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<br />AUG/12/2004/THU 02:18 PM ZEPHYRHILLS BUILDING FAX No 813 780 0021
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<br />A. NOTIc;lt OF D&EP Rl!l8'l'RIC'l'IO)l4l. f
<br />Tn. under8~qnad underBt~nd~ that tnia permit may be subject to ~daed reatr1ctien3M whieb
<br />"Y be .... '..','ot1.. th" al.Y....,1.".... ,.. ......, .. .......-,...::....".. ...
<br />oompliance w~th any applicable deed restrict1on~. .
<br />B. OH~ICZNSao coktMAOToas AND CO~~C~O~ RESPONSIBILl'l'IES
<br />. If the Q_llr has h.i.:ae.d a contractor or cont;oaators to 1.UId.r~ake WQJ;k, they 1lIa:v :be l:eq\li:nd
<br />to be licen~ed in accordanoe wit~ ~tat..and looal re~la~loqs. It the cOn~aetor i. not
<br />lioensed a5.requi~~ by law, both the owne+ and ~nt~a~er fY be oited fcr a ~sdemeano+
<br />violation unC1er state law. 'if the Qomar or intended contZ'a tor are. QDI;!.r1:ail'l a8 to ..,hllt
<br />liceIlain'il rIlqui.:emen1;;\I fI1I1'j apply for 'the .i.nt"nded worll., tl'le are .dv18ed to contact the
<br />City of Zepnyrb!lls Building Department, B13-780-002~~ .
<br />Fu;cthe:tDIore, if the 0_'" hu /\.ired a oontractor or cont;,a~ars, he is advised to n4lve the
<br />oontractcr(3) eiqn pOftions or the "Contraat~r SectionaN Oi.lt~B appl~a.tion fer which they
<br />will be reS~sible. Ir you, AS the owner ~~qns ae the COD saoto~, you are ~n4iaatin'il.that
<br />you, ~athcr than the contr~~tcr, are ~.~ansible tor the wo~. If tbs cantsa~tor wi~hcs
<br />~ t~ ...iqn' as contractor tMt may be an :i..nd.i.ca1;ion that I\e 111 net properly licensed .ancl ia
<br />not cn~itled to permittirig Privilege. in ibe City of ZGPAyr ills;
<br />C. TRAN9POR'fAfIOIf IM!'AC'1' i'EIlS ANIl ('UI.I'n' CONNl1c'!IO!il FEES
<br />D.' COllSTRUCTUION LIEN LAtl (CllAPTRR 713, FLORIDA STATti'l~. AMililCEIll
<br />I C!.rtify that I, the applicant, haye been Ji)llo'V.l,chld with A py Of: ""lor1dij' a (:cII...t:t'uetion
<br />lien Law ~ Home~wn8r'5'~~ot.ctian Gu1~" prepareQ by the rl sida Department ot A9rioulture
<br />&nO Consumer Affairs. If the appl!canb is 8~one other th t the ~~wneru, I ~siry that !
<br />nave obtained. copy Of tn. above ~8oribed dOoUMent and.pr i_e in good taith to 4elivar
<br />it to the "'owner" p~ior to Comm.~cemene.
<br />E. CONTllACTOll.' S/Oi9NIi:R'''' AlinMVn
<br />I omrtify that all the information in this application is ~rate and that aLl work will
<br />be tioDe in gampl~anoe with all applioable law~ regulating t~~ruOticn, zon~ng, ~nd land
<br />oevelopmcnt. .
<br />AppliqatiQn ~s hereby made to obtain ~ permit to dQ ,MOrk eft installation as indicated. I
<br />certify ~~at no work ~ ~~5tallaticn h.. ccmme~e4 prior ~o 1;I~ae of . pesmit And tnat
<br />a~l work wiLl be performea to maet stan~rds of all laws re ulAting eonatruotion, City
<br />OOdes, 20nino re'il'\llat::i..ons, and ;l,and' da9,oloP,JDent requlatioIlS in the j=i~ciiO'l::ion. I aIllo'..
