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'4 <br /> � S <br /> � �s <br /> H��`�9C� �� ���D [�f��'�'Ft@C'�9�8��: Yhe undersign�d understands that th6s permit may be su�ject t�"ii��d"restrictians" <br /> v+r7�ich may be more �estrictiv� th�n.CounQy regulal:iuns. Th� undersigned assumes responsibilsty for compli�nce with �nv <br /> ap�iica�bi��eed r�strictions. " <br /> �B�[LC���9SfED ���9`i'6t4���'0�3� ��Bf� CO�ll`�l�l�a i�'��4� fi���U�IC9R��B�9�B�'�f��: Bf the own�r ha� hired a contractor o� <br /> cont��ctors to u�cSertak�work, th�y rr�ay be req�ir�d te� �e 1{ce�s�d tn �c�ordanc�wifh stat� ��d loc�! rec�ul��ions. If�he` <br /> cancrac@r�r i� not lic�nsed �s r�c�uire� by law, b�th kh� owner and cantractmr may be ci4ed fa� a misdemeano� violatoon <br /> under s4�t� law: if tPie ovu't��r o� int�c�d�d conQr�c�or ar� eanc�¢�kain as f� wha� 14cerssing cequirem�nfs`maY ��P�Y.far khe <br /> int�nd�d work, kh�y are advis�e�fe�eontaet th�;�'�:�oo �aun�y�e�i(cfing 6nsp�etion C3ivisian—L.ie�nsing S�cf'soe� at T27-82�7- <br /> SOCI9. �lBPtFI�PpYIOP�, if th� own�r ha�s hiPed � conkractor or contractors, h� is advis�cl ta h�ve th� cmr�tP�ctor(s) s�gn <br /> par�9��s of fhe "��an#�-actor �la�k" af t6�is appticafiora for wh3�h fhey wilp t�e res�onsibte. tf yo�a, as th� owner s"sgr� as �fi�� <br /> cantrac4o�r, thak r�aay be an indication th�t he is ncik prop�rly �ic�nsed and.is not �ntitled to p�r�ni4tin� privile�es in Pasc� <br /> Cr,eanky. , <br /> 'V'fs�V���'�l�'P�'�6��1 9�i�t�.�`�d���'B�.➢T@i�� a�l���`���9� ����99��� �����IE�Y����: Th�unde�sige�ed und�rs�ands� <br /> fih�t�r�nsportation dmpact Fees and �ecourse FS�c�v�ryi F�es may apply to the construction c►f new buildings; �change of <br /> LiS�' iPi G')(tS�tFig f3UII{I1Pi�S, ar exp�nsion of�xisti�� buildings, as sp�cifii�d i�t Pasco ��unfy �r�inanc� numb�r t39-�� �i�td <br /> 90-07, �s arri�nd�d. The und��signed also und�rstand�, that such f��s, a�s Pn�y be due, will be �d�ntifi�d at fh� tiPn�: o� <br /> ��r�if�i�e�. �t is f�rth�r uncf�rs�+�e�d fh�f Tr�rtspor��fi�� I�pa�� �e�s and.t��sourc� R�cave�r Fe�s �nust b� paic9 pe9or Y� <br /> r�c�ivio�g a "c�rfifica�� o� occup�aracy" or final powc:r,Pefease. B�Qhe proDect d�oes not involve � �ertificafe of occupancy or <br /> fr��! power rei�a�e, fihe f��s miast be paid �pior @Q per►nit Isst�ance. �=urth�rmor�, uf F'�sc� C�unty Wat�r/5�w�r impacY <br /> f�:�s ar�c9u�,-the�musf b�p�iai prior fio p�rmlt is�u��ce in�cce�rdance with�pplicable Pasco Cmunfy o�di�ar�ces. <br /> ���1��'��Bc�'�'V��➢ �.nf�P� L�@�009 Q�6v��n��r���P 9�D�Pa¢9�����au4c��o �� ��o�o�¢���I): I�valuatiz�n of wor6c is �2,5U�.00 �P mor�e, V <br /> �erfif�r t�►at 1, th� ��pli��rrfi, 4»ve b��n �rovtd�d �ruifh a capy of th� "Florid� C�nstrucf4on Lie�t l.avu—�or��o�ivn�;r's <br /> �'POt�c6im� Guid�" pr�par�d by 4�ra� Flaarida D�paPtur�ent af Agriculture an�9 Consurner Affairs. 