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<br />1\. NO'J'ICE Ol!' DIilE:lJ HEB'l'fUC'I'IONS
<br />'J'be \1ndet:s.lgned Illldet:stallds that: tl1:s p:Hmlc Ili,~y be s'lb.leut 1:0 "deed resl:rjnt;lolls" Hhlch
<br />way be lIIore resl:1.1ct:Jve than City u,g111aliolls. 1 Ill, uildEHsiqlled aSSlIInes respOllslb.llJI:y for
<br />compliance III th allY applicable deed reI311JeU.oll,s.
<br />B. IJlB'] CHa'l S Elll CON'l'HAC'I'OHS AND COl'/'1'Hl\.1 :'l'lifl. RElS POll 9 T B If ,1'1'1 H:.9
<br />lf the Dlmer: has hIred a contr:actol: e)j ,.ontract:olS to 11Ilclertake Hork, l:hey may he t:eqll:l red
<br />I 1.0 be licensed JlI Eluuordance v1Jth state and loci> l reglllatJons. If the cont:.l:auto.t: Js lIot:
<br />JJcensed as reqll.l.1:ed by la~J, both l:he Ol.mer and contltlcLol may be (l'll:ed for a m1 lidenneannr
<br />IIJulal:ioll Hilder state lall. If the o\>lnO::i: or .intended cOllt1:acl:or are Illwertaln as to Ilha\"
<br />I luensl llY rerlldrelnent:s may apply fot tlH~ lnteflclt,d IWJ:k, tlley are advl sed to contact the
<br />I: Il:y 0 f Zepilydd lIs Bui ldlng Department: I fl13-'/fl fj'6611.
<br />F.'1I1LIlEltll\ore, if the OHllet: lias hJJ:ecl a contractor 01 contr:actors, Ite 1s advJsecl to have the
<br />(JOlItraclor(s) sign porttons of the "Contractor ~lectiollS" of thJs appl.ication for IJlllch they
<br />ViLli be responstble, If you, as the OHnet slYI1S as the contl.actor, you are indioating that
<br />YOII, rather than the cOlll:ra.ctor., ar:e responsible for the Henle. If Ule conlt:acl.:o! \.1.1 shes
<br />ynll Lo s.l911 as cOlltr:actot: that may be all 1ndication L1lat he 1s not p.r;operly ,licensed and is
<br />nol: entitled to perlllittlng pl:ivileges ill the City of :?ephyddlls.
<br />c. 'l'R1I1-ISPoH'I']\.'J'[OI,j H1PAC'l' IfffiEiS AI/D lJ'l'ILITY CONl1EC'I'ION WE;ES
<br />D. COHB'I'RlIC'I'llTCll'l I,[EN LAW (CIIAP'l'H:R '713, FI,ORIDA S'l'A'I'U'I'ES, AS At1ENIlH:D)
<br />I cer:t:1 fy that I, the appUcant, have been Vroll1ded Ht th a copy of "Ii'Jor.1da's Constl'llCt.1on
<br />I j en La\1 -. lIomeo\'lller's Protectic)!) Guide" prepared by the E'lorida Depart:ment: of Agd.cllll".l1re
<br />and Consumer AJ'EaJrs. If the applicant: is someone other: that the "OI-met", I cf.lt:1fy that I
<br />haVE: obtaJned a copy of the above desor1bed document: and promise Jll good falth to deliver
<br />.it. to the "oHner" prlor to commencement.
<br />E:. COH'I'Hl\C'I'OH' S/OWHRiH' S AFE'IDA\!l'l'
<br />j nel:tJfy Ula1: all the lnfounaUoll .in thl.s aP1>11<:a\:J01l 18 accurate and thai., all \lorlc 11111
<br />be done ln compl.1allce Il1th aU. <lpplJoable lat-IS regulating construction, zonlng, and land
<br />development:.
<br />Appl.l.oaU on ls hereby made to obtaIn a permlt to do wcn'k alld Jlls\:a11at1011 as 1Ild:loated. I
<br />ced:j fV I:hat: 110 Ilork or lnstallat.ion has oommenced prJol: to 1s511allce of a pennil: awi thaI:
<br />al 1 ~Iorl{ I'll 11 be pel:rorJned to JIIeet standards of all la\1S regulat.ing UOllstrllctlon, r:1 ty
<br />codes, zonJng 1:eg\11al:10Ils, and land development reglllatJons.in the J\lLtsdtctJon. I a.1so
<br />ceIl:! fy L1lat r IIndetsl:and that the regulatJons of other 9oveulIllenl:al agenn.les l!Iav apply to
<br />the Jnl:ended V/lnk, and that Jt :La my I'eaponsibility to Jderll:Jfy l'lhat aut.i ons I must take 1:0
<br />be in cOHlpJ 1.811Oe, SlIch agencles :Lrwlllde bllt are not Limited to: *neparl:ment: of
<br />H:nvironlllsntal HegulClI:lou.-CYP1:ess Bayheads, Wetland A.l:eaf.l and n:nvJronmentally SensJUve
<br />l.and.s, Hal:er/Wa6l:el-lal:er 'j'reaLllIent
<br />ASollthYlesl: F.'lor:1.da ~Yater Hanagelllellt LJJstd ct--Wells, Cypress Bayheads, Wet.l.alldl\reas,
<br />AJ terlllg Wal:ercOllJ:ses
<br />'lH:lIlY Corps of mug! uesl:s-Bea\'/al18, Docks, NavJgable Waterl</ays
<br />AIJElparLlllElIlL of Ileal th << RehabL1j taUve Services, E;nvlrOlllnelll:al Health uutt'-Wells,
<br />~vastewater 'l'J:eatment, BeptJc 'l'an](s
<br />*U. S. H:nvl LonrnentaJ Protection Agency-Asbestos abatement:
<br />T .daD ceLl:! fy that, Jf flll materIal Is to be used In E'lood Zone "A" or' "A,etc,//, :LL .is
<br />lllHlersl:ood that a drai.nage plan addresslng a "colllpensatJng volume" H1.11 be suhmj tt;ed './h.1eh
<br />j S prepa ted by a jJ1:ofessional englneer. registered in the State of E'lorida prlor to pennl\:
<br />tssllallCe.
