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<br /> �90TiC�OF���D RE�Ti81�T10[�S: The u�dersigned;.undergtand�;th�t;tht�<p�rm,tt-,may:b�.subJe.ct.to."a�ed"v�strietlons'�,�';�,..,;..�:_:.
<br /> �rhich may ti��rnot�°r.est�tctive:th��Coun@�`:�g�latCoeis: �The underslgned�s�sura�es�'re�pDn�itillttq'.for"`d;o�npii�r�ce�v�ith ariy�' �� `
<br /> �ppNcable deed res4�lctlons. ..... .,.�; �._..� .� � _ _ ,._ .... _ .....� ,.,. �� :�. ,. _
<br /> �1BdLICEN3E��'CONTRl1CT�R� AND CON�RACTOfd��IESPON�I�ILITIES: �=1��t�ae���wner h�s�°hiretl�a"conttactar or
<br /> coni�actors to underta8ce work, they may,,be:?re�gulred.�te��be�Ilcensed.In;�ccoPdanc�.writh sta4e_andalocal,regula4lons:��If-the-�� � �•�
<br /> .�x . . . ,� :;4._..,,.
<br /> contracto� Is�not lice�iseii'a�s�eequlcedAtiy law, botfr the �wr9er_�nd contr�ctor��may be clted°for�a�anisdeme�nor violatton
<br /> ., .
<br /> und�r state law. If the owner ar int�nded?;contracto,r�aPe_,uncer��ln ��to wrhaC Il�n�ing.r�qul�m�nts„an�y:.apply:�for•:4h�����>• � �� �
<br /> ... ,. ._,...___....,:....,.�....u......, <
<br /> int�nded iniork, they ar��ddised 4o contac4'th�_Pa�co County�ulldln�.Jnspection_,Drvi�Ior�-Licen�ing Sectton et 727-847-
<br /> �OOg. FurQti�rmoPe, if the owner tias"hir�d a cooit�ac�or`o� contea�ctors� he is �dvis�d to h�ve:th� contr�ctor(s), �ign _ _.
<br /> �-��:..-,,.s.._,.,; �,. ,
<br /> portlons of.the "contrector �lock° of.this_application.f.or which..th�y.wiilt...b�-r.�spor9slbl�.-.:If..--you;��s�:�he own'�c�Ign�^�s the"' ' '
<br /> contractor, �hat inay`be an Indication that"he is�not.prop�rly licen��d'and"is�n'ot�e�tit�ed Qo p�rr�iitting�priiiileg�s In Pasco ,. , �
<br /> County. • ; ;-�;�_ .;,::.
<br /> 'P���POItT�T10N;IIlAPACTIUTILITIE�=I�l1��4C't'�At�b�RE30URCE RECOd@t81f�FEE3:'�The und��lgned�understands
<br /> ��a�?Ta�FE�p�1�.��9�5! alY1p^e,e:� F����il�.l�$9d�.���.l3��4��.F��s:rs����:���9y���:��e;c��ao!tr�:���,��s�ew�,.��l9d6r,�y.,��h�����:��i��. ...�, ,.,
<br /> use in ��isting bulldings; or:�exp�r�'si�cr��of-Sezistin�g;1buildings, �s speclfl�d.in Pas� Coun4y O�din�nc� number�9-07.and,
<br /> 90-07, as amended.:,:Th� undersigned �Iso,.urtderstai�ads� that_'such f�es;;:�s,en�y:ti��ryd��„wllitbe Ed��tified at the�tiirne�of�� • �
<br /> ' p�rrr�itting. It Is furtFaer und�rstood that Tran�po�tation I�npact F��s ancf°�R�aour:c�,,Recou�ry�F��s..mu�t be p�id prior.to
<br /> . receRving-a'c��Ei�cate of occupancy"�orflnal�-.power;,r�l�ase: �:I��the.p�ojec�:;.does�;�iot involve>ja�.:cerQifio�te of occupancy°or-���-'�• � �
<br /> ,._�., .
<br /> �inal power rele�se;.the.fe�s.mu�f"be�p�Ed;pclor to.,permit Is�uan�. ,Fu��eranore;�:-if:Pasco,Coun@y��INat�r/S�wec=:lr�pact ��� ��
<br /> feesaredue,.they,rnyst�be;,pald;.p�lor..to,.p.ermid:I�syance�:Ir�.accoctlanc�.ailth.applloatile.P�sco'�Coun�"ordin�nces. •
<br /> ��id3TF3U�T1�N°LIEN'�LdW(Ch�ptee�713� Florlda�t�tute�,��rn�rad�d): i�v�luatlon of work is�2,500.00;or anor�,-I,� � .
