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JuI.05.2017 07:05 AM A HARTLETT ROOFING 1813?$01805 PAGE. 2/ 2
<br /> .. . � Nql'!CE l3F q�6L1 RESTRICTIa1d8: The underslgned underet�rtda that t�ls�ermit may be�►�i}aot to"deed"nesbic�ans"
<br /> Whlch me�y b0 mora rast�c�v�tt�n C�unty r�gula�ons. 't'h�tmztetelgned a�aum�s r�sp�nslblllty to�'Camp#ettce t,�th eny
<br /> �PP�c�bie tt�ad r�att9c�On�.
<br /> UNLIC�NeED CCNi'!'tiAC1'OR3 AND C1�NTFiACYOR R�8POI�6I�ILCI'1�8; IP the own�r t�s hir6d a co�actor or
<br /> oantras�tors to ur�l�rlake vtork,th�y may be r�qulred#a be Rcensed!n eccar�ant�wl#h state end tocat ce�ul�8ona� tE the
<br /> aontrsc#or fe.not liceneed a�required by taw,bo�the awner end conhactor may be dtad far a mlademeanor alatatlon
<br /> under et�te law. IC the awner ar Irtitanded oontr�ckar ar�uncertain ea to wh�t Ncan�lr��eyuU�ments may appty far�e
<br /> {r�tecuied woilc,they sre advleed to conta�t th�Paeco Cou»ty�u(kk�ng lnapectlon t�tuislon�-�.icenaing Sea�on at 727-847-
<br /> 8089. FurNtmnna�, Ff Nte awner ttn$hired�cotttrslcEer ar conhttctors� t+e ta advJeed to haye t�te aontraa�s}sipn
<br /> parGans oi the"Cont�ect�r 8iock"of thls applicetlan for whlal�they w1116s respon&ibte. If you;as the ownsr alpn as the
<br /> c�antractar,that may be an 1ndlcaNen that he!s not properly Itcetta�ad and 4�na!on�tled to pa�mitNnp pdvllegea tn Pesco
<br /> CouMjr.
<br /> 'FRANSPQRTAT1flN!NlpACTAJYILl7lE$IMpAC1'ANp R�80UR��1i�C0YERY J�E�8: Th�und6rrsigned underaf�ride
<br /> that'fransportatlon impecf Feee and Recouree Recavary Fees may�pply to!h�conehucflon ot n�w bultd(r�e,ot�nge ot
<br />, use tn a�s�ng buildlage,or s�ane�rn cf+��s�t�buikltngs,�sped�ed ln F�a�cc Coanty CkdlnencQ numbsr 88�07 and
<br /> 80-47,as arrrended. '1'he unde�aigned�Iao underetande,th�f such feea,�e may b�9 due,wlfl bs Idelttifled At t#lo dIT10 of
<br /> re���et+ce�r���raf arcupan�y�or��{�paw���re��e��►f he projeGt daaa�t femoi�a�r�flc�a etof��y or
<br />' Bna1 powdr retema��tit�fees must be paid P►�or ta permi!issu�nce. Fnrthermo!'b�it Pagco Ctiuniy WamrtBewer irnpsct
<br /> t
<br />' fee�e are due,Usey muet�e pald pr9or to permtt tasu�nc�in acooMence wfth appllcebl�Resoo Ccunry o�llnartcea,
<br /> GOldBTRUCTlON I,IEN l.AlAt{Cheptor.718,Ftarldt 8tatut�t►,tta�tmat�ded): It valuation of wosk Is$2,rp0.00 or rt�are,!
<br /> csar�fy thet t, #se ��ticsnt, h�vs baen prov#ded v��s a co�y af tt�e "Ftodda Ganatruadan #ten t,a+�—Namecswae�s '
<br /> ProbecNnn�uld+�"prep�rod by the�Florlda Dopartrnant of AQrioulhue end Coneumer Altalrs. IF ihe appllcent Is aomeone i'
<br /> other ihan the`awner",i cdrtlty that!have abfeined�copy ai ths dbove tkesCcibed dacuma�!and promlae In goad!a(th to
<br /> d8liiter�t to tha°ovutt�r"prlbt#�cCttsmenGemBr�.
<br /> CONTR�0.CTAFt"4M"/OWN�R'8 A(�M�InAVir: I cartlty that�q Rhe fnfaimatlon in thle appllaatlon ta eccunate and that�A work
<br /> w111 be datte ln Camplisnce with all appllcabl��awa repulating eor�►tructtan,�aning and lend devetapment. Applic�iMa!e
<br /> har$by nt�ct� fo o8t�ln a Pam�l#to da war(c attd 1ns�(l��qn&8 ittdle8��t#. 1 c8t�fy that no wOr�t o�`kutt&1{ed#Crn ts��
<br /> commens�d prior ta is�uanCa of$permit and tfiat aii work wiii i�e pertarmed ta meei st�ndarde of ati tawe roSulaUng
<br /> cpna�uctfpn, Caunty and Clty codea, zanlr►� re�ulaAane, �and land develapmer�regulattorq In th�)arlad)cUo�. l also
<br /> t�r#1iy thet 3 undatste�c{tftai the C6gttia#ons oi othet government a�ancfea tnaY apPiy ta thb inte�xl�d wark,aRd th�t tt I$
<br /> mY resPons�bt�fy to lde�ltity whai actl.one I muet take ta be In catnpqenee. Such agenciea inctc,�de but ere not Amtf�d ta:
<br /> - Gepertmen!oi Environment�l Protactlon-�ypress Hayheads,Wetland Ara�s attd �nvlronmentplfy 3ensttive
<br /> i.eGnd&,WakeciVl+aefewat�r Troatment
<br /> - Southvassf Flor#d� Wa�r Mar►a�ert�t�t Gtiet�ct We1fa, Cyprese �e�Y��ads� tNe�and Areas, A3Fering
<br /> Wate�rcoureee.
