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<br />,OC1/25/2005/TUE 11:33 AM ZEPHYRHILL BUILDING
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<br />FAX No. 813-780-0021
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<br />P.OO
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<br />A.: NOUe::!: OF one RE8TRtct'1011S
<br />Thill undllra.i.qQed underlrta~lI ,the t~18 pem1t llIay be subjec1! to "deoed restrictions"
<br />maYbe ~orereatrictive bane1 y regulationa. The undsralqned assume. reeponalbl
<br />Compliance Hith ony' .ppl cable d reGtrict10ns;
<br />B. ONLICIMS20 CON!RACTo AND ONTaAC!OR RESPONSIBILITIES
<br />If the owner haa hireG a c6ntra tor or contractors to undertake work, 'they aay be
<br />to be licensed in aeoord oe wi h atate and looal reoul~tions. It the cOntractor
<br />licensed aa r.qutrad by law, be the ownar ond eantractar ..y' be citod tor 8 mi.d
<br />.iolatign ~r state 18. If Owner or intended contractor are unoertoin a. t
<br />11o.n8.11\9 nlquireunts ilia' appl for tile ~nten~ _...k, th.y'a.re advilled to OonCiIIO
<br />City of Zepbyrbills Build'nq Ce ~ent, 813-780-0020.
<br />'\Jrtbarmore" if th. owner ,,*S h ed a oClntractor, cr controcto~s, he .ia advi.ed ~o
<br />oantractox(e) .iqn po~ti $'OL . ~CoAtractor SectionsN of this appllcstiOD fox
<br />will b. reaponaible. It the owner .iqns aa,the con~ractor, you ars ~nd1Qa
<br />you, rather ~h.n the 'cont a~e re.pan'.1bLe for the wor~. ,1% the contractor
<br />you to sign ~ contractor y be ~n indlca~ion that' ha i. net p~arly ~ic.n_
<br />nqt .nt.1~led to perlll11:tln ag.. in tbe,City ot ZephyrhUl~.
<br />c. TRANSPOR'rA'I'ION IMPACT D tnIUTY CONNBC'I'IOll'l E'1l1lS
<br />p. CONS1'Il~I1ION L12N a' 713, i'UlIUDA SI'A'l'tiTES,' AS AMENDED)
<br />I cerbify that I, the app hays been provided with B copy 'of ~'lo~da's Cona
<br />Hen L'aw - HOIlIOloWl1er'. ,Pr tllCti Guide" prepU'ed b)' the Florida Department ot Agr'
<br />and ConaUlt.er AUain. If ~e ap l1cant ia someone ot:he,r that l:~e "o_r", I cerlt
<br />hBYe obtained a cOPY' of t abo deaor~ed document and promi.. in good fa.ith to
<br />it ,to the "o~arN pr10r t ~omma celllent.
<br />E. CONTRACTOR.' S/OWtlER' S f'IOAV 'r
<br />1 oerti!y that all the in o~tl n in this application .ia accurate and that all wo
<br />be Clone in compliance wit ,.11 a plicabIe lawa rllgulat:ir.q construction, zoning, an
<br />development.
<br />~pliq.tion 1s ~e~eby mad' to ob ain a'perm1t to dO work and 1nataliation a8 indica
<br />certity tnet no wock or 1 .'.11. 1an ha. c~nced p~loz to 1.~anoe o~ . permit an
<br />all work will be perf~ tq ~ t atandarae ot ail laws regulating co~.truation,
<br />oo~.., zoninq regulations, ~d 1 nd d.9~lopmerit regulatione in the juri.dict~on. I
<br />oectify that Iunclenumi that t e regtiJat1.oNl of o~her !lovec_ental agenci.. _y ..
<br />the jntend.d work, and th t ,it i my responSlDl1itv to idontify what aet1.on. I .uet
<br />be in compliance. S~ch a e~oies inolUde but ate not l~it.d to: *Deparement 0:
<br />EnviroriMental aequ1ation- ypre,a Baynaads, Wetl&nd ~eas and Environnentally 8ena1t ve
<br />Landa, Water/Waatewater T .t~en
<br />*Southwaat Florida Water n.~ nt D1Btriat~ell., Cypre.. Bayheads. Watl4nd Az...
