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• � <br /> �fJ►A/28/2007/4Y�D 07:20 AM ZEP�ILtS Bl1ILDING FAX No, B1'3-780-0021 P. 002 <br /> ,�pTIC� OF��RES�ICTtoNS. 'Che,underslgned und'erat�mds tJ1st t�� permit m�ybe•aubJec�ta•"de�d"a�,e�trlCeions�� �, <br /> �rhfch maY be moo� rasirk�ve than Count'y�e9ulatlor�s. 7he��ndetslsned.�ssumes respons�Dny'.forroomp„ar�e+�uuith any .�. <br /> �pptloeble de0d reeq�fottotm. <br /> �t!lVLfC�ISED �CVNTRAC7'ORS .ANp �'CONTfiACTC�R.R�SA+�MSIBIL•iTIES: (f �tlie �wwner has �hEred'��conhractor �or• . .. . <br /> contrsotor� fio u�ertak�e wvrK, ihey tnay be reqt�ked to be lb�enead � acGOr{dacica vvkh sEete and looai•t+�qulattens. if thg <br /> cOt1d�a0tor ls not Ilaeeeed � r+Cqub�ad by i�w, bokh the o�er �nd •a�dr�a n�e�y he c(�ed Yar � mledsme�nor vlode6on <br /> .under slade law. N�tltie dwner or I�ended �cartihactar erca unoertatn.e� to wltat Iroenain9'req�+ireme►�ts meY apPly tor the <br /> , liltended work. they �e �dvlsed�lo contact the•Paceo CMar�y �ulldhl0 Inepedion Diviebn 6ec�ton,at 727 <br /> 8009. Fu A�etrno�, tf ownet hss htrecE .e contrac�or or '�nb�nctors� he is ad�sed ��hsve �lhe contrac�o�r(s) sipn . <br /> �cto� th�t may ba �n Bndk�tlon ��r+at is hot Ptope�iY Ilae��+.se snd Is na�t enfl�ed•to � i!6'ng �pes � Rasco <br /> County �I� <br /> Cpt�ST1{UC?ION.L.IEN .LAW (Gh$pber7'13, •Flo�rlda Statutss,.�s.amsnd�: If wdtusGon of Wo�k Is "j2,�00.D0 or mars, I <br /> , rr,� •�eat i, �he �P�io�nt, heve .been pfwided wlth � copy of �t11e 'Fiwid� Consfrua�on .Lien. Lew—Homeovrnet"6 <br /> Pro�acqon Gulde' prapat�ed by•ti�e FI� Depertme�n# of A9riculture and Con�umer A1�ks. !f iAe epp�nt le'eomeone <br /> otlter Shmn the'"aavrie�', I�tity that ! have ot�ained � copy o# the sbove deacrlbed clacurnent �trui promlae iR pood fcttt� io <br /> delh/8f' It to tfie'aNmef" p�1o� b CoA11s1e11G9me�i�, � '� � ' <br /> _ CON1'R,ACTbR'Sl�WN?�R'�S.AFFlDAY1T:.1 oactlfy that �1i the infprm�tioe Irrthle �pplk�Non is�gccurete snd <br /> fhat all woH� nn�f �be'dbiie In compli�t�ce w�th aG appilcable laws repulaifig oons6'uctlon mr�ing and land <br /> dewdopntee�.. ApPil�ion Is hereby m�lde io'ebtain a pemit �e do .wdrk ant! it�stal141bn � N1dk�bed. 1 cartly . <br /> • that no workIar ir�llatton has comrnenced prior to Issuanoe nP a pevmic and•that a11 wark wqt be Petfotmed to <br /> n�eet stand�s of qll I�us regulaltng potmhnw�t}on, �nty end Ci�► codeg. ,�aanin9 re�ons, and land <br /> dev�iapment negule�ons in tho jwisdlcMon. t atso certtfy that I wndershand that •the re�ulaqons of other <br /> . pove11�11rlent �genales tnay apply to the i�,Eended tNOfl� sncS ttlat 1t la my I�espnns�►lllly to idenilfy Whst acHof�s 1 . <br /> must feke�to ba in compllance. ' � <br /> If I am the ACFM FoR� � oYVNER, I prdmise tn good fefth to iMrnm the ovmer of,lne pertri�tinp c�or�di�an6 s�t forih in <br /> H�ts affWa�lt prlar � cor►�mencing r:o't�roGfln. �I ur�ders�arnd tf�t � separate petmit may be requked Tix elechicai work, <br /> plyRlbih9� 9igtte� Weq6, 8k o011dliiqnillg� 9as •or ottter Mstalladons not apea�fiaalty h�ittded in the ePplic�attion A <br /> peimtt fssued sheA be c�ttstrued to .be a 11cer�e to pr�ooeed wkh tfie work and not as auMerlq► to vloi�te; can�:el� ake�', or <br /> set esidB ar�! pt�oa+isfa�s of the technicaf codea� nar shaA Issuance o�F a permit prevenR ths�u�a Oft'bia�'fl'om thetesiter <br /> requinng a oorreo�on af in plair�s, oon�truobion or vlolaqons aF snY codes. �very pa�mlt Issued shall beoame irnrolld <br /> untess fhs vwrk suthor try sucf� permR is c�nmenaad wlthle aht months a1 perm� fseu�e� or ff worit authorltsd by <br /> 1he �mN Is s�.�spende�lor abandoned iar a period oF's1x�tGj moriti�s aRer the tlrne the w'orlc le comm��wed. An extensfon <br /> may ke reAuesked� in w�tirig, from the euqding O�cial for a Rerbd not to e�xceed nMebl (90) ,d�ys aiul wIN demansh+ate � <br /> '' �UBiiF18k1I9 GaIISE � N'IC �BIOR� I� W01'IS 06S,SHB fC� �U1�9lS/ (9O� COfl9�Ct1tIV8 dd�/S �b is c�nalelered abandoned. <br /> 'WARNMCr TO OWM��I: 'YOUR �A�I:URi�''i0 �RECCRD A'NOTIC�'O,� ;COMM�NC�M�NT Mi4'Y`"R'R�SULT Mi'Y6UiZ� . .. � <br /> PAYlNG 'i1MC� FCR �IPROVEM�NTS "�O YOUIt PRO�R7"Y. !F YOU lNT�ND TO OBTAMI �INANCING� GONSUL�' <br /> W• RN 0!NG U OF CG ' , <br /> FUORIDA JURAT (F .117 � . <br /> / � ' ' ' . . ' <br /> ' OrVM�R ORJAiGEIfT `� CpNiRAC , <br /> ��� � � dP � m ltlls <br /> y�y��y knaiwn m�ne or ve prod�wod Wlw pe�,o�eyr 1� me or are pradueed <br /> • N1A�` • �s Id�tE��s6oe� , �'� . . <br /> � , � ' '. . <br /> ��, jVo�ary Pub1lc � � Nobwy p�Uc , <br /> Oomn+teslon o. l CanNnbrlon I�w. 1 , <br /> 1 _ � �' ' � � �'C�ylLn'e = • . <br /> Name of Nolmy bpeel'� QrY�ctl or cLamAed .� • Neme� No�' OiP� PriMoa'or alsmpod . <br /> . ,., , f <br /> � QOMINM�fld�l 10b�� � <br /> OOIM��01� • t00i � ! �CCT '� <br /> � l�ANli4CT0��018 amwa <br /> � I�HNCIA�'�I�111U ■M��M�OC�IN <br />