<br /> �.,,
<br /> certify th�t I, th�. �pplicant, have -been prgvtde� wtth-�>copy� og�th�-"Elorida-�Construction:_Lien :L�v�Homeowne�'s
<br /> Protection Guide" prep�r�d by tNe FloFid� D�partment of AgrEc.ulture and Con�umer�Affairs. If the applicant E� someone- .
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<br /> other than the�own�r", I eertlfy_that_:I;;have::obt�lned�a��py.of:�he.�bpye::descritied::docui�ent�and�p�omis.ein,ggod"faiQh•to
<br /> deliver it to.the:`othrne`c":p"rior`to c�rnmencement:``' ' � � � � ' • .
<br /> ��WTRACTO�d'S/0lAI�IER'�AFFID�►VIY: I.cerflfy::th�t�:�lf.th�,i�forrn�ti�n:.in�tht�applicatlon is accur�te and that all EnraPk
<br /> �rill'be done in cumplfance w(th �il appllc�bfe Vaws regula�ing consQructlon� zon(ng �nd�land���d�delopment. Appl6catlon is
<br /> hereby made„to� obtatn..� peemit�Co,;do...;woek,:;and�lns�iallatlon as ir�dicafed:•�-�'1� certify that no woPk�or Installafton fias
<br /> commenced pPior to Issuara� of a p�rmit��and that�.aEl work will b� p�rtormed to m�et:standards�•of all Oaws regula�ing�
<br /> construction, County and City codes, zoning r�gula4PQns, and land dev�iopm�nt r�gulations��in 4he .jurisdiction.- i��0'so
<br /> certlfy th�t I underst�nd that the Pegulations of o�her gov�rnment�g�ncies may��pply:to th�..int�nd�d work, �nd th�t 3t is
<br /> my responsibEloty`to ident6fy�what.�ctions!must•take_:to,be,Fin:,complianc�;yS,.uch.,agencl�s-include`but=are.not @fmited to:
<br /> - Department oi E�vlPonmental'`'Protection=Cyp�e�s�Bayhe�d�, VUeNand Are�� and Environrnentally sensittv�
<br /> Lands,WaterMl�stew�ter Tre�tment.
<br /> - Soufhwest Floe3da W�,ter I�lanagemer�t-�.DIst�6cQ-lNell�;' (:ypres.s.A+��yheads;� W�Qfand Ar�as, Altering
<br /> Vl4��ercourses. � � •
<br /> � Arr�y Corps of Engin�ers-Seawalls,`Docks, ��vigable Ws,terways.
<br /> - Department of„Health:,.�.:,Reh�bllitative..ServiceslE�vii�n�nenlalrt-He�it�i Unit=Well.s; l�Iastewat�ra Treatm�nt,
<br /> Septic��'a�ks.. ' - .
<br /> - t1S Environm�nt�l Prot�ctlon�►g�n�y-Asb�stms abatement..
<br /> F�d�ral�Avlatlon.�Authorlty-;Runwr�ys. �
<br /> o und�rst�nd that the,:folloviiing;�esQrlcttons�pply'to the use of flll:•
<br /> - lDse of fill is not�Ilowred In:Flood��one"14"un0ess expresaly p�rmltted.
<br /> - !f 4h�:�flil- materiaf is to b.e used,:`In.�Floo�-Zon�. "A°, !t. is understood`th�t a drain�g� plan addressing a
<br /> °comp�nsattng �olume° �nrill be subr�itted aQ tim� of;peennif�ing wFiich �� pr�par�d by a profession�l er�gin�er
<br /> Ilc�nsed by,the St�te qf floMda: - � . �
<br /> - Of th� flll�mat�Pial�(s to be used In Flood Zon� 'A° in�c�nriection�dvlth:a permitt�d buildEng using sterpo wall ,
<br /> � cons4ruction., i c�r�ify that fill�i�iD�b.e-used only.to.f111 the-�rea wtthtn th���4em�eva91. .
