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<br /> Np'i���OF DE�D F{E3tl�lCT10N3: The undersigned understands�at this perm'st msy ba subjsot tn`daad`rsstrtcNans°
<br /> - w ich may be mare resttictive 4han County regulations."the undersigaed assumes respvnsibllity for campUance wlth arry
<br /> w"' a ptir,a6la aasd rasWcUons.
<br /> fJjYUCEN3ED CW�!'1'I2A�TOtt3 AbiD COI+ffRACTOR RESPON5IB�lJ79ES: N the ownar has hired a contractor or
<br /> c.�ntrectars ta undartaks work,thay may be requ'med to ba ItcenSed in accardar,ce wkh state and locai regulaUons. !f ihe
<br /> cdntractor t�not Ifcensed as�qui�d hy law.both the awn0r antl cantrector rnay be clted for a misdemeanor vwtation
<br /> under st�te(aw. If the owner or ir��ded contractor are uncartaln as ta what licensing tequiremanls may apply�th�
<br /> intended work,they are advised to can+act the Pas�a Cetmty 8ui(ding InspecNan Division�—Licertsir�Section at 7Z7-847-
<br /> 8408. Furthermare, If the avmsr t�a hired a conusctor ar�or�tractors, he is adv�sed to have ttsa contractor{�)sign
<br /> por�ons uf the"cantra�vr BtoGk'of this appllca8on for which they wiq 6e respansble. if you,as the ownsr ei�n as tfie
<br /> cqrttractor,that may he an indicstiors thst he is not propsdy Ilcensed and is not�ntitled fo pertnilting privileges in Pesco
<br /> 1'F 4NSPORTA7IQM IMpAC'C!�'iIUSiES iN1PAC'f AMiD RESOURCE RLCOVERY FEES: The und�►signed unqecemnds
<br /> tt1at 7r�rasporlaGan Impact Fsss and Itecourse Rscovery Fees rt�y apply to the con�4uc�on of nQw bu�dings,eriange of
<br /> u�e in existing bundln9s,nr expansiar�of extsting buildic�s,as speafied tn Pasca Gou�►ty C�rtlinanee numttisr��07 and
<br /> 9Q-o7,ea em�ndgd. The u»derslgn�also understands,•that such tees,as may ba dus,will ba idenNfied at the ttme at
<br /> p�rmttUng, Ii Is further understood that Trensportatior,lmpact Psas and Resou'rce Recovery Fees must be paid prior ta
<br /> receNing a'certific�t�of or.cU�n�nY"w flnei power relaese, tF the projed does not invotve a ce�tif"�cste oi accubancy or
<br /> fi �powe�re�esse,lhe fees must be paiH ptior to permSt lssuance. Fu�th�rtnore,if Paseo Caurtty WaterlSewer ImpaCt
<br /> �re due,ihey rctust be paid pr�ot ba pertnit fssuance in accordance with appli�abtn Pasco Cnursry artllnancas.
<br /> � �QN9YRUC71Q�t k1EH LAW{Chaptor 7�#S,Florlda Stati�tes,as amended); M vatue6an o�waric Is 52,54II.00 0�more,l
<br /> cgrtify that 1, fh0 appftcar�t, have 6een provided with a copy of#he "�lorida Gonstruntion 1.ien law�—l-lomeowner's
<br /> l�ote�tian Guide prep9r8d by�����de DepaMtent of Agric�ftune srid Cotisumar Affairs. If the ap�fic3M is Somdona
<br /> o than th�"owner",!certify t��t 1 hsvvra ohtainad e copy of the above described doaument arwi pmmise Sn gbod f�ith to
<br /> d iver it to the'Qwne�'prior Ro o0mmeneament
<br /> ,p�1TRAC'TpR'S11�W13E1�'S AFFIDdVYT: 1 cerdfy thai all the ir►i�ormati�n in this app[ic�t�on is acaurata and that al1 woric
<br /> v�ill be dona in compti�nca with ell e�plice6t�lavrs regulating consbvotian,zoning and lastd develapmenk Appfir�tion is
<br /> : hereby made tv abkain s perrnd ta do wprk er�d Installatian as in�ic�. I certify that no wark ar in�kaO�aGon has
<br /> cpmmen.ced prinr�o issuarrcQ of a permk and lhat alt work vv�'il be perfom�d 6o meet standa«ts af all la►vs ragulatlng
<br /> cbnsttuction, County and Clty code.s.zoning regulations,and land devebpme�t ragulat�ons in th�jw�tsdictlon. t also
<br /> cartify that!understand that the regtt�ations af ofher govemmetrt age�cias may apply ta thg Intended arork,and Ehat it is
<br /> my respottsibUfty ta identify wf�activns I tnust teke to ha in cort�pllance. Such agencl�€indude but are not limited to:
<br /> � - Department of Em�iranmental ProteCtion-Cypress 8ayheads,Wetland Areas and Envimnmentally Sensitive
<br /> � l�nda,WetarMiesteweter Treatment
<br /> . � - Southwest FlorEde Water Nlanagement Dishict-Welis, Gypres� Be�yhesds, we�and ,arsas, Akshng
<br /> Watercourses. _
<br /> i - Army Carps af Er�gineecs-Seawalia,bocks.Navipabl�Waterways.
