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<br />l\
<br />
<br />NCT ICI',
<br />
<br />'::OND IT IONS
<br />IONS
<br />
<br />
<br />iT T; :::':: 1 [l}: '-.1 'I'
<br />
<br />,
<br />~,r"ia~\:~ ~jith sta~e ar:
<br />hi' 1,31,-,.], r~,c",th the owner and t I -.[
<br />~aw. If the 0wner '~r irlteI1jed C,jrltla(~t-,r
<br />rer~ll.:irem;::'r:':::::-; :-".3'/ apr~,ly for the int;:::n,je,j \-:,,~"Lk, the'} are
<br />eitj" :=eI=,h'~./rhil bTjil,ji!:.'~l Department, b13-7::>~,'-;~<:2n.
<br />Furtheune,:e,.if :""\,-inr::'[ has hired a t:or1tractc'r '~-,r -"'~'Ltractcr.s, he is ad\/,ised te' ha'vTe the
<br />cc,ntract(~I.:c(s) SirjTI [-_:}rt~j('ns of the "C<:=JntractiJr Sec~,i.."t.!s" ,::,f this applicati'::lfJ l V-Jhich they
<br />'",~ill l.~,p r"':'sp',~Jnsi,t:,lp. If j/c;u, 2:IS trle c"wner 5i';.1n53.:-:; th~-=, r=.;ont::actcr, you are il,:Jicating tr:at
<br />, rat~er f.lla!! tl'je ~acto~, are responsible for the worJ:. If the contractor wishes
<br />Y'='u t,~) si''-Jn C~jrl::.ract'~'r that may be an indicati..:::;f: t_llat he i:::~ nClt p,[i::!perl~l lic'ense,.J and is
<br />n'.::,t enlitled tc F''?rmitti:-FJ" privileges in t.he l:::it:J' ,::..f Zeph-yThills.
<br />TRANSf'ORT1'.TI:JN IHF'N;T FEES AND UTILITY CONUFTTION FEE:~;
<br />D. CONSTRUCTI,:IOt'j L1SU UI.\', ('~Hl"E'TER 713, FLORID!', SH'.TUTE:::, P.S PJ.1ENDED)
<br />I certify th3t I, t~je ,3pplicant, have been provided with 3 ~opy of "Florida's Constrllction
<br />lierl Law H~~np~lwI1pr/3 ~rotection Gui~e" prepared by the f'lr~rida Department of Agricultllre
<br />,~nd C:>::)fl:::urner r,ff,':=jil.~, If the apf=-,licant is SOlne''':lne (--:,ther ~hat the "u,.,rner", I c:erify that I
<br />ha1fe ()bt,~ilv?,j a thl:? abD'JE descrirv?d document and pr(':'lrni:=:e in !;-y:\od faitl t,.::, :J"?li'Jer
<br />i.t j',- thf:-::' ",::',.';:-'ler" pri~,r :'::'::'Inrnencement.
<br />E. CONTP.]v:TOP' S,iUv,]Nt,~R' S AFt'IDll.VIT
<br />I certify ttlat 31J :~'te infcrmation in thi2 application is acel_Irate an(j that all work will
<br />bp in i"l',. '.dth all applicac1le lav/s requlatiL cr~-,n.:;:t.ructi<~Jrl, zunin'J, .3n,.::1 lan
<br />,je \,';: 1 '='r:::'rne r~ t .
<br />Appliea i3 tlerp~,y t':l Gbtain a permit tr) w'~rk arl,i il-Istallation as indicated.
<br />certi f\/ that ',;:=,.:::t: installation has cCJtnrnenl:~E"-:d pri..~',r i.3:3uance of a permit and ~h3L
<br />',7111 .d(~'Ik ',,/ill L.e f=-'F?rf'J[IliEd tr::> meet standards L.::;>f all 13"1".;::; r'?f]clatin(;l constructi , l::::it,T
<br />codes, zOllinq re'~lllat arid land development regulations in tr1e jurisdictic'n. I also
<br />cert.ify j~_hat ~ ulv-Jerstand that the regulatii)ns ')f ('.lther ';1"o'v'ernmental agenc2.'2s Inay 3t='pl::/ t.)