<br /> - if fiill m���rlaf ts to be used in �ny ares; I ce�dffy t�at .us�. of'such�f�ll wrllE not �dvers�ly �ff�ct adJacent
<br /> pPop�r�les. .If u��.,of.flll is found�4o adv.e�sely:��fect adJ�cent�propertie�,.the owner may b� cited foP viofating
<br /> Qh� eondl#ion�,;of Qhe building;permlt;i�su�'d�und�r the.�E�ached:permi@..�ppltcatlon;°for:9ot��.less�than.one (1)
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<br /> acve wNicti are�O�vated�tiy flll��n�ngine�r�d draln�g�plan ts required.
<br /> 1�i am dh�:AGEfd�FOR TH��OIMNER, I;prom`ise In,good falth to inform the o�nrner of•the_pePrnitting condEtlons set forth in
<br /> 8his afQidavit'prior to commencing cons4ruction. I underafarad th�t�a:���parate perrrelt m�y be requtr�d for�lectrical.work,
<br /> �r�.,..,,
<br /> plumbing;:.signs� wells,<pools;. alr conditioning,-.gas,-.qr_othee 6nsta9l�tlon� noE.spec�ically included�in 4he applie�tion. .A
<br /> per�o�lt Issued shall be constr�ed Qo be��a'Itcense`40=proca�d with�-the�vyork and,no.t as::a�athodty:.to:violate.�:cancel; alter, or ,
<br /> s�Q aside�ny provisdores�the.technical.c,�des;:nor shall Issu�nce�of a.p�rmit.pr�ve�rt the Bulidirig OSiicial from�hereafter
<br /> �; . .
<br /> req�airing a.corcection nf e�rors=ln�plans; conatructlon.or,violation�of•�ny codes. .�v�r�►��p�rmft`Isaued sl�all�become invalid
<br /> unless the work�uBhor(zed.by such pg�anll:�Is.connr�n�nced•withln sia�..an,�nths bf p�rmOt Issuanc�, or tf vvork authorized by
<br /> the�perrnit i�suspended�or;abando��d�-f.or.a;p�riod tof�six�;��)�montt�s.�f��r the,tlme the�wotk�i�commenced. An�xtenslon
<br /> , . , . . �. .._
<br /> may b� requ�sted,_!n wri#In�;�;f�om.tFie.�uilding,Offici�l for a p�r(od::root to �xce�d��ninety�(90)=d�ys �nd-virili'demonstrate
<br /> •justifia6le:caus�for.�Qhe extens�on�. If woPk,ceases:for nin�t�.�90)cons.ecutive•day.sr..th�Job�is co�side�ed aba�doned.
<br />, 1l��RR11�IG `f0 01NIdERc YOUR.;�AILWRE,�Ta,REC.O�tL1;A,�40TiGl�::�F;�COnAMENCE�VIEi�T;:�AYTRESULT�IIV�-YOIJR
<br /> B�t�1PING TWI,.C,E;�OR:IIIIiaPl30�'IE{1AEN�S�.T�;fY�D.lJE3�::P,;1�Off�ER+i•Y:'•�S�r:l(O.EI�Ik1�'�'END:�TO��OBTAIPO�iF1I�it�F:f1e1G;°CORISULT
<br /> '�91TH YAUR�L�END�R OR AN�A7TORPI(��FOQt�}t��O�11���Y�IIf��IAtOT1�E`��F�'�AMII�ENC�� ��T' .,h .
<br /> FLORIDA JURAT�(F�S:1.17:03)„ �. .'�° . . , . ,_ , , _ �
<br /> OtMP1ER OR A(3EtdT . Cf�NTRACTOPt`�: .% � '
<br /> Subscrlbed and awom to(or afl9rmed)betor�m�fhl� Subscribed arad'�worn to(ot atfl►medpbefore me'QtilA.-
<br /> I by .by , .v _:. ... -; ,
<br />' Who Is/are pe�sonelly known to.me or h��lhave pr!red�?aed_ Whe.ls/are p,er�on�lly�nowr�;to..me�oe ha�/hav�:produced • -. -
<br /> � ' a�id`entlflcatlon. " as Idantlflcatlorr.
<br /> Notary Public . tdotary Public
<br /> Commisslon No:'� Com�Isslon.Noo_ �
<br /> fVame of Notary typed,printed or s@amped idartse of Notary 4yped,printed or�B�mped
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