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<br />
<br />Gr,r'll r KI1 J LL:;) t,) 1 WI N<.i
<br />
<br />P.X }L., S!3-7S~'-OD21
<br />
<br />D iJ02
<br />
<br />A. NO'rICE OF DEED RB:ST1UCTIONS
<br />The undersigned understande that this permit ma.y be
<br />may be more lestrict1~8 than C~ty regulations. The
<br />compli8nce with any applicable deed r~stLlction3,
<br />B. tlNLICENS!:O CON'l'RACToRS AND CONTRACTOR RISPONSIBILITlES
<br />If the O~i.L has hired a contractor or contractors to undartake work, they may be reqUitled
<br />' d l' 1 lations If the oontractor 1s no
<br />to be licensed in acoordance w.;.th state an ooa regu. ,
<br />lioon..d .. 'o.ui'od "y law. "oth tho own.r .M oontraoto. ..y '"' citod to. . miod""e~oot
<br />vl010tloo .,der ...t. ,... If tho owner or lot.nd.d oontraotor .re uno.rtain a. to . ~t
<br />Ucondng rltquireillent.s ma,V apply for the intended work, they U'Q lldvised to contact thE'
<br />City of ZE.'p~yrhil1s Buildillq Oep~.tt.ment, 813-780-0020. ,
<br />Furth_rlllc:>re if the owner h.!\l! h1.J:'E1.i lOt contraotor or contractor., he is advi!led to hElve t"\(.
<br />contr.cto. (~, d.o pOrtions of th.. "Contucto, S.cHon." of thLa 'PPl1C.t,on for whion th,,.
<br />~1ill be rl2spon!lible. It y<.;u, !'IS the I)wner signs as the contraotor, you are .l.ndic8.t:tng that
<br />you, raCh(lr than the oontractor, are reapt:.nsiblfl tOl:' th@ work. If the contractor wieh~s
<br />you to tJil,ln ~s contractor thc.t may be 4n lndic(lf;J.OTl th~t he is not prop.xly li.:uan.ed and h
<br />not entitled to permitting prhllgygS in the City of Zephyrh111e.
<br />c. TRANSPORTATION UfPAC'1" P'l!:EB AND UTILITY CONNECTION nn:s
<br />D. CONsraOCTurON LIEN LAW (CHAPTER 713, FLORrOA STATUTES, AS AM&NO~D)
<br />r certify that I, the applicant, hl'\ve been providl!ld with 1!I copy or "Florida'l! COO!lt,rUctior
<br />lien l;aw - Homeowner' 8, Proteotion Guide" prepared by the i'lorida Depa.rtment Of Agric:ultu::e
<br />~nd ConsulIer Affairs. If th. appllcant is !ilomeone "t her that the "owner", 1, ce.r:i fy that I
<br />have obtained a oopy of the above deecrib~d dOC~nt and promise ~n good faith to deliv.r
<br />it to the ~own.rh prior to oonmencsrnent.
<br />E. CONTRACTOR' S/OWNER' S AFFIOAVIT
<br />I oert.ify that all the information ln this application ill aCcurate and thl!t all work will
<br />be done in compliance with an i:1pplicab.Li'l lawl:! re9ulatlnq conet:r\1ction, zoning, !:\nd 18nd
<br />development.
<br />AppIlqatlon 1. n..."y m.do to obt.in . permit to do work .nQ inst.ll'~ion .. indlo.ted. 1
<br />certify that no work Or inetaJ.lat..Lon haa OOmmenogd prior to i$8UahoQ of a permit lIInct thAit
<br />.11 wo.k .,11 be P"'....d to m..t .tandor.. of .11 l.w. r..ut.tin. oon.truotion, Olty
<br />codes, zoning t'equlation~, and land development requlationa in the juriSdiction. I also
<br />C..tlty that Iun....ton. th.t tho regUl.tion. of oth.r .o......nt., '.'nci.. ~'y .pply to
<br />tho Intend.d Work. 'nd th.t it 10 my r..pon.ibility to id.ntify what sotion. I cu.t t.I.. to
<br />be in oompliance. SUoh agenoies inolude but ar. not Limited to: *Oepart_ent or
<br />Enviro~mental RsQUlation-Cypr-.ss BaYhRad~, Wetland ~Lea8 and EnVironmentally Sen$lti~e
<br />Lanae, Water/W..tew.ter Tre.t~.nt
<br />.SoUthwest Florida ~.t.r Management Distrjot-Wells, Cypress Bayheadll, Wetland Area~,
<br />Alter!nq Watercourses
<br />*Army Corpe bt Engin..r8-SeaW&1!s, Docks, Navigable Wat~rway.
