|
M0710E OP�EED RESTOtICTION3: The u�dersl8�e�lyunderstands�st�8t ihls;p�tmlf��itay_be:subaectzto,'aeea"„[estr)ctloti's"° ,- :.-,_
<br /> , ' which mey;tie�riiore-'tesUrictWe�tha�t Goti�ty�regr�latCons.-"The undei'slgned��esaumes responsibittty tor comptlaAc�i uvitti any
<br /> applicab�e.deed re�Mctlons. "� - , - •> � . , �._. �..
<br /> UNLICENSELI�GONTRAGTOR3•ANd�COFiTRAG"FOI2�RE$PONSIBICITIE$: •�li'the-owner fias hlre�t�a`contracMr or
<br /> conUactors to undertake work;#iey_m'ayb�_r,equired=to.tie�(kensed in_aa�rdartce;wtth state.and�locai regulationsb��It�the= �
<br /> coMractor 7s riot ltoen'sed as�te�atied`by taw,bottr the owner and aonirector mey be c(tc�d'for a�irtisd�meanor vtolatlon
<br /> under stete law. iC the owner or tntendedrA�;►Mractor a,re.uncertaln as to what Itcenatng reyuiremeMs;mayaa{�pty�.for:tFie'�-•�• �"
<br /> intended worR,they are advised to contsct fhe_Pasco County Buildtng tnspectign Cf(vistotr�„t.icenstng SecUon.et 727-847-
<br /> gopg. Furtherrnare, ff tt►e vwner lias`hired a cotii�ctar or contractots, he is advtaed to have ifie coniractor(s),_stgn. _.
<br /> ,�-..,..�. .
<br /> portians af the°contrector.Block"of thle.eppitc:stton..forwhich.they:wilt:be,_�esponsibte.�-if,.you,,as,Y.the irit'nie%"stgri:as tfie` ,
<br /> co�t�ctor,Uiet-inay'be�an ini![c�ttan theYlie`3s nbt'{�rbparSy'fl�nsed`and`is`"rtot enti�ed`to peririiEt#ng pririiiegea tn Fasca
<br /> County. ; _ . . .. . ,��,.. :
<br /> 'FRANSPOR7'ATit}N.fMPAGTNTil:i�lES�(MRAt,'°1�ANb-R�$E?k}l2CE RECOVERY fEES:-��te undetsighed understands
<br /> thatTrarisporkaUon Impact Pe�s:and.Recourae i2ecoy.ery_Fees ttia'y,asPAh►-ta�the;conatructton.at nqrnt.buAdings,�ahan�e�of'�'' °-� '�
<br /> ase In ezt"sNng bultdings,or.:azpa�tslo�of���',bullfttngs.a§specifted.in Pascq Gnanty O�"dinance number 89-07 and,
<br /> 90-07.as emended�.;The underslgned also�uriderstattds:tti�tstsch tee#:,as:may;;�s�dne.Gwfik;�ie lderitlfEed at the='tiiiie•of-}. , '
<br /> germiritng. It is tu'r'ttier understooi!that Ttan�pottaUor�impact Fees atiit`�ftesaurce.�tecove�i=Fess.musf be pafd prEor to
<br /> recetving a'cediElcate•ofo�upanr�y'orBnal;poNrer>releaeer;..=f�tttB:Ptol�ctdoesirioGtnvolveia�certNicete of occnpan�r.:or;:':,. ;.
<br /> Ma!power.release;_t4�e;tees<mn9k��tie�pal@;pitor.-torpe�mlk Iss4ienca. F}e{xthannare;IE.Pasco::Gounty��Vl►ateNSewer�{lmpact� : �
<br /> fees are due,.theX;�nusl.be;qald:p'itor�to.perm{Fflssyan�e�.ln.accorcla�ce witli,ap�tr'�6le:Pasco�.Cauntji-'osdlnsnces. �
<br /> CONSTRIICTICIN'CIEN'LAllV'(Cli"epte�713i E[O�de'�t8ltite3��E elRe[tded): !f Y81U8@OA o1 WOTk is 34'2�500.OQzdT',1it0T8�,;� ,:• , ..