<br /> I - DepartmeM af Healkh & RehatitlltaiArg Serv'sceslEnvironment�t Heaith Uni�-Weiis� Wastewater T�afi►artt,
<br /> i _ Sspt�c Tanks.
<br /> US Environmexrtsl Prateotion Agency-�lsbestas abetemant
<br /> Federal Aviaticn Authori�-l�nways.
<br /> I IuRderstand that ttte foltowing restriCtions aPpfY to th¢use of M: �
<br /> I ` Use of flN Is not al4owed in Flood Zone°V"unless exPre�fy parmittstl•
<br /> lf the f111 material is fa be Used in Floqd Zane A', k is uc�darstoa4 that a dralnage plan addressing a
<br /> I "wmpensating voiume"wil{be 8u�rrirtted at ilm�of permitting which is prepared by e professianal eaginesr
<br /> � Iicenaed by tlte Statb of F�orlde.
<br /> - If 1he fi11 matari�l Ss ta ba used In Ftood Zona"A°ln oas�necCson with a pertnitte�i buildi� using s#sm waA
<br /> cans�uctlo»,I certtfy that flll vrift be used only to fill the area within ihe atem vuall.
<br /> i - If f�l materisl is fa be used in any area, 1 cettlfy that �tss of such filf wDt not adversely affeo#adjacem
<br /> , prop�erties. if use af fill is tound to advarsaty affact adJacent properties,the avmer mey be cited far viol�bng
<br /> � #he�nedKions of th�buildin�parmR Issued under the aftached permit appiica�4�,for�ots l�ss than one(i�
<br /> �cre wl�iah are elevat�d by iill,an ert�ineered drainage�fan ie�aquirei.
<br /> I�I am the AGENT FOR 1'HE OWNER,{prom'�e in good fiaith to infarm the ownar af tha permhtlng condltlons set forth in
<br /> t is affidavit prior t4 commencing constru�tion. t understend that a separato pe�m►it may be reqa'ired for eiectricat work,
<br /> plambing,signs.wells. Peols,a�r cond�en,rr�,gas,ar other instalia�on�not specifically included in tfie applicaiior,. A
<br /> permit issued shat!be wn�trued ta 6a e ficenss to procesd wtth the woric end nai as authority to vioFate,asnca�,atter,�
<br /> ��t aside any pravisiort�af#he tachnical wdes,nor shali Issuance of a permit prevent th�Buitding�icia�irom t.ha�aaRs,'
<br /> r�aqufdn�a conecean af errors tn pfans,construcHan or vi�ations of arry codes. Every pe�mk�ssued shai!becan�e Envarid
<br /> 'unisss ths work authori2�d by sucii permit(s commensed wikbin six manfhs of permit�an�,or if w�ork autFrorized by
<br /> th�psmttt is suspended or aDsndoned for a period of sx(e)months eft�r the tima tha work Es commenced. M exfensian
<br /> t�ay be reques#ed,in writing,fram the Bulding Oifiaet for a period not to exceed nlnetyr(90)days and wll demonsfrate
<br /> ji stifiabfe caus�foc the exteneion. If wark«�+sas i4r qlnaly(9bj consec�itive days,the job is Cans�dered abandoned.
<br /> WARNING TO OWNER: YOUR FAlLUf2�TO RE�QRD A NOTICE t�F CQMMENGFM�NT MAY RE$URT 1N YOUR �
<br /> I�qy�H,�',7WICE FOR 1MPROV�INEN'CS 3b YOUR PROPERTY. tF YOU 1NTF.l�1D TO Q8TA1N FIMRNC1htG,CQNSUL7
<br /> W::�'�`Ln•�•�••��aR A AT�ORNE1f 9EFORE RECQRDIt14 YOUR ND7t�_QF Ct�MMENCEMENT
<br /> �LOfi1DA JURAT(F.9.117.43) n ,.�.� ��{�y��
<br /> WWNGRWiAn�NT CONT1tAGTOsr��lJL� '�"Jt�[�.F� „�/tAY�fy�yLt-
<br /> ��bea an4 awom m(oramrmea}netore me thls ��swom ts(or�ed)0�are ma tt�a
<br /> by
<br /> Whois/arepeeeont�ttyknowntomeothaelitaveptoduced W P�a loareorhsslharepreOuCetl
<br /> ! as ideni'�ficadn�+• ea Ideralflcetion.
<br /> ' Napry Pu6�iC � �""� oYdryFt+GCio
<br /> �ommiss�o»tvo ' cammissionNa '4
<br /> � Notary P��c-Sfete ot Ftorida
<br /> Name nf Nt,t�[y�ypetl.P�ntetl or eten�petl Namc ni Natsry typ tl tfl 68i611#�FF 84�1739
<br /> I . ��;,n� A�y Co�►1m.ExAlre6 ARit 20�202D
<br /> B�eStttMou9h N�ia�t Nuta�t Assn.
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