<br />Altering Watercourse.
<br />~Aimy Co~p. of Enqineera-S
<br />*Departbent of H.alth , Re
<br />Wastewater Txeatment, S.pt
<br />.U.S. Environmental Pcot.o
<br />I also certify thet, if fi
<br />.understood that a'dza1naqa
<br />is prepared by a profeslio
<br />i"suance.
<br />A permit 1s!ued ahall,ba ,c nstruto be a license to FroC8ad with the wor~ ~d not
<br />authority to violate, can: , a1 er, or s.t asida,any provisicfta ot tne ~cbnical
<br />nor shall i,auanoe of a pe . t P event the 8gild1ng arfic1al tram ther..fter ~8quir
<br />oorrect1on of ~rors 1n pI e, nstruction, ~r violationa or &ny code. ' Rvery pa .
<br />~.,u.d .hall becOme in".li ~D~e a the work authorized by such pera1t 1. caNmenoea
<br />siX II\Onth. cf i.SUGCII, or it wo Jc. authorbed by the pertllit. is s\Upendad or abandon
<br />period or s.ix II'IQn~h. after thli t "the. work J.s c~ence<1. On. 90' day exten.lon of
<br />-y be allowac:i tox tne'pe t wi h tee Charge o:f $1S.00. Tne exttlne.1.on stwl.Ll be re
<br />1n writing to "the 81l!ldir>q ot~:l.c al. Jll\ -,proved in.pection must be lOCJ9ed dUJ:inq
<br />IIlOnt~ period. or the proja t, wil be COneidered abandoned.
<br />WARNING TO 0WNEIt: YOUR LUllE 0 RECORl> A NOTICE or COMMENCEIG&N'l" MY RIIStlLT IN ~O
<br />~AnNG TWICE rem' IMPIlOVEMJ: T~ '10 YOOR pj\OnR'l'Y. II' YOO INTEND '1'O,OB'r,Jl.IN i'IllAWCING,
<br />HX'l'1l YOUR LalCEIl OR AN A'rT IlblEY EFORE RECORt>ING YOUR NOt'IC2 01' COHHDlCll:H!:N1'. JOB'S
<br />$2,500 IN VALUE: DO NOT NEE TO !I' CORD AND POST A "KO'l'IC!: or COHKE~EMEHT".
<br />
<br />
<br />..,ill
<br />land
<br />
<br />
<br />, DOck," ro:Iav1qable Wsterways
<br />at1~e Services, Enviro~ental ~~alth Unit-Wella,
<br />s
<br />eDCy-~b..to. .batenent
<br />rial L.. to b. o..ed 1n 1"100<1 Zone "A" or "A,. etc:....
<br />e."1n" a "compensating volume" 11111 be suDm:itt.
<br />i~.r,r.;ister~ 1n the State of rlo~ida ~rior to
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<br />stGNATOU: OIfN&:R DR AGENT
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<br />S1<:NAmRe : COtl1'1lAC'rOR
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<br />STATt or 1'L01UDA.
<br />COON'l'Y OF
<br />~he fcreqoinq ~R~trum.nt we
<br />eafore lIIe tllis _ day , of
<br />,by
<br />fna.e' or person aoknqw
<br />(Jwho 19 personally Kno~n
<br />
<br />O'who twlli produced
<br />, , (type
<br />and ..lioO cUd Qdid Dot
<br />
<br />STATE OF' f'LOllIDA
<br />COUN'l'~ 01' '
<br />The torego.l.nq inatrwDeDt waa aelmoNl
<br />!!d'ora ma, tl\i.' ----sIB)' or:
<br />by ,
<br />(n._ or peracn aOlllJo"ledqedl
<br />CJ.ho ia personally .known to .., or
<br />
<br />o who ~s produced
<br />It YEN' of idenU f'
<br />and wl\o Ocha D:11d 'not take an 0
<br />
<br />9i9nature ot per"OD
<br />
<br />Slgnature df parsan tak1no .ckno~~
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<br />
<br />Nane typed, printed or
<br />
<br />HIllY typed, pzlnt.d or ""'lIlped
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<br />2.d
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<br />)(l:l~ .J.3nJ3Sl:l.., dH
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<br />Wl:l22:11 S002 S2 ~OO
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