<br />the inten'J.eLj T,-.;i~'r~:, an,,] that it is my responsibility tel :identii"y i4hat actic1ns 1 ml.lst take L'~l
<br />boo> .in c.::Jfllplianc:e. ~~uch agencies include but are ne-+::. limite,j t,~': .j,D'2partment e'f
<br />EnvironmPIltaL Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
<br />Lands, Water/~Ja ter Treatrnent
<br />*South~;est Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
<br />,D.,l te r inq [,',Ja tF;' t c'-:::' 1 1 r :312 .'3
<br />'*l\rmy CCH:pS '~jf EtJC;)'tn'::?er:s-Sea'Nalls, Docks, Na\:igal.::,le ['\l3ten.vays
<br />*Depar~mpnt of Healtll & Rehabilitative Services, Environme[ltal Health Unit-Wells,
<br />Wastewater 1reatrnent, Septic Tanks
<br />*U.S. Environmental Protection Agency-Asbestos abatemerlt
<br />T Iso cE'rtify that, if fill material is be used in FloJd Zone "A" or "A, etc.", it is
<br />understood trjat a dr,].inage t=,lan addressing a "c,ompensating 'Ic,lurne" lr,'ill be submit':.ed "fhi.cft
<br />is prepared by a professional engineer registered in t~le State of Florida pri,~r to permit
<br />issuance.
<br />A permit issued shdll be construed to be a licenEe to prc,ceed with the work and not as
<br />authority violate, cancel, alter, or set aside any provisioI)S of the technical codes,
<br />nor shall issuance 0f a permit prevent the Buildi~g Official from thereafter ~equiring a
<br />correctiorl of errors irl plans, constructjo[), or violations of any eode. Every permit
<br />issued srL:'lll LJI~co!TIe inv,::llid unless the \.vork aut.hclrized by such permit is corrunenced \,.,,rit.hin
<br />six month:::: c::,f issuance, or if 'vlork authorized by the permit is suspended or abandoned for a
<br />period. of six mc>nths after the time the 'Nork is cormnenced. One 90 daJ/ extensie,n (.,f time
<br />rnay be allowed for t~e permit with fee charge of 515.00. The extension shall be requested
<br />in writing the Building Official. An approved inspection must be logged durirlg each six
<br />month period, the project will be considered abandoned.
<br />\'U\RNING TO O\-lNER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCEHENT HAY RESULT IN YOUR
<br />PAYlN(~ TlrJICE FOR IHPP.U/EI'lENTS TO YOUR PROPERTY. If YOU INTEND TO OBT,II.IN FINANCING, CONSULT
<br />1,-lITH YOUR LE:NDER OR I<,N ./I.TTORNEY BEFORE RECORDING YOUR " TICE OF COI"1JVIENC NT. ,JOBS UNDER
<br />$2, 'JOO IN VI<, NEED TO RECORD ,II.ND POST A "NO OF ENCEME
<br />
<br />
<br />l j cens!,:,j
<br />
<br />
<br />"dc!rk, the'j rri,=i'i b~ r~q.Ji t:e,j
<br />If the c:ontr3L:t'_'t- i
<br />,-.:::ited f'::l[ ,] rnj:3,-lemean'~,r
<br />are uncertail1 as w~lat.
<br />advise,j L~ct the
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<br />un,-je r"
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<br />'Y,:-i'y"
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<br />be ITI'
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<br />l~ i? ~- ~:: ::'" !' i
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<br />-~~nd:'3 that this permi t L,e ,~:'.Jl:'l
<br />; ',;'-: r~h:i~-j City .!:"e(.j'ulati ';-'r-,-:. IrJd<=.rs~
<br />~ble deed restrictiQn~.
<br />i',NC CONTRACTOR. RE'i"OW:[B1L1TIES
<br />t[al~tor or ~ract,~r? t
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<br />",'ieed :.:.e::::t 1 i c: t.. ,1' j~-I:,:;"
<br />"Iej ]SSUnlE>S i_I::'l
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<br />is perscJnally
<br />
<br />STATE OF FLOP
<br />COUNTY OF
<br />The
<br />Bef
<br />by
<br />(name c, f r>e r .s,.~.'n
<br />~\'~ln l'c nnrc"r'~'I"
<br />F ^ll~, ~J r'C::: ,,-' '", ,..;;1 _ y
<br />
<br />acknowledged)
<br />kno\"I'n to me, or
<br />
<br />Dwho has prod1lc:ed
<br />( t\/pe
<br />~id . n';t
<br />
<br />Dwho tlas produced
<br />(type of identification)
<br />and who Odid ~id not take an oath
<br />
<br />(2t/.trl1 J~ J(\N1~
<br />
<br />Signature of person taking acknowledgment
<br />
<br />
<br />of person taking ae
<br />Luann CawIfieId
<br />p No;OO~i'1!
<br />My CommteeIon ExpRI 0&'1e107
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<br />Na
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