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<br />I .... .-', .,) _ __
<br />l~~...JJ..-.l..":1:.. v.~ ....J.tt..eD p.i::::'T~~r(,TIONS
<br />ro')e. und~.t.9igned. under9":Gnd~ "that this pliJrp.dt may be sUbject to ....dE:e:ct restrictions" ',"hien
<br />~,!lY ?l:! more restrj_C'':,:",''''e "(~an Cit~, regt:.2.;.tions. The "-.1ndersigned a~3UIfl.e.9 :=:-esp:)nsioil.:.ty fa
<br />"',0"1",1" .i..".c" with a:!y /lppllcabl.. deed r~st:t'ict~;>n8.
<br />a. :lI,ICB:NSE::J ::;om'AACTCIl.s AND CONT!t":::-TOR RESE'ONSISILITIE3
<br />1 f tr e owne", has hired a corttract:>r o:t' cont;t'actcrs to '~nciertake "lork, they may be requirG'
<br />to b~ lice~9ad in accordance wi~h s~at~ a~d lOC31 r9g~:ations. If t~~ contractcr is ~ot
<br />1icer ~d as req~irad by law, ~oth the owner and contractor may be cited for a misdemeanor
<br />vi~l~ ~on under sta~~ law. :f the Oh~er Qr int&oded contracto~ are unc~r~ain .s to wh~t
<br />l:lce~ ,in~ requiremen~s ll~Y apply for ~ne i~tended work, they are advised ~o contact the
<br />':::.ty f Z.",phyrhills B'.li1din" Department, 813-780-0020.
<br />FUJ:::1.:h -rII':O.re,. ::..f tnG own;a:::: has hired a cantracto.t or oo.atra:;::tor!lr he is advisQd. to ha~.e t:r..,
<br />-::<:;>ntr.:. ~tor'~, s1~ po~'tion~ of ,tha "Con-::ractor Sections" of tr..is appl.icaticr:. f:lr 'lIhich th~
<br />tl,'J.ll 1 d ~e8.9onsible.. If you,. liS the OWner 9ign$ as the contractor, you ..re i~dic.atir~<;, th.l
<br />yo~, ~th~r than the ccntractor, ~re responsib:e for t~e wcrk_ !~ the contr~ctor wi~hos
<br />ye,,, t ".i9n a.. contraotor that may be ..n indication that he :..s not pJ::oper~y l.ic..n....d ,or,d j
<br />,,~,t .ar, it.l..c. to perlll.it.1:ing pro.vilegQS in +;he :::-ity of Zephyrhi11".
<br />C. 'I'PJ.. .:Sl?'';R'SATION HIPACT FEES AND 1JTI:'ITY CONtIECTION H,ES
<br />D. CV' .s-fRUCTUION LIEN LA.) (("HA?TEI'. '113, n..ORIDA STATUTES, AS AME[,jjBO)
<br />I cart fy tha': :, 1:t.e appJ.ica.,t, have be&n provided ,.ith a copy ot"Flor.:.da' IS Constructi"T
<br />lien:. w - Homeowner's Prote~tion Guide" prepared by the Florida Departme~t of AgricuiturE
<br />and Co ~umer Mfai:::,". If tll'! appiic<lnt i" someone other that the "o".-r,er", I cerify tllat 1
<br />h"'JE 0' .ained a copy 0:: -:11.. above -:loillsc:ribed document and p::omise in good faith to deli',rer
<br />i.t":'o he "owne~" prior to comra~ncelDen-:.
<br />E. COITAACroR' S/Oi'iNER' S PJI'HDAVn
<br />! certi'y that ,,11 the information in tt':"!1 application ia a:::curate an", t.hat all wor:.c '..ill
<br />be den.. in c?mplianoe 'nth ,,11 appli,oable laws regulating constrLlctioll, 2:oni<>g, a."ld l.m::!
<br />de'Teloprr ~~t.
<br />hpplicatlon is hereby $Ada to obtain a permit to do work and installation a~ indicated. I
<br />aartity ".hat no work or installatJ.on has comtnencad prio:t' tc .iSlSIu.a:1.06 of a perlT:..it and t:h6.t
<br />all work will be per!or~ed t~ naat standards of all laws regulating construction, C~ty
<br />co,;I....., "<.'in.; regulat.:..ons, and land dev..lopment regulations in the jur.isdictien. :t "lso
<br />e'Htify t...t I ',mder3t:and 1::';>.1; "-he regl,llaticns of other qov~r".r.\ent:al a'.1encies ITay "pp~y to
<br />th.. i~tenc~d work, and that it is my r",,"ponsibility to ia"utify ~hat actions I must t.aKe t
<br />be in comp~iance. S~ch agenoies incl~de but are not l.:..roited to' *D..pa~t.m~nt of
<br />Ell"Tironnent ,1 Re9ulation-CYPx'e"." 3..yheadB, We-:land ArGas ..nd Envircnrnentally Sensitive
<br />Lat'4ds, '~&tel 1~4astlilwa't.er Treatroent
<br />*S')utr.to1est F .":>r1da i'lator Manaqem"nt Distriet-~le.l.ls, Cypre3:5 Bayheads, We'C:land Areas,
<br />A1 ~~erin9 Nat>'. rCOUr3$S
<br />"Army C:>rps cf Enqineers-Se....a12s, Do::ks, Navi<;1able Waterways
<br />*Dopartmer..t c Health & Rehabilitat.:.i.Eo Ser'lice", :::nvironmental Health ;;n~t-W..lls.