<br />.Dep4rtment of Health, Rehabilit9tlve Services, Environmental Health Onit-Wells,
<br />NatJtewater Treatment, Septic Tanks
<br />*U.S. Bnvironmantal Protection AgencY-Asbestos 4bate~en~
<br />! .1'0 oertify thet, if illl m. t,ria1 I, to b. u..d in FloOQ Zone "A" or "', etc. ". 1 t i.
<br />underotood thAt · drd...... pl.n 'ddr.'.ln. . "comp.outing vol...." w111 he .-ittod -hioh
<br />i. .'.P'''d by · prot..don.l .n.ln..r "gl.tor'd io tho Stat. Of rtor!Q. pzior ,. p.,.""
<br />issuance.
<br />A PO"'t i..u.d .h,11 he COn.trued to be a 110.n., to proc."" with the work 'nd not "
<br />.uthority to '101at., oonc.l, "'.r, o. ..t a.ide any provl'lon. of tn. t.cholcal cod."
<br />nor .h.U i"u.nce of · permIt prevent tho Building Offldd f.om th....ftor requldng .
<br />oOrr.ctlon 0' .rror. in pl.o., oon.truotlon, o. .10I"ion. or .ny ood.. '..ry peroctt
<br />to.ued 'h.n b.com. in.alid un1e.. the Work authorized by ,uch permit 10 c__ncod .1thlo
<br />aiR months 0' 10..,.,.,., or if wo.k .uthod..d by tho .e...lt 1. .u'p.ndod or "',ndM.d fo<.,
<br />P'dOd of 'h month, .ttor tho time tho wor" 10 """".noSd. on"O dAy .'hndon of time
<br />~.y ". .llowed for the POmil .ith fA' oharg, of $15.00. Th. ..t.ndon .h.u h. r.qu'''.d
<br />in writin. to .'ha BU!ldin. OftlclO1. An 'pprO'.d In.peotion -u.t b. 10...d durIn. e.ch sh
<br />It,onth period, or the project will be cr:ln.!id~ned aballdol1.d,
<br />OARNl.. ro OWNER, YOUR FAILURE TO RECORD A NOTrc. or CONOt.C....T MRr "SULT 'N YOU,
<br />'ArING .....,C. I'Oa IN_-""sro rOUR PRo'.nTY. "roo INTEND TO O.'AIN FINANCING, CONS'JLT
<br />.'TH YOUR LENOER OR AN ATToRNEY BEFORE RllCOROI.G YOUR NOTICE or C-.,.C.....r. JOBS ONOEn
<br />32,500 I. VALO. 00 NOT N',O 1'0 .'CO.O AND POST A "N011C' or O","",NC'"""." ,
<br />
<br />~+~ ~~:: (57-~~~-r-
<br />
<br />SIGNATURlI:~ OWNER. 01'. ENT 'SIGNAT~~NTl4ACTO~
<br />
<br />eub~ ect to "deed restriot ions" ~" ieh
<br />undersignod l!S!lumes rl'!sponslbil.1 t:}' 10;
<br />
<br />STATE OF FLORIDA
<br />COUNT't OF _ ,
<br />The foregOing inst:1.'UllIent: wes 8clmowl edqed
<br />Berore me thia_ diy or _, 2L
<br />by ~
<br />(nam~ Df pereon aCknowledqed)
<br />Owho i~ personally known to me, C~
<br />
<br />o who bas produced
<br />(tYPe Of 1deot1!1cation!
<br />and whoD did Lld1d not take an oath.
<br />
<br />~
<br />
<br />STAT&: OF !"LORrtlA
<br />COONTY or
<br />ThQ foregoing in.tr~.nt WRe aCknowledged
<br />Befrn'l'! mfl this ~ay of , 20 __,
<br />by
<br />(name of pereon acknow.LedQed)
<br />Ckho is peraonally known to me, or
<br />
<br />o who has produced
<br />(type ot idl!ntftic::ationJ
<br />!1nd who Odid DUd not taka an oath
<br />
<br />Signature o:t peraon talUng aplcno..rlildgernent
<br />
<br />Signature of pe~.on taking aCknowledQment
<br />
<br />Name tYP9d, printed or 8tampHd
<br />
<br />Name typed, printed or starnped
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