<br /> certlfy tNak-I, lhe-appltcent,-harre;been provlded��with a-coFy':of;xhe:'Etod"da Conafiictton�Llen.lav�--�ktarneowner's
<br /> Protectlon Gulde'prepared by.tlie Flo�lda D�pertment:of Agrlc�lture and Gonsum�arAfl'alt�. 4f the app!lcant is someane. �
<br /> other than the'owner"t I certlty-Uuat_l�ha+re.!vbta�ne"c]�a''qiiPY oGthe;abQve:desall�ecl;slocii�nant-and`;p�mise:iri,9pod:telkh•to .. .,
<br /> ,- - „ ,�,r�...:.. :. ,,.. _�,... . _ ... , -,.,-
<br /> deliver it to`the'a+nine�?;piionsto�comrtie�me�iR `: ..: r :,, -,.,<.� . .�.•... . _ .
<br /> CON7RACTOR"810YVNER'S AFFIDAYIT: l cei�4ty�tkSakalt the+,informatlon�l�th{�appliaatlon is accurate.and that aii wark
<br /> will'be done 1n compllance wNh a1l.appUcable laws reguledng con$truc8on,zpntng a»d,las�d=devettiprnent. Applfcatlqn is
<br /> hereby made ta obteln;;a.pennik.tQ FdofvKof�r�and Fll�st�lladnn as (nidlCeted:�:-1°c�%itfjr tha# rm work�or.lnstailatton tias
<br /> .�;...
<br /> commenced prid�to issuance of a permif af�d that`all work w!!I be performed�to meet-standards-of a!!laws�egulating�
<br /> conatrucUon, Counq�and Cily codes, zoNng regulaHans, and land development�egulaflons=ln lfie,jurisdlctton. l�:ai'so•
<br /> cerdty thei i under�tand thet lhe regulaHons of athergovemment egencfes may�app{y�to the intended-wark,and thai It Is
<br /> my responslbllily ta Identity•what.actlons I muatt+�ke�o bedn c�omlpllance:.Such.agenclss inc{�de�buf=are.not Iimited to:
<br /> - Depsrtment ol Etrvironmental=�PrutectlorrGyipiess.'Baytiead�;We@and l#reas and�Env(ronmentally Sensitive
<br /> Lands,WatedWastewaterTreatment. i
<br /> - Southwest Plorida Water Managementi; blstricRWells; Cypress r�Bayl�eads; Wstland' Areas, Altedng
<br /> Wa#ercourses.
<br /> - Army Carps of EngtneersSeawalls,Docks j Navtgatile Waterways.
<br /> - Deparkmant af,Heaith•8 Rehabili#atiqa,Selnrices/Er�vironmenfal.Health lintt Wells;:Vllastev�ratac�Trsatment;
<br /> Septtc-'Fafi�ti�:` -� = ` � ° ' �
<br /> - US Ernrironmentet ProtecUon Agency-Asbe§#os abateme.nt. �
<br /> Federa!Aqlet[onAuthority;Runways: �
<br /> 1 anderstand that t�e.foitrtwlrig,fesirl�ttnris appty to Uie use of flll:• f
<br /> - Use af f�ii Is no#allowed in'Flpo��Tone M untess expressiy permftted. �
<br /> - If the.fllY materiat is ta`ti`s useit,fn:ffaod Zone.'A`, it ts undatstbod that a dratnage pten addressing a I
<br /> °compe€�ssting volume*wiA be submitted�t#ime of�pe�rnttting wi�ioh ts ptepared by a profesatonai englneer y
<br /> UceRssd by the Stete of Ficttila: j ' �
<br /> - !f th�fl!! material-ls'to 6e•used in Ftood Z.one'A"ir�cannection•wtth-a permitted buitding using stem waii
