.
<br /> 6�CE�`I�� �F D��D����'�9�TE��1S: �"h� unoler�ign�d und�rs�and5 th�fi fhis permit may b�subj�ct�o"d�Qd"r�stric��n�"
<br /> �vhich'gnay b�more r�s4ric�ive th�t�County regta4�#ion�. Th� und�r�ign�d�s�umes r�s�n�ibsl�ty f�r compli�nc��ri4h�r�y
<br /> appiicabl�d�ed r�st�ictiens.
<br /> 6�ft��l��6V��� ���`�6�C'T�7R� �6�� �f��l1'F�C�'S�� ���t��6��fl�lLlg���: !f tih� own�r ha� hired a contractar ar
<br /> contra�tor��o under�a��work, they may b� requfred f� b� 1Ecens�d i��ccardance with sf�4e and ioc�l regufa#ions. ifi t�e
<br /> c�ntrac#ar is nat lic�ns�d �s r3quired by law, both tha owner and contractor may be cit�d for � mi�d�m�anor viol�fiion
<br /> under state �aw. i#th�t�wn�r or i���nd�d ccr�fractQr�r� uncertain as #o v�hat iicer��lt�c� r�quirem��sts m�y appE�for fihe
<br /> infiended work, th�y are advised �a conf�cf ihe Pasco Coun�y Buiiding Insp�ctfan Divisionm-Licensing S�ction at 727-8�7-
<br /> 8b�D9. Furthermor�, if thc� own�r ha� hired a cantr�ctor ar coniractars, he is advis�d to hav� fihe contractaP{�} �ign
<br /> par�ions of the "contr�ctor �loc�" of�his applicafiiort for which fh�y wi[I be respansibl�. 1#you, as �h� awner sign �� th�
<br /> confractar, tha4 may be an indic�Zion 4h�f he i� not properly 1lconsod �nd is nat on�tl�d �a permit�ng privileg�s in P�sco
<br /> Goun�y.
<br /> `��6�5�'ID�T�'�IO�I 1f��r�C7Y0JTILl'Pl�� I���aC��a6�D��SOURC� ��GO!l�Rl(F���: The und�rsign�d und�rsta�ds �
<br /> that�ransporta�ion Imp�c2 F'oes �nd R�caurs� Recovefy F�es m�y��Pply fo th�cons#rue4ior�of new build[e�gs, ch�a�g��f
<br /> iJS� I�t£;X1�#it1� �3UII�i11�S, or�xpansivn of existing buildinga, as specified in Pasco ��un4y Ordinance r�umb�r 89-07 and
<br /> 90•q7, a� am�nded. 'The undePsign�d al�o understand�, thafi such foes, as may b� d�a�, will be identifi�d a�the tim� of
<br /> ��cmifYirtg. !�is fu�fher unders400d �hat Trans�ortation 1m�act Fees and Resourc� R�c�very Fe�� mttst be p�id �rior��
<br /> rc�c�iving a "certificat� of occupancy" or final power releasc�. if th� pro�ect does not involve a certiflcmfie of o�cup�ncy or
<br /> final ��wer relea5e, the foes must be paid prior to perm►t is�uance. �urthsrmore, if Pa�co Gounty WaterlS�war tmpacfi
<br /> Y
<br /> fen�sra due,they mu�t b�paid prior to permit issuance in accard�nce�ith appiicabie�asca County ardinancas.
<br /> �5��4��`t�UCTa+Df�'! L@�6e4 l��a�44!(C�����s^'�930 �`'E9��'l�.dt� �'$�$�9$t;��o �ss�ee�e�ad���: If valuation of worbt is$2,5QO,Q0 or more, I
<br /> cer�i�y �haf t, the appllcan�, h�v� bsen provided wi�#� � copy of th� "Fforida Gon��r�ac�an �ien ��w—Hameow��r'�
<br /> Protaction Guid�" prepar�d by the Florid� D�par�ment of Agriculture and Consumer Af�air�. If the appiicant is someone
<br /> othsr than the°ov�rner", !r,�rtl�y tktat! have flbtained a copy of t4�e abovs describect�acument and promi�e in vo�d S�i�h�o
<br /> d�li�r�r it to fih�`bwn�r"prior fio commenc�ment.
<br /> ��R4'��C`d'��'3/�if�d�E�'�R���I�A1lIT: i c�rttfy that all the tnfvrma�an in thls�pp8cattan is accurat�and 4h�t�II vuerk
<br /> vuFll be dar�e ln compl�ance wi�h ail appli�abl� laws regutaYing constr�actlan, zoning and tand devefopmen4. Rppl�c���n i�
<br /> hc�reby made 40 ob�ain a p�rmi# 4o da worl< and ins4aila�ion as indicafed. 1 c�rgify that no work ar ins4�lla4ion has
<br /> commenced prioc to issuartce o� a pers�it and 4haY a!f work will be petfiormed fo mee4 s't�ndards of �Il 1�ws r�g�atating
<br /> cansfiruction, County and City codos, �oning regula4ions, and iand d�velopmenfi regulati�r�s in t�e jurtsdic�ion. I also
<br /> certify thafi I understand that#h� r�gulafiians of other�ovsrnment agenci�s may appiy to #ha intended work, and th�t it is
<br /> my res�onsibility to id�n�ify wh�#actions 1 mus��#c��o�e ir►comp{ian�e. Such ag�nci�s inciude but�r� na�limifed to:
<br /> - Drap�rtm�nt o# Environmental Prat�c4ion-Cypr�ss Bayh�ads, We4land Are�S and Envir�nm�ntaHy Sen�i4iv�
<br /> Lands,Wat�rNi(asf�w�fer Trea#men4.