<br /> - Army�Gorpe 44�ngin�ere-Se�walis,C�acks,Navlgable�Waterwaye.
<br /> - Dep�rhssent of Hea4tF► & Rehab311tative �otvlt�$lEnvtronrnen#et Heai#h t�nit VNelle, Wastaw�ter't�+eafi�ant
<br /> sepqc T�nk�.
<br /> - US�nvironrnantsl Prot�cdon Agenay,Asbastoe�baNament.
<br /> - Federet Avl�tlon Autk�a�i�r-RcNr�ways,
<br /> f unde�atar�d that the toikswing reekricHans appiy M ti�e use of�ti;
<br /> - Ur�df'AII Im rlqt allotiv�d fn Fiaod 7»one W unfese expraaely perrnitted.
<br /> - t#the flfl mate�af b #a 6e �ssd fn Fbod Zone "A", It is under�toad tk�at a dratt�ga plan add�easing�
<br /> "carnpc�nsating valume"w111 be stt�mit#�d at tlme oi patmitNng whldh 3e prepered by�prafeesionel e�ineer
<br /> Ucansed by the 8tate pt Flo�da.
<br /> - ff the filt matedal is to�e used!»Fload Zane A"!n cotttiec!lort wlth e parmtktaQ bulklln� ustng starr�walt
<br /> ct,ns#ructian,t cer#iy tha#Rlt wtlt be qand anlp it�flil ttse area wtfhln fh$atem watC.
<br /> - If fltt mated�l ie to be ueed In any arsa, l c�r�ty that uee cF auch flll will nqi adver�ely aftect aoljacant '
<br /> proper�as, N use of fll�Is tcund to adv�realy alf�ct adJ�r.�n4 prape�iee,fhe owrs�r tn�y ba cltad iar vlol�flr�g
<br /> #he condl#�ns af the b�ttd{a }�atmtt I�cteti undBt#h�ait�chad pertt�tt�Rt?I�a�on,iar lats tee�then o1��('1}
<br /> ri
<br /> acra which ar�e(evaEdd bY i,an enginesrsd dratnage plen ia required,
<br /> i�t sht the Ap�NI'T FOR TH�OWNER,1 promlem Ih good fehh to Infotm th�owner at'the p+armlldt�pondltian�set farG►In
<br /> this affldavlt pr3ar tc witfiner�cl�construcHan. i urtderetand thet e separpte p�rmlt may be rsqu#rad fa�sSect��1 nvork,
<br /> plumbir�,signs,w�ti$,paate,air canditianir�g,g��,ar other irrsie�lla8ans nat speGlflcaify lrxcluded ln the ap�pcetlon, A
<br /> perrrrit Issued sha0 bs canstruad ta be a lic�nse b procead with ihe work end not e8 eutharity to vtolate,cancet,elter,or
<br /> set a61tlk►�nY provlalon8�Of the�eahri4Cai tx�d9s,nor�he#f fesua�e of a perrn3t prevant the Butldls�g O�Ic�si fiam t#�ereafter
<br /> requ4ring a camtc�cn of errors in pl�ns,c�ts�trttcl�on or vlcEatior�a cf any ccd�s. Every p$rrrttt is�ued sttalt becAme inuelld
<br /> unlese tha wark�qt�orizad by auch permlt le commenceql withln elx manthe�of permlt issuunce,or If work euthortzed by
<br /> the parmtk 1c auspend�d or�bandaned tar a p�rtad of elx(8}months eRer!he Ume the work!e commartosd, An a�ermlan
<br /> may be requesfed,ln writin�,#rom the 8ultdtn�atftcte�fcr a 1�ds�nct ta e�eed nit�ety{80y days�ar�witl demonattate
<br /> Jus�Beble cauee tor the exienalon. Hwork ceases for ninety(80)cqnaecuUve deys,the job Is conetdered ebandoned.
<br /> WAfiidtNQ TO OWt�i�R« YQUR FAt�,l11R�TO E2�GORD A NOt'tC�OP COMiNENCEMEN'i'lI�AY R��t1t»T I!�!YOU12
<br /> PAYINt�'tWtCE FQR tMPROVEN[�t3T8 TC YOUR PtZCp�RfiY, lF YdU[t�'�NQ TO 08'!'A1N�'INANC{Nt�,CON$i,ll.T �
<br /> Fi,QRiUAJ!lRAT .8.7 �3
<br /> 8u�ep bed�ro(o�afHrma e mo t U� 3�ur�bed aroi mtinm ta(or e x eforo t s i
<br /> ' Whn tefei6 pdtsGite�y knawn t0 me�heattmvs praduoed Whn�srero�Y k�+rn ta ar haetha�va proCUCed
<br /> �aiQertUfttA�top. , e�lslend9ceUon.
<br /> Nutary Pctylia t�tpta►YPubtIC
<br /> Can�mlalan No. Cafimiealon Nc
<br /> NartwofNolerYlyps �pN orei9nfped NeM6o1N4ttuyWpea�Pt�triOtlorot�mped
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