. � , y
<br /> i��t'TI�E OF DE�Q R�STRIC'6'IOA��: Ttte u�d�rslgned��det�tands°;t��t.th6�.np�tmit.may.b�,sub}ecf to"d�ed"r�s#r�attons"
<br /> which may be=more-rest�ict(ve.�tha�Coun�'��gulafions: �Tiie ainder�igr�ed�as'sumes=r�sponsitilitty forcomplla�nce wlth a�iy
<br /> �pplicable deed r�s�Clatlons.
<br /> UML��ENSED CAN'�'RAC'�'URS t4ND CANT�►�7'AR R����1N��B��:i�'8��i: If-ffie owner has �hired a contractor or
<br /> co�traetars to saa�dertake wark, Qhey m�y be;c�quire:d.�to-;be--1lcens�d !n a�cordanc�.with �#ate.and�local regulations. If the
<br /> contr�cioc ts not t�censed as�r�quit�ed`by I�w� batt� the owraer and cc�ntr�ctorRmajr b��clted for a-m€sderne�n�r vloi�tion
<br /> under st�te law. If the owne�or Intended=;co,ntr�ctor-�ere �ancertaln as to wha� Ilcensing.requlrean�nts,anay::apply•for the
<br /> intended work�they are advised to+contact the 4��sca County��Ila!!ng Insp�ct4on Dtvlslon--Licensing S�ation a$72?-847-
<br /> �Oq9. Furthetmore, if the owner has tilted a caniractor or contractors, he is advised to have t�� canUactor(s) sign
<br /> pmrtions af the "contractor 81ock° af this application far vehich they w►ill be re�pon�lbl�. .If.you, a�s.Qhe� awne�`'sign'�i�� 41ie
<br /> caa�tr�ctcar, that may be an Indicatio� thaQ he=1s na#.�r�perly 61c�ns�� at�d��s not�nt�tEed to per�itittih� pr�r}leg�� 1� P�sc�
<br /> Caunty. '
<br /> YRAN�F�CIRT�►TION�IAApie►�C7/U'P��:�TIESrIMPdC�'APIb RE��URCE REC�V�RY•IFEES; The undera0gt�ed unde�sta�ds
<br /> tt�at Tran�porta#ian �mpa�t F�s a�►d.Reao.ut�e Recave.ry.Fee�anay`:appiy:tc�the can�#ruc#tc�r�af nev�r buildings,�chang�-of
<br /> use Ira existing bulidings, or;expa�sion>af,5�ii1�#in,g'=buildings, �s speclfied.in P'asco County Ordinance raumb�r�9-Q7 and
<br /> 90-�7. a� �mend�d., The underslgn�d �Iso-urtd�es#and�; ti�����such fees��.,a�,�na�b�•du�,t.w11F:=6e ident�i�d at t�e�t�t��°of•
<br /> pero�r�ittlng. It i� furtlier understo�d that Tra��por�at9on lmpac4 F��s �nd Rescaurce R�covery4Fees must be p�id prlor to
<br /> reaetvia�g a"cetf�icaQe.of occup�ncy" or flnaF�power.cele��e. :1�=tl�e.pco��ct.�oes no�inv�lve;:a=.ceetl�cate of cscc�p�ncy or
<br /> �nat �avwer rete�s�,.the#��s mu�t�e padd priar.tm permit I�suaroce. Fu�Eher�nore;df:Pasco C.ounty VVaterlSeuwer I�rrepact
<br /> fees are due,.-they.must be-paid.prior to permit�issyanca-in aecorda�nce wlth�appllcable Pasao'�County ordinanc�s. �
<br /> C�MS'�'t�OJCTi�D�t'Lf�N EAVH'{�1iap�er T�3s FI+�NdBt S#8itl1����81��trt�t9d��}: 1f valua,�on+crf�n+Qrk is�2�500.00 ar trcor�, 1
