />It the owner ha~ hired a contr4etor or ccntzactor, to und.rtake work, theV may be requi~d
<br />to be ~1cenl.d in acoordanoo witn .tat9 and local regglat~~.. I! tn. contr~ctor 1s not
<br />H.Cen.ad a. zeqy;i.lCed by law, both tho Owne:t and OOntraOtor mAY be cited for a m1a~aI\O:Z:
<br />,telat1cn under ~tet. law. I~ thc owner oz ,j,atended contractor are uncertain ao to What
<br />.L.l.~nsing ;reql.\.i.tement~ 1IIa'y :)pply fox the intended ,",ozolc. they a~ I(\"i..d to Clontaot the
<br />c~.I.tl oS: Z"pbyrh.nl~ BUllcSing DtI~artment, 8:1.3-780-0020.
<br />;~!I;tl\ellllore, i( 'the owner has hi1:ed I OOl\tzoactor Dr e,;n\1:J:lllctorll, b. is IdvislflCl to have el\e
<br />I,ontraetoz(ft) s1gn po~1:~~ of ~h. ~Co~traator S.ctiODSW ot th~~ applic&tion tor Hb1ch they
<br />w~ll bO ~.pon.ible. If you, a& thQ owner a19n, a. the oontk5ctor, YOU oze inalcatinq ehat
<br />~'ou, rather than the contro=eor. are r.~pon.;\.ble tor the work. If the oont!l;actor W1$h~.
<br />1fQU to .~9ft as aontraetor. t~lt may b. an 1ndlea~ton thee ho 1. ~ot proPezoly lioeneed and 111
<br />not .nU~l.d to perlftitt.l.n; privl1.gu ill thlll City or ZlRphll'rbill,.
<br />I:. rMNSPOIl.'rJl,UON IMPACT nES AND UT.ILITY CO\QlUK;fION FIlEs
<br />I). CONSTlilUC'1'OION t.IEM 'LAW (CRAPTEl 713, nOIl.,tDA STM'UTES, AS NiENDIO)
<br />l: ".rti1:y t:hAt l:. the ~liC41M., nil... baen p;ro"id.ed with a Ciopy of "Florida'1I cOnStruction
<br />:.1en Law - HOmeowner' 8 ~rot~tion Quj,c1l1" preparad .by the Florida Dllputllont ct 1I.qriWltuze
<br />llnd Con.~e~ Affairs. If the 4ppllcant i. someone Othor that tb. "owner", I cerify that I
<br />ilaVil ebtalned IS OOPY of the a~ov~ deQorlbllCl dOaulll$nt Md prOlllisIIl io good f::llth to deU.er
<br />j.t to the "own"'r" prior to Clllllllllm09lllent.
<br />.:. CONTRActOl\' S/~R'S At1'%DAvIT
<br />l: cert.tfy that all the intOJ:IM.tion j,n t)lh appJ,1e..ti.ol'l is l!Ieourate and tl!.:l.t dl -~l( ".1.11-
<br />~l' <lOne .l.tl COl\\Plianee !fith all appUoablll la.." :r:equlat.l.n<:r conctrl.lct:l.on, ZO!llf19, enll land
<br />el'\"eloPftl~t .
<br />Appl1~ll.tiDft is h~reby IlIAde to obt.~.tl ill perm.l.t to (\0 work ..,ad 1nlt&11a:ion _; 1nd.i.catad. I
<br />e,trtity th..t DO wo~k or instillation haa commenced pzio~ to is,uano.. of I perm1t and thllt
<br />~-ll wo;rk will be perfOrm8d to meet Btaft~r~. of all la,,:!' n1GUlllt1n; construction, CUy
<br />CodA", zooing ~..~lation~, and lend dovelopment requlll~ion, io the ~ur1.diot~Qn. I .110
<br />cert:l.t1 thlt I ~nderstllnd that the ~oqUlat~Oft~ of oth.~ governmcnt~l .genQ~Os may apply to
<br />tl'le .l,nhl>4ed work, and that it 18 my r<l>GS>onll.1.])l1.l.ty to .l,del\tify what IlCltionll 1 IlNst take to
<br />he in ocmplilll'lc~. SUch ~genciell 1nclude but O~ oot 11~~ted to: .Cepllr~t of
<br />Env1ronmAntlll Ae9Ulation-Cyproa. 8ayheada, WetlAnd At~a~ ..nd Environmentally Sens1tlve
<br />L.n~, W.t.~/Haete..ater Treatmont
<br />.So~thwa.t rlo~:l.da W.t~r ~anl;omant 01.trlct-~.ll., Cyprel!l~ BaYhead.. Watlaod ~....~,
<br />~lt.r1n; Watercourses
<br />+Army COrp. ~~ 2n<<ineor~-S.aNall., cook.. ~.v~9ab1e "a~~rw~Y8
<br />+Cppartment ~t.aea~t~ 5 Rehab1lit.~1ve ~eOV~ClI., &nv:l.~o~ent'l ~~.lth 00n1t.Wells,
<br />W~stDwAtQ~ Tr..~cnt, Sept1c r~~ks
<br />.~.s. ~V~r&fta.ntal Protect1on \;.ncY-Asbes~&. ~tem.nt
<br />I alao cllr~ify that, if fill material 10 to be uocd 1~ ~lood Zone ~AN or ftA,etc.", 1t 10
<br />u~derGtood that a draina9Q ~l.n Iddroa8inq I ftcompenBfttift9 ~l~H w~ll be aubmi~t.d Which
<br />i~ prep.red by . prof~~e10nal en9in.er reqlstered in the Seat. of Flori~ prior to PQrmit
<br />:I.~lIl1ano..