6�fh� �pplica,nf is somecme <br /> a�h�r Q�a,n 4he"�uun��", t certifi�r�hat ! hav� obtai�ed a capy of th� above d�scribed document��d j�rom�s� in good fai�h fo <br /> d�Gaver i�to th�"orrun�r" prior�a ce��r►m�ncem�nf. ' <br /> �c�G���,Qe�'��1�`�/�D�i19�9�f�'� I�CF�°V��a�9�: � certit'y fhat �II the iriform�tion in �his application ia accurate an� thak all worlc <br /> wiil be d�e�e in compli�nce uvith alt applic�bl� laws regulati�g �onstructi�n> �anirtg and 4and c4ev�lopr�i�nt. Applicatiorl �s <br /> h�reby rr�ad� �o obQain � pePmit to do woPk a�nd installation as i�¢9i��t�d. I certify that no worlt or in�tall��ion h�s <br /> ce�rr�m�nc�d prior t� iss�aanc� �� a permif ��ic9 fhat at{ wo�6c uvf1E b� perFormed fa m�e� st��rdards �fi ail #�ws r�gufatin� ' <br /> construction, County and'City. c:ades, zoning Pe�ulafioros, and land dev�iaprnc�nt regulafions in fhe jurisdic�ion. �� a,lso <br /> c�e�ify kh�k ! und�rstand that th� reg�alatimr�s of a�her gov�rnm�nt agenci�� may apply Qo th� intend�d worlc, and that it is <br /> rrey r�spo�sibili�y�o id�nfify wh�t�ctic��ts 1 rtttast t�l�e�o be in camplianc�. 5uch a�enci�s inclttd�b�t are r�ot 9imif�d fo: <br /> - D�paPtment c�f Erovo��nm�en�al 9'rotecl:ian-Cypress 8ayh�acGs, We4la�nd Ar��s ancl �nvironment�lly Sensitive � <br /> Ga�ds,W�f��1W��t�vuat��Tr�atrm�r�t. <br /> - Sauthwest Flori�� ON�t�P �Vl�nag�unenf D15�PIC$-W�IIlS, Cypress �ayheads, We;�land AP�aS� A1g�rong <br /> W�t�ecc�urs�s. • <br /> - Army Corps bf�ng3ta�ers-�e�w�lls, ��c�cs, Navigabi�W�teruv�ys. <br /> - D�partm�nt of �1�alth � Rehabilitafiv� S�rvic�s/�nviranmerr4al F-d��lth VJnit-W��Is, 1N�stewater Treafm�nfi, <br /> Septic Tantcs. - <br /> - U� �nvironrrient�l P'roteckion.Ag�ncv-Rsbestos abatement. <br /> - Federal Aviati�n�t�Yhori��t-Runw�ys. <br /> I can�9�s��f�nd #hat Qh�follawing r�sstrictions �pply��r the use of fisi:� <br /> - Use of fil!is not all�vued �n �lood Zon�"V"unl�ss�xpr�sslv perrni�ted. � <br /> - if th� fiil material o� fo be us�d in Flood Zon� "A", It �s und�rsfoad thaf � drain�ge plan addr�ssing a <br /> "comp�nsating vol�ume" will be subrrritted at Qime �f permatting which is prepare�d by � pPOf�ssional enc�ineeP <br /> iice�sec9 by fhe Sf�t�of Florid�. , <br /> - If �he fill mat�rial ia to b� us�d in �laod �one "P�" in c�nn�ction wiQh a permiQt�d building using s�ern wall <br /> co�s�ruc�i�r�, I c�rQi�'y�ha!fill wi!!b��as�d only��-fi1!the ar�a within th�st�rr►wall. <br /> - if fill materi�l is �o be �used iri any area, 1 c�r#ifiy th�t �s� of sueh �i11 wiil o�ot adversely affect �djac��f <br /> � prop�rli�s. If use og�ill is found to ac9vers�ly �ffect adjacent prop�r4ies, Qhe owner rriay