<br />1\. pel:nd t .1 Bl':llled aha il he (~onat.tued to lJe a license h) proceed Hi th the work and not as
<br />aul:horl ty to vlolaLe, oancel, alter, or set aside any provisions of the Leol1ll1cal cocles,
<br />nor shall ! SSlIance of a perrnU: prevent: the B\lJlcUng OffJc1al from t:hers<lfte,t 1:e'1u1dll9 a
<br />con:euLJoll of BlTors in plans, constl"l1dt1on, Dr violations of any oode. Every rJElrrnit
<br />issued shall belDome invalJd unless the work authorized by such permi t. 1.6 11011ll11611oed Iii Ud II
<br />sill months of issuanoe, or if \'1017k a\lthor.1zect by Lhe pe.t:mJt is s\lspended or abandoned for a
<br />pedod of s.1x lIIonths after the I:lme the llOr), is commenced. One 90 day eJc\:ells1ol1 of Lime
<br />may be allo\./ed for the permit Idth fe~ chal:ge of $1.5.00. 'l'he eJ{tsnsioll shaLl be 1.eqllElsted
<br />in Hrit:ing to the Buildlng Official. An appr.oved 1nspecl:.1011 must be logged dllrJng eauh EL.la
<br />month period, or the project \o1ill be considered abandoned.
<br />Wl\RIHllG '1'0 OVlNElHI YOUR ll'AU.UlIE '1'0 RHlCORD A NOTICE OF COMHIr.NC1!1MIW'1' MAY nmSIJJr'l' 11/ YOIJR
<br />PA YHIr, TWICE I!UR IMI?RO\!EHEN'I'S '1'0 YOUR PROPgR'I'Y. IE' YOU IH'I'H',ND 'J'() OA'l'AItI If'IIlAlle] J.113, COilS!)},'!'
<br />WITH YOIIR I,fla/IJE:H on AN A'l"I'()RIIF~Y BI!:H'ORE~ RECOHDIIIG YOUR NO'I'rcm OF COMME:NCHlNEII'I'. ,TOBS IIHIlER
<br />$2,500 HI VALliE: no 1'10'1' HE:E:!) '1'0 RECOil!) AND POS'I' A "NO'I'JCI!~ OF COHMElNCmt'lE:tl'l'''.
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<br />\_,()U ,/) .,'. '~I.'.L (;),'.r S (}.r.;
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<br />IJti'n"""TITI
<br />.. <.1, '",,', J. ~
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<br />l\FE"J:JJAVlfJ'
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<br />...--.... -- -----.- -~ .-. .... .- .....- -~_. --- -.-.---...? -.- -, --_..~._-_.._~~-_._,-,.~..~----
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<br />S I. G\IJ\'l'U Ilm: UWI/ER llll AGEtI'1'
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<br />-~._---_.._._....------~--._---~--~---~ -....-. '--, "_'___._. .0"- ......_._._____.._ ..
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<br />S 1 (3NA'l'U HE:: CUN'l'RAC'l'On
<br />
<br />S'j'1\.'l'E: 011' H'UlHlIlA
<br />C01JII'I'Y o Ii' ______________.___________,_._.
<br />'J'he foreyoJllg Jnst.rmoent VIas ackl\o~J1 edged
<br />Befcl1:e me this _..____._ day of____________, I.~q___
<br />
<br />by ._.____._. ___________ _ _._.._.__ __...__.._ .______.___._________._..____._
<br />(name of perSOll aclmowledged)
<br />[] I~ho is pe.l:sollally krlOHn to me, or
<br />
<br />A'I'1\'I'Ei OF FLORI DA
<br />
<br />COI' N 'I' Y 0 I!~ ____._ _ _._____.___.__ _,__________ _,.__.__.___._
<br />
<br />IJ'he foregoing lnstrl\ment Has ackllOv/ledgsd
<br />BF.lfore me tlds _._____1Iay of-----.-.----____, 19
<br />
<br />b Y ________._______________.____..._..______,________,__. ____.__
<br />(name of person acknowledged)
<br />[1110 1s personally lmolin to me, or
<br />
<br />[I Hho lias p I:odllced___________________._____
<br />(type of .identification}
<br />and WllO[J cHd [Id td not ta);e an o<lth.
<br />
<br />LJ v.lho bas prodl\a~cl_._______ _._____,_______ __.._.
<br />(type of JdellUflcallon)
<br />alld ~/lIo []dl d []Hd nol: take an oat:h
<br />
<br />.'Jj Ylla\:ure of persall taklng ilcknov/ledgement
<br />
<br />.-.. .... _.....~.._-..- ~-.' -----.--.-------.--- - --.-----.---...-.-.-------.
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<br />..-- ..._..._-_._---------_._._-_._-~---._, -'-'-'~---"'- ----.---.--------.-..-..---.
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<br />Signature of persoll taklng acklloHledgmenl: I
<br />
<br />Hellne typed, priuLed 01: stamped
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<br />. .,....... ----.. ..,.~- ,~. -. ..- .---...-..----___..__..4__.__ ..~... __ .._.._.____..______~_
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<br />-.,~-_..--_.-,.- .--...--~--_..-.- '., .~-_._~----_...----..~___.. H__ ..__.__
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<br />Hallie typed, pl.-J.Ilted or sl:amped
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