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<br /> NOTlGE OP DEED l2ES"[F�lQTIONS: The�mderstgnsd understands thet ihls permlt may be aubJect ta°deed"r�ahlcEions°
<br /> whlch may.#a more rest►�k�ive then Gaunty r�gulettans. 7hs u�clerstgnsd assumes xesponsfblli�r for complianoe wft�any
<br /> apP1lcable dasd restrt�tlona.
<br /> tINR.ICEN6�D GONTIiACTQR8 AND GOM'RACTOR [2�SPONB(BILI'f'I�B: If the owner has blred �t conVahtor ot
<br /> cantractcrs ta undertake work,they may be rsquired to 6a Ilaensed h1 accardancs with s#sk�snd locaf caguiarions, If thaa
<br /> aanhactor Is nat 1lcenaed as requlrad by law,both tt�e owner end oontraoCor may be olfed for a misdemea�mr violatlon
<br /> under atete law, ff the ownet or tntended contractor sre uncertatn as to whet Iksensing requi�sments may apply for the
<br /> intended work,they a�e advieed ta contact tha PaBco County Bu(Iding inspecdbn Divlslon--l.icansing SecElon at 727$47-
<br /> 8609. Fu�tttermore, if khe owner haa hlred a contracEor or conkraators, he is aQvlsed to hove the conUactar��j sign
<br /> portions of Etse"cantracfor Btack"of thts applic�tlon far whioh thsy wil(Be responsible. If yau,as N�e owner sign es ihe
<br /> corttrector,that may be an indkretton that he ie nat praper(y Itcensed arxj is not enflBed#o psrmitt�ng ptfvlte8es In Pesaa
<br /> County.
<br /> i'RAN$PORTATlOPI(MRAGTNTlLC(IE8((NPAGT ANC?RE8t?URCE I2�COY�ERY FE�ES. 'f'he undarsig�ed u�cieretends �
<br /> li�at Transposietlan lmpact Fess and Reoourse Recavery�ess maY sPF�Y ta the conahuctlon afi neur bu8din9s�ahenge of �
<br /> use In eads4ng buildings,or e�ar�slon af euisting bu!ldings.ea specHled!n Pea�Caunty Ordinance numbet 89-U7 and �
<br /> 9p-Q7,as amended. The tx�derslgned atao understenda,that 8uch feee,ea may be due,v+rlfl be IdenUfled at tite Ume of
<br /> permittirig. It Ie iurther urtderetoad that Trans�o�lallon Impaot Feea snd ResnurCe Recnvery�ees must be peld prbr ko {
<br /> r�celvtn�e'certific�te of occx�pency�'or flnal power release. It the pro]ect does not[nuohre a cer�Ncate of ace�apanay or
<br /> finei pawer r�lease,ihe fees musE be pald priur tu psrmit Issuance. Furtt►e�rnore.if paeco Caunty Weterl3ewer Impact
<br /> feea are due,they must be paid prrlor to permit Issaance in aocordance with appllcable pae�County orcllnahaes. i
<br /> GONSTftUCTtON L1EN t;AW{Chapter 7^i3,Ftarida 3tatuEes,as amended}; ff valuatlon of work ts$2,600.00 ar mare,!
<br /> cerBfy�iet t, the appttaant, have baen provided W1th a copy of the �Ftortda Con�Uuctian Uen LaW--M�ameown�r's
<br /> PCot�Gt1D'it�1lid�°�arapared by the�tarlda Department of Agricuifu�and Consumer AffeGs. if fhe appiic�an[ia sarneane
<br /> ather than th�"awr�sr",t oertlfy that!t�ave oMained a copy of tha above dssaibed dacument�nd promise in good f�ith to
<br /> d�liver tt�o th�`ov¢ner {rsior!a comrqencement. ,
<br /> GUN'CRACTOR'3fQWElER'8 AFFlDAV1T: 1 cerUSy that aA the i�ormatian tn thts applicatlon is accurafe and thaf eii work j
<br /> wil!be done in comp!lance with a!!e�pp!laabls laws regula8ng consUuction,zonlag and tattd developrnant. Appif�#lan is
<br /> frereby m�de to ohtaln a petmit ta do wark snd (netalla8an as indlcated. 1 cetttfy that nQ work w insia!letfon has �
<br /> cammenced prlor to Iseuanoe of e petmlt and that all work will b+a perFo�med tn rn�et standards of a!f laws regula�ng
<br /> constructlor�, Ca.unty and C'�ty cadee, zaning regulaHans,and lend developmant regul�8ana In the Jurladiotbn. !also
<br /> aertity that i unders#an�tfiat the regulaHons of other govemment agencles may apply M the I�anded work,and the!kt ts •`
<br /> my respor�aibliity ta tden#liy what acilans I must take ta be tn complfance. Such A�enotea Include bu#ere not Umited to: �
<br /> .. ' Department of Envirnnmentai Pr�iectiori-Cypress Bayheads,Wetisnd Ar�as and Environmefltally Sena{tive !