<br />certiry tha~ r underetand th4t tp~ regul&t1o~. of other go rnmenta4 8g8nc1es .may .pp~Y ~o
<br />tha intende~ WQrk, and that it: is &1 responsibility to id ify what a~tion. I mu~t take'to
<br />be in compliance. S~h agencies inolude but .~. net. limit to: 'Department of .
<br />&nvironmental Rsqulat!on-Cypress Bayneads, .stland Areaa a 2n9ironmentally acn~itlve
<br />Lands, Watorllfaetewater Treatment .
<br />wSouthWS5t Florida WA~.~ M.na9~nt 01strict-Well~, C~ree a.yhoa~, Wetla~d AreaS,
<br />Altering Watercourses. . !
<br />*AImy COtP5 o~ Enqinee~8-a..~allsl DoOks, NaviqaQlc Waterw y~
<br />*Departamnt or Health . kehabilitat~va Servi~., EAv1ronme tal Health ODit~~ll&,
<br />Wastewater Treatment, S.~ic ~~ka
<br />.0.9. ~nvirOnmenta~ Protectio~ Agenoy-Asb<es abatement
<br />I ;01..", oe.rlify that, if fill raaterial .1.s to to. used in ;olo d Zone "A" or "A,eto,"', it is
<br />un~rstood that a ~ain~ga plan ad4ressing a "oomp&nsatlnq volameN wi~~ be sUb&1tted wbieh
<br />is prepared by a profe~s!onal engineer ~~qi8te~ed in tho B a~e ot rlorida pr1o~ to permit
<br />i8euanoe. .
<br />A pe~1t iS3Ucd ~h~ll be oonstrued t9 Qe .. licen.. tQ P~OQ ed with ~hG wor~ and Dot ~$
<br />a~thority' to violat91 oancel, alt.r, Qr set aside any pro~ siona of th_ technical codc~,
<br />. nor sh~l issuance of a permit prevent ~pe ~uild1ng Offi~1 + tram thereartQr reqair1n'il a
<br />correction of error& in plans, cODat~t:iaD, or violations ot 4!nY code. ~ver~ ~t
<br />issued $h.ll to~eome i~valid unless the work authoriz&d by JUCh permit is oommen~Q ~thin
<br />six month~ or iS8uanoe, or j,f work allthor~,..d by the permi is 1I\l.lIpomded 0;' ebmdel\ed for 'a
<br />periOd of $ix IIU:ln1:11s aft!!r the time the IfOrlt b oOlllllUlrlced. One 90 day extension ot time
<br />may.be allowed 1cr the pe~t wi~h ~e. charge o~ $la.OO. he ~tens:i..on shalL be requested
<br />in lfriting to tile Bulldinljr Ol:::10iI!-1. An aE'P+o""d irl8Plilat:iirl llI\18t be 10Q'Oed C1qrlnq each li~
<br />IlIOIlth ~er1o<t, or .the p.rojlilot: ...ill l:Ioe Qen..:I.d\!!:~ec1 abandoned. .
<br />~ING '1'0 OWNER: YOO~ FA;ILURE TO R!lCOao A NO'l'IC5: Oli' C~ NCEMmlT 1mI' R&:StlI.\r IN l'ooa .
<br />PJU'ING !IttC~ &'Oa IldPROVEHEN'I!5 'IO YotnI E'aoP1!lR'l'Y. IF YOu IN lilND 110 OB'l'AIN FINllRCIRG, CONSULT
<br />\!lITH YOUR utNO!:k OR AN AttOM2Y Blilli'OlIE aElCOllDIIiIG YOUR NOTI III of COtICEMCI!:M!N'l', JOIJS OlllDElI.
<br />~2,500'INv.A~UE DO NOT NI!l!:O TO RSCORD T A "wo~;rc~ 0 COHKEI!lCEHER~n.
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<br />~Id~
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<br />SIGNATURE I OIntEft OR AGl!:NT
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<br />.5lTA'l'E OF FLO~I~ fJ~ (' /)
<br />COUNTY OF - ___
<br />The foregoing in ~nt was ckncwle~~~
<br />Befor m t ill 61! 2~
<br />by . .
<br />. ~(naMe or pe~son aOknowledqedl .
<br />B"h'ho is pe.sQnlllly known to:>...., O~
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<br />P. 002
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