b� �ite� far violaRing <br /> th� candiRior�s o�Qh� building p�rmit �ssu�d unde¢� the at��ched p�rmif app4ic��ic�r�, f�r I�ts I�ss �han �ne ('�} <br /> acre which are el�vat�d by fill, a�r er�gineer�d drainage plan is �equired. <br /> �f� ar� �he�6,���T�O�'�8�� ��98��1�, 1 pror�is� in good faith to ir�form kh�owt�er a�4h� pe�m@Rting conditio�s s�t fortln ir� <br /> flhis affid�vi4 prior to commencir�g constructi�n. I und�rsfand that a s�pat'afe p�rrriit may be required for etectrical woc(c, <br /> p1�rr�bing, sig�ts, we!!s, pools, �ir co�ditioning, g��, or c�th�r ii�sta11at6oros i��t speci�ically includ�d .ic� fh� applica�tion, �L � <br /> g��rmi� issu�d shail b� co�tstr��c� Qo b� a lic��s� #o proc�ed vui�h th�worlc and no� as aisthority t€�.vio6at�, c�ncel, al�er, or <br /> s�Q asid� �ny provisions of�h�$�chnical c�des,'n�or�h�ll issuance of a p��mi� prev�rr#the �uildiric� Offici�l fPOm ther�after <br /> ��c�ui�ir�g a cor��cfion of errors Ir� pl��s, cc�rtsfiruc�io� or violaQiocts of any codes. Every pePrr►E#iss�aed sha!! b�come invalid <br /> unl�ss Qh� work auQhori�ed by ;;uch permi� is ca��rnenced uvitG�in six rnonths of perrrri# issu�nce, 17Y' I$WOP�C �U�PIOPIZ�� bv <br /> �h� permit is susp�r�d�cf or�bandoned ioP a period of six(�) rri�nths affer fh�time the woPlc is corr�menc�d. Ar� e�cQension <br /> ma�� b� requested, in wrifing, f��om th� �uilc�ing ��ificiat f�r a period n�f tcs ex��ed nern�ty {�0} d��s and wilY�d�rrs�r►strai� <br /> E�.�5�9f9an�DI�'UutaS�7t7F�ha�xt�n�ic�n. If wor6t c��s�s fior tiinety f90) cansecutive days, th�job is cor�s6dePed ab��don�d. __ <br /> �, <br /> a4r�JRa��iJ9h�9G� "9"� �1V41BR9�1�: �°�D@.Bf� ����9.Df�� �� ��I��CD�� �, G�➢01'V�� �G° C��if11���C�f�61i9[�V�9�' �iifl�Y ��S�DII....B' ��9 �'�iQ.D(� <br /> PI�a��G��`�9��� ���H�6����91����9`�'�"P�V�H.��Pl��ff���.'�°. ���4�9� 9R➢�'��D Td� ��°P��l� ��G�19�G�CV�➢�, ��G1���Dd..�' <br /> �fr99T�8 V��bl��.,f��9@���3���6d 6�1f Tt�I�V���'L��[�9��t1� �(��O��BP��1f��Di�P���'9�� ����bbi��il#6��d�1�6�i���`. , <br /> FL�RIDA JUF�AT(F.S, 117.03) + <br /> ����ua�a������ c��T�c�o����� 11 C��1 Y1�l <br /> Subscrtbed and sworn to(or affirmedp before me this u s rib and swarn to(or affirmed)be e me ihis <br /> by bY - <br /> Who is/are personally known ka me or has/hav�produced �(W o is7a e personal}y knoavn to me ar hasthave produced , <br /> as IdentlficaGon. ��` as identification. <br /> r � <br /> �Sotary Public ��A�„�C������ ��- t�otary Public <br /> Commisslon No. Co issio No. <br /> r�t*pYA�A�•, 1MF"'ti7__��-i. <br /> i�ame af Notary typecl,printed or stamped ` � Name of Notary typed,pri � ;o ai�ype�Y COMMISSION#FF144817 , <br /> .i <br /> y`'�. o�°= EXPIFtES Je�ly.24, 2018 <br /> ,Of¢1��� <br /> (ao7)398�ot53 FlorldallotaryService.com <br /> , � .1 <br />