<br /> cecRify that I, #he applicant, hav�•been .provid�d wiah a r�py of 4he "Flor3da Constructton Lien Latn�Hameawner's
<br /> Prot�ction G�id�" prepared by the Fl�clda Qep��tme�nt�o�P�gric.uit�r� and G���umer�lrs. If#he applic�nt is som�ane
<br /> other @ha�the"awne�°, 1 certify tha�i�h�ve.�bta6ned��capy,of.th�:above..de�crlbed dacument-and.proml��in,gpod�aiQh to
<br /> deliver!�to the"�avvne�'�prio�to•cor�nrence�nent: �
<br /> COOdTl�CT�R'�I��fitWER'�J�►��IDAY11': 1.certi[y.that=a�t.the�l�forartiatlt�n 1�thi�s�plica�ton is ac�urat��nd that all w►�rk
<br /> will'b� dc�ne in compliance �vith �II.applicable law� regul�ting construction� z��ing and land developm�r�t. AppEicat�mn ts
<br /> hereby anade to abt�in .a permit to d� work:,�nd in�talla#io� a� {ndt�eted;. 't c�rtifjr that no waric�c�r Ins�l�a�tor� has
<br /> comrrr�nced prio� to Issuan�e oi � permit and that.alt work wiil b� pertormed to m�et standards of all 9aw� Pegaa6ating�
<br /> con�tructlon, Caunty and City cod�s, zaanirag regulattans4 and land devel�p�nenQ c�gc�lakt�a�s�fn the �uri�diction, I al'sa
<br /> ce��ity $ha� 1 uc�dee�#��ad th�t the r�guAations of ather gmv�rrtm�nt agencie� m�y�apply�to the int�nded work, and that it 6s
<br /> my resp�nsibiliky to id�ntify.wh�t,a�4��n�I musk�Q�ke:M bedn:.a.:�mpllar�ce. S.uch agencl�s Include but-ar�.not IPmited 40:
<br /> - D�partm�n# of E�lvironmental�Rrotecti��-GYPres�.���yt�ead�� tt�letland Area�s and Enviroranr�entally Se�s6tive
<br /> Lands,We�tedWastewa��r Tr�atment.
<br /> - So�athwg�t Florid� Water I�1a�aag�ment: .i�istrict Vlteils, Cypr�ss...Bay��sds; Wettand Areas, Atter3ng
<br /> NVaterco�rse�.
<br /> - Arany Corps of Engineers-Seawralls, Docks� Navigabl�Water�ray�,
<br /> - �ep�rtm��t af Flea�th � f�etaabilit�tive Seivlces�E�vOronrpaentat �lealth Un€t�tt�lls, 1dNast��rater Treatment,
<br /> Septic Tan1c�.
<br /> - 41S�nvirot�mental Prot�aU�n E�►gency Asb��to��b�tement. �
<br /> � Federal Avi�tton.Author04y�ur�ways.
<br /> I und�Pstand th2�t the fallowing.resiricQions�pply to th�use of flil:•
<br /> - U�e c�f fiEl l�not aElowed�n Fload:�or�e"10"ur�le�s expr�ss�y permift�d.
<br /> - If th� �ill mat�Pial Is to be usetl. irr �Fload �on�a. "A", (t is under�tood that � drair�age plan addressing a
<br /> "compensating volumep w�l1 be �ubr�lt�ed at#ime��per•.mlftOr�g�hl�t� is prepared by � prt�fe�slona! ec�gin�er
<br /> iicen�ed by#he S#�te of'�iorlda.
<br /> - If ih� fill materi�l Is to be �sed in �Ivod Zon� "Afl In�conn�c�ion�wlth�a���rmitted bc�ildlr�g using stem waH
<br /> cor�s#ruc#ion, l ce�tify th.�f fill:wJt1_b�used on0y.�a flil th�ar�a onrith6�th��stetvy�wa18.