<br /> - �ou�hwest Florida Wat�r Man�geme�rfi �i�tric�Weiis, Cypress �ayheads, Wetiand Are�s, Altering
<br /> Wafiercours�s.
<br /> - Army Carps of Engit�e�rs-Seawalis, Docks, #�aviga�le Waferways.
<br /> - Depa►fiment of Meal�h � �ehabili4ative ��rviceslEnviranmental Health Untt-Well�, W�s�ewater Trea�m�nt,
<br /> S�ptic i"�nfcs.
<br /> - US�nvironrrr�ntai Protection�4g�ncy Asbaskos abafiemen�.
<br /> - Fed�ral Avaatiot��4u�harity-F2unvuays.
<br /> 1 ur�dc�rstand#i�a�the fiatlawing restric�ions app3y to�he use af#�11:
<br /> - Use of fill is not allowc�d!n Flood�'ana"1/"uni�ss expressly psrmi#ted.
<br /> - !fi Yhe �ili material is ta be used in Flaad �one `�A'� it is und��sYa�d thaY a drainage plan ad�ressing a
<br /> "comp�n�afing voluma" wil( be submi�c�d af �im� of pc�rmitting which is prepar�d by a pr�fessionai englneer
<br /> licensed by the State of Florida.
<br /> - If ti2e ftfl maferi�l is fo be usecf in F1oad �ot�e <`A" in conn�cf�on with � p�rmi#ted buitding tasing sfem wall
<br /> cans4ruc#ion, I certify that fill will be us�d only fio fiil th�ar�a wiYhin the stem walt.
<br /> - 1#' f 1f materi�l 3s #o #e �s�d in any src�a, I cer�ify fiha# use of such fill �ril1 rtc�# adv�rseEy �ff�ct �djacent
<br /> �i properties. if u�e of�iil is faund to adv�rseiy a�foct adjacent properties, the awner m�y b�cifi�d far viol�a4ing
<br /> the condi4ions af the building p�rmi�issued under the af#ached permit appilca�on* for !o� less th�n orr� (1)
<br /> �cr��rhich ar�efeva�ed�y�i13,an�ngineered draln�ge pl�n is required.
<br /> if I �m�h�AC��6�T���`�F4� Ol6�6�9��, I promise in good��ith ta inforen �he owner af Yhe permitting condi4ions set forkh in
<br /> , thts a�idavit prior ta commenc3r�g construc�an. 1 understand thak a sep�rate perc�nifi rn�y be required for elea#rica! wartc,
<br /> piumbing, signs, w@il�, paols, air condi#ioning, gas, or oth�r inst�ll�Yions not s�ecific�lly inctuded in the applicatian. A
<br /> � permit i�sued shal! be canstrued �� be a license fo proceed with fihe vuor�C and not as authority fio violat�, cancel, alf�r, or
<br /> se�aside any pra�isions of fihe technical codes, nor�hall issuance af a permi�prevcn�the Building Of�cial from th�reai�er
<br /> rc�quiring a corrc�cfion�f errors a�plans, con�truction ar viol�tions c+f ar�y code�. Every permit issued s�talf becvme inv�lid
<br /> unles� Yhe�vark �uYharitied by suckt permit i� commer�ced wi�hin six mon�hs o#pertn#�i��uance, ar i�wortc authar��ed t�y
<br /> the p�rmit is susp�nded or abandoned�or a period of six(�)months after the klme th�work is cammonced. �\n extension
<br /> may be requested, 1n writing, from the �uilding O�cia! for � periad not 40 �xceed ninety {90} days and wiU demons#rate
<br /> jusfifiablt�cause for#he exten�ion, t�work c��s�s for nin�fy{90}con�ocutive days,the job is cansidertd abandoned. I
<br /> �9A���9��''a �C> ��i�4��: i(��� ��E�.�t�� "�'� ������ �► �4�°���� t�� ���i��#����f��!!� �,�Y ���l�3' I�f ����
<br /> ��1YQ6��'�!(�� ��� 16�P�O��f��Cd°f'�'�0 YI�l9R€������TY. l� Y�IJ tR9'P�ND'PO O�T�If� �lNA6��ii��,CO�l�iU�T
<br /> 1f�li5'H Y+D R � �R 4�9 A OR��Y��POR�R��t�R �!�Y�D6J Pt4�9'YlC� �►� �A il�� C� �6� .
<br /> ��.oR�aA su����.s. �r a3� .,.�-... �
<br /> o�c���o�a a���T—,.,..��./CY_�--� � c�a�►��ac�ra�a1���.., �',,����_ -
<br /> Subseribed and srr�m ta{ot a�inned)befo e tl�is 8ubscribed and swarn Eo(pr a�irtned} re me th�s
<br /> - by ..3_
<br /> Wha islare personally known to me or ha ava produced Who f persona nawn to me or haslhave praduced
<br /> as iden�flcatiact. as identiflcation.
<br /> �
<br /> Notary Pubiic f �—Notary Public
<br /> Commission 1�a. Ca m3s on No
<br /> """"''•• JACQUELINE
<br /> ,,�`,�¢1�Py,�i y
<br /> Name of Notary typed,printed or stacnped Name afi Not � �ro�= ��a§Ef�C9irib�t 12,2018
<br /> .*.
<br /> ''���q;;;:�F Bahded fhru Yroy Faln Ineur�nao Boa395a01s
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