<br />Wa..t""'ater Tr",1 t.Inent, Septic. Tanks
<br />*U. S. Environ:nt 1":1:..1.: Proc..ction AIJ..ncy-Asb~.sto" abate:nent
<br />I ",lso ')en:ify :ha!:, if. fi11 '~at"~'J..~l is to be used in !flOod Zone "A" 0= "A, etc.", it i.9
<br />'molerstcod -:hat '. drainage pla.n addrEt5e~n9' a "compensating volume" will be submitted "hJ.ch
<br />is Prepared by p:t'ofe3sional enginee= registered in the Stat.e of F1cr~da prior to per~it
<br />issuarJce.
<br />A pennit iSSUGd .hatl be con:5tJ::ued to be a li:<<nse to proceed w~th the work ano. not a6
<br />autho~~ty ,Q vi~ ace, cancel, ..l"er, or set aside any prc~i~io~s of the tachnical cod~5,
<br />nor shall issuap-~9 ot a per~~t prev~nt th.. Buildin~ Of1ioi..1 frOM therearter requiring a
<br />correccion o! err'ra in plan5. co~st~uction, or violations of any cede. E~ery permit
<br />iss~ed shall beco~" inv..lid unles~ the wo=~ authorized by SUCD permit is commenced withi:!
<br />six months Of i"S1.\a1.-::" , Or if work authori2ed t.y the permi.t is euspended or abandoned fer '..
<br />periou of six months ,'fteo:- the tlzlle the wcr:~ is COIIUf.enCec.. One 90 day extension of time
<br />'ma~ be allowQQ for the "errr,it with tee e~ar~e ot S15.00. ~h& extension shell be requestec
<br />in .'"ri 1:i.ng to the B,-,ilo.1.-<;r Ott'ici...~. An ,,-pproved :.nspection m...st be 1:;'9ged during ....en ..i~
<br />month period, cr the prcj~"t will be oonside~ed abandoned.
<br />WAR~lJ:~jG ':"0 OWNER: 'fOUR FAl. eRE TO RECORD A NOTICE: OF COM.!-IENCE:1.E;NT \i'.i'.Y RESULT :N YOUP.
<br />FAYIN3 TWICE FOR IMPROVEMENT~ ~o YOUR PROPERTY, rF YOu :~rEND TO OBTAIN F:~A~CIN~, COKS1JLl
<br />\,!TH YOuR LENDER OR AN ATTQ~,E. BE~RE RECORDING YOUR NOTIC~ OF COMMENCEMENT. _OBS UNOER
<br />$2,500 Iti VALUE DO NOT NEED TO ;;. ~CORD AN~ POST H- "NOTICE OE' COI1l'1ENCE~ILNT".
<br />
<br />SIGllf;Tl'RE; OWNEg OR AGENT
<br />
<br />SIGNATURE, CONT~~CTOR
<br />
<br />S~AT' OE" ~'lORICh
<br />COUI; ,:' O~
<br />Th~ toregoin~ ins~r~.ent was ackn~~ledged
<br />Bef'.>::e nle this _ day of , 2(L-
<br />oy
<br />(name of person acknokledgect)
<br />D t"no is personal:l.Y know;'l to me, 'r
<br />
<br />STATE 0:' FLOlUDA
<br />COUNT: O~' ...
<br />The foregoing instrument W~5
<br />Befor& me this _----day of
<br />by
<br />
<br />ackr.owledg~c:
<br />,"<0-
<br />
<br />:n&g~ of. per~on aey_,owledgad)
<br />~ho is persona21y k~own t:> mQ, or
<br />
<br />o "h", ha.. produo..d__
<br />(type
<br />.;.:10 wnoD di d D di d n",t
<br />
<br />:-1 who ha~ pxoduc"d
<br />(type ef identification)
<br />a:1d .:'0 Ddid Oc!..d-,not take an cat:'
<br />
<br />of ide~tj 'ica,ion!
<br />take an " ,th,
<br />
<br />Sig:r:.a.t~;re of person tii.king acknc\ol' ),Q ~re..T"Qbr.\.t
<br />
<br />Signat1;:e e,f person takir..g ~ckn:""'lV..IQdfJIllent
<br />
<br />Name typed, prin-:ed OJ:: s'C:amped
<br />
<br />Name t:lP' ,ct, 'P.rint~!l or stamped
<br />
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