<br /> - If fill mat�rlal (s to be used In �rty e�re�, I �cert9fy #h+at .use. of s�ch flll will re�t �dvers�ly a�fect adj�cent
<br /> properttes. f�use of flli is#�t�nd to �dversialy:�ffec#adja�nt�proper�les,.#h��wner may be ci�ed for u�ofiating
<br /> the condlQ9ons of the bwiYding,permit i�sued under the �t�a�hed �rmtt applica�tlon, far:lots (ess than.or�e (1)
<br /> acre which are elevated�by flll,a�engir�eered dr�lroage pl�n i�req�alred.
<br /> If�am#F�e�GEN'�'�Ctl�'THE O�P➢�R, f,promdse In good faith to ir�for�n fihe awr�er af#he perrriitting conditions s�t fa�rQh In
<br /> this �af�idavtk�pNor to ccrmmencing canshuction. I understand 4hat a-s�parate permit may be requtred for elect�ical wrork,
<br /> plur�btng, slgns, wells,.p��ots,_a1r conditic+ning,.��s� ar oQher I�s�al0�ti��ts nok spec�'f�ally inciuded�i� ti�e apptic�tion. .A
<br /> pe�mit lssued shaii be corrstn�ed 4ea�e a�Ilcense to-prcace�d�rith the work and not as.auth�rity to,violate, canc�l, alker, or
<br /> set aside a�ry pPauistons of the.#echnlcal cc�d�s; rr�r shall Issuance��f a.permft.prevent t��6�ultdirig O#�Ic3a�i irom therea�ter
<br /> reqt�lri�g�car�ection af er�or�ir�pt�ns, car�stru�tion or violations a�f any cod�a, �very pemnit issued�hai9 become invalid
<br /> unless th� work auiharized by such permit.�ds��o�m�nced•wlthOn sIX months aY'p�rmit laauar�ce, �r if work auth�rized by
<br /> th�p��mi4 is susp�nded or.abar�doned-for a:perlod of���C�fB}mor�tF�s.��ter th�#1�n�#he�rnro��t�camm�n�ed. An exte���on
<br /> m�y be r�quested, In w�itlrig, f�om the Bt�llding,�3fficia�l for� p�rlod�not to ettceed nir�ty�(90) days ai�d vvili demonstraQe
<br /> �ust�iab��c�use for tl�e extens�lo�: If work cease�.f�r ni�ety.�90}cons.ecutiv�:days...the�ob�is considered aba�doned.
<br /> IRlARNING TO O{lVNEiR: YC�dil�.�,�I�WRE�TO,R�C.C��tD �1.MO�"MGE�:OF��CONIMEMCEN9�I�T_NG�1Y R�SUl:T 1!d YC�UR
<br /> PAY�NG't'1MICE����BM�C)VEME�4TS�T0 YE'�tUI�.P1t't�P��TTt�. IF°Y���11�'�E�ID�TQ���'�''i�IN���l�AR�CIMG;'C�NStt9�.T
<br /> 11�l�' Y U E. � � �1, T`i'O N � CDR '�, E�- � 1�:� At� ' : ;C :. . _,., . � �
<br /> _.. . _ _ "
<br /> FLORlRP�JURA��{F,S.t17.03) � -_- - -- _--— _— _ _
<br /> 01f��Ft OR AOEN1� GOPd'P'RAC'TOI�
<br /> Subsalbed and swom to(or��lrmed)before me this Subsal6ed and'�wom to{ot�fflrmed}�bsfors me ttif8
<br /> �' •�yY
<br /> Who Is/are personally knowm ko.me or has/have produced Who.ls/�re p.eraonallykno�rn�to me orfies/hav��praduced �
<br /> as IdentlBc�tlpn. �s(denB�caticn.
<br /> Notary Pabllc . Notary PubHc
<br /> Commisslon No: Comrnlssion.No.
<br /> Nam�oP No@�ry typed,printed or stamped Pd�me oi Plotary ryped,prinNad or�tamped
<br />
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