<br /> Letxts,WaterlWestewatsr 7reatmetd. �
<br /> • Southwast Flaida 4Vater ManagemeM Dietrict Weils, Cypress Bayheads, Wetlar�d Areas, Alte�ing
<br /> Watercatrrses.
<br /> � A�Y CnrA$ot Englneer�eewalts,Dc�cs,Nav�e6(e V�laterways, j
<br /> � Department af Hs�th& Rehab�ltative SsrvlcesfEnvironmen#ai Heatth tinit Weils, Wastewatsr Treabnent, 1
<br /> Sepkl�Tenks.
<br /> - US Environmantal Prote#!an Agency-AsDegtos abatemenl. �
<br /> -• Federal Aviatlon Authorit�Runways.
<br /> I understand that the foilowlne restrlctlon.a epply to dte use of iil1:
<br /> � Usa of flli ta riot atlowed tn Ffaod Zone"V"unlesa expressry pecmttted.
<br /> - if Nte HA material9s tp be uaed in Fiond Zana °A", it is understood tl�t e dralns{�e plan addressing a
<br /> "Campeneattng votume°wiY be submit�ed ai time of permitdng whlch is preparad by a pro►esslonal enginear �
<br /> itoens$d by tha Slate oF Flaride. .
<br /> ' - !f the fl! mskeda�Is to be asad in Ftood Zone"A in connacHon with e permtNed buliding using atem we0 i
<br /> cansWctlon,I c�rtlfylhaE f�l w��l be used or�{y to fltt the area withtn the siem wali. i
<br /> - !f fi�l matsdal ts ta be used !a any area, t certlfy thai use a#such fiEt wIQ not�dversely affact adjacent
<br /> ProAertles. ff use at i91t Fs f�und to adveraely affect adJacent propert(ss,ths owrter may be cftad tar via(atin9 , i
<br /> the candlUons of the bufldtr�g parmft issued under!he aBached p�mlt appljcaUan,far tots less t�in arse(1) �
<br /> &cre wttich ere elevated by�[[I,en ettglneered dralnaga plen Is requtr�ed.
<br /> if I am the AGENi FOR 7klE OWN�R,!promtse in good falth to infrorm the cwner of the permitdo�t�ndEtfons set fortta�t
<br /> thls affidavit priot to commenck�g canst�ucstion. I understand that a separate perrnft may be raqalred far aleeldr.�!wark,
<br /> plum4ing,slgns,wetls,paots,air c�ndlUontrug,�as, pr ofher instetla8ons rwt epeciflcslly Induded tn the app!lcat(on. A
<br /> pettn�tss�ted sha4#�e coitstrued to be a Iloec�sa to proaeed wlth fhe work and nat as authadty to violete,c8nce4,alk6r,w
<br /> sat aslde arry provfslc�na of t�e techniaai aodes,nor shalt issuance af a permit preuent the Hutlding Offlclal from thereafler
<br /> rayuh(ng e Fot�reattan o#etrars tn ptans,sonstruof€an or vtolatlons of any cpdea. Every permlt issued shall becrame tnva(Id
<br /> anEess th�work aukhorized by such petmit f&commar�ood WtEhtn six moMfis of permtt Irsuanao,ar if wurk aulhorized by •
<br /> fhe permlils suspet�ded or abanrtaned far a perind trt shc(8)merrths after the tlme tfie worlc is cxrmmenaed. An ea�ens}on �
<br /> may be requested,!n wrlttng,tmm me guildktg O�ic��for a pertod not to e�cceed nlnaty(90)days and w�t demons�rete i
<br /> Justiflabte aause for the extensl�a. !f work ceasea fo�n(nnly t80}cnnsecuttve c�ys,ihe job is car�siderad abandatred, ;
<br /> � WARNINti TO QWN�R: YOUR�AILURE 7�R�COFtl1 A NdTlC�QF COMMENG�MENT MAY RESULT IN YOUR '
<br /> PAYtNG�VYtGE�qR tMpROVENIENTS TO YOUR PROPERTY. IF Y4U INTE TO � N F ANCINQ,CON�ULT
<br /> H YOEJ dRhS Rd CO UR T F B !
<br /> FLDRkaR�lllRAT(F.$..177.03) �
<br /> OWNERQRAOBMT CON7 TO � c+
<br /> � � S��ed erai awam tn(m aHkmad}beiore me Qds ' 5u q C3 4"'�
<br /> - bY ';""�
<br /> Who Ware persuna[ty Imooy�mm to mes tdmdlftcatlm�Rtoduned Who(slare kaa+4 to me or � ve pmdu� ;
<br /> � � 1
<br /> . ' ' Motary P c AtNSYiVAtd1A
<br /> CSnmmlasmn No. +nlseton No A�.
<br /> � ("�� �� K 15TtNA 6ALlAGNfR
<br /> t+k�meofNolmy �ttint6dorstafiped NameofNofanl��t�tedorstamP � ,
<br /> MARSNAIt TWf?,A1.LfGHENY COUN7Y
<br /> ' My Co�niseian Ezptres May 13,2017
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