<br />~ permit 1DaQed shall be construed to ~e a lican.. to procecd With ~hc work an4 not a.
<br />a11thotlty to violate, oancel, alt..:-, or .et alll:Lde any prgviaionll of the ttllCihnlc.l eQd..,
<br />"lOr ahall :L..uance of ~ permit p!I;pvent t~e a~11dinq Official ~tcm th're&~t.r rQqul~:Lng a
<br />e,)rrllCtAO" of error::! 1n plana. conn.~otion, or "lolat:l.ons of any coci.. l!:"Afl' ptIm.1t
<br />1'1'\1~ .hall become in....Ud unleu the WOl:k l\lthorhoo:l by 8uch pcmit is ClOlllmlilno.d w:Lthin
<br />~~x months of iS$\1~n~~, or it work aut~Q~~~ed by the permit i8 ~uapandod or <<ban~oned for 'a
<br />p,.ricd of d~ Il\gnth. artc~ the tiAo the werle 11 CDlllllAI).<:l8(\. One 90 day oJltlllUli.on ot t1lle
<br />~\y be allo~ed tor ~h. ~erm1t with ~Q' oh.~9. or $15,00. The exten.ion ah&11 bc ~qua.ted
<br />ill wriHn9 to th~ iu,udinq OUia1.1. An .appr~(\ 1nspee1:ion must be .loClged dtlr;lnq e.lll\ six
<br />IlKlnth patied, o~ tone pro:lect .,ill be considertd III:llnd"necl,
<br />IfJJ{)U/IJG TO OlfNEP.1 YOInt !'A.l:Lll'RE '1'0 IU:l:(I.P.D A MOna; or C<Mft:NC!IMl!:IfT Ml'Y RESOLT IN YOU1<.
<br />i'l,yrNl: '.l'WICIl FOil J:~P.OVJ:HsNTS '1'0 'rooR Pll.OP~"1'Y. IF YOtl ;l;1il'l'EMD TO OB'l'AIllI FJ:NAlIC:l:MG, COtlSOLT
<br />wn'R YOUR, LENDER all. AN ~TTOIUf!Y erroR.! UCQRDIN<; YOup' NonCE or COMM!lt"...ma:N'l'. .;rOA Uli'DEa
<br />$~ . :;00 ;J;W VALUZ DO NOT m:zn '1'0 lU:COW AND POST A ~!IIO'1'Ia: OF COHH!l~Ift".
<br />
<br />~~-LZ-
<br />'~
<br />
<br />11/05/2003 16:18
<br />
<br />7275714377
<br />
<br />SIGlfA'1'OU.
<br />
<br />0IftIl-='Il OR AC;~
<br />
<br />STATE Or JUO~;Z;OA
<br />COONTY 01'
<br />'1'he rozollgo1n~ lD.trum'~t ~aa acknowledged
<br />Safore III. tb1. _ MY of , 2ll-
<br />by
<br />(n8me O{ par80n aCknowledOedl
<br />1:1 who 10 plIX'80ftl-lly ltQOWII to me, or
<br />
<br />CIWhO haa produe.<I
<br />(type Or identilicat10nl
<br />..n~ .,1;,,0 did Od.l.d not t:l!lke IItI oath.
<br />
<br />9~?ft~turo of pa~Don taking aCknowledgement
<br />
<br />~~~ tYPOd, pri~te~ or .t.~d
<br />
<br />_ _Z . d
<br />
<br />6m-ON
<br />
<br />APT
<br />
<br />~~
<br />SIGNA I ONrllAC'ro~
<br />
<br />$'l'JI,TIi: OF n.aRIDA
<br />COUNTY Of
<br />Th. foregoillg .
<br />1I.~ore III
<br />by
<br />
<br />
<br />, 1~~
<br />
<br />...~ ANA LASA6A
<br />\. Notary Public - State of FIarlda
<br />Ij My~~1eOOe
<br />:: CommIssion' DO 107958
<br />Bonded By N8fIonaJ Notary Aun.
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<br />PAGE 05
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