<br /> ' constru�Uo�,l c��tfyr thst�ll�:i�r]lt:he:used aNy.to flli the ar.�a withtn:the�stem wa1i: ;
<br /> - If fill materia! ts to be use�#=1ii�:enjt area,,i�aertlfy tha# uae of�su�h�flii wtii not adveraely affect adjacent 4
<br /> ' propertles. !#use:of flll!ai fuunc�.to advers��y,�ffect�i+djacent=properNes,.the owrter may bs cfted for.vioiaUng f
<br /> � the cond!#lons,iiiF>lk�e balliling:permft is'stied uttder ttse'aEtactted�ermtt 8pptkaUon;for.tots�ess Uian.one(1) �
<br /> acre whtali are elevaEed�by'.ft!!;���nglrteered dratnage plan Is required. . }
<br /> If 1 am the AaENT FOR,TM�OMMt�IER;({P�mise In_gadd talth to fettorm#he owner of-the'pemiitting caridi�o�s set forth i� +
<br /> thfs aHidevit pNor to co'mmencing conadvct4on. "I urideiis[ei'id lhet a�s�parate pemtlt may be requlred for electrtcat wark, $
<br /> piumb�ng, aigns,wells,.pools,alr.candlUoning,.gasx,or:Eottte�Instel�tloris naE.specJlic�ily Induded�in.the appifcatlon. :A }
<br /> permlt issued'shail be consUued to'fie~'a'ltcenae`�to piaceed with ttie vuo�k.and not ss:aukho�[tyrto vlolat�iY'caiicei,atter,or j
<br /> set aside ei�y�provlslons of tTie.tec�iNcal ycode�;nor ahall lasuence�of a.pecmlk.pcevent the Bulldirig Qlfide!irom thereafter j
<br /> requiring a.correction a�f,-errors,lm,pians,constFuctlon.or vloladons ofany codea:-�verypermlt-issue+d=st►a11-tie%ome�invaiid 4
<br /> unless ihe worlc autFiorized:by such permft:�ls.commenced�wilhtn shc,,menfhs af permlt lesuance,or!t work autho�lzed by �
<br /> the permN Is suspended;o�:a6ando�ed;.fo�a;PeHad ot sUe(E#)�monttis.efteir,ttre Nme the�wotk�s commence�l. An e�denslon
<br /> may be requested,tn writlrig;�from.tHe;Builaing,(3Hicial for a perlod=not.to ext�eefi,nliiety-(90)�days sad wql demonstrate �
<br /> just�iabier'c�ause for:�the extenaion. if worlc ceases.for nlne#y.(90)cons.ecutive days,,th\�ob�ta considered abandoned. �
<br /> WARNtNG Td OWNER: YQUR�FAILURE.Ttl.RECQROl.A;.t+lQ't�CE�pR:COMM6filGEMENfT•MAY=RESULT IN YOUR �
<br /> PAYING TWtC,E;FOR;IMI,'ROxv':��r�rs:.�a%xowr�:�i�erR���ruir:�:14�.Y.OU?ti!F7ENIDr�TO'YJB°FA#N�F1MifiN�iN�;�OIVSUL7
<br /> . " . ' d ' . :. p � . � . �
<br /> . ; ..
<br /> _
<br /> "'la. � ..4 ,,..i�_:u...��,�.. }...::... ..........~__ ` . • •. ��
<br /> FLORIL1AJUftAi'�(P�ttt.43j . ' .'�I
<br /> QWNERORAOENY � -- iCONlRAGFqR :, = �
<br /> Subaaibed mui ewom to(or aiRaned)betoro me tlda 43ubaalbed'andawom�lo(ot aHirtn�6dfore me tlNA
<br /> ey ,�y .. . , �:
<br /> Who Isfaro pe[sor�ally losawn to.me or:heslt�ue prodsiced aWho.tatare pelnonatiyknrnm:tama.octfaafiaveprodi�ced ,
<br /> " e�Identlllda6on. entlfi n. �
<br /> . � � �
<br /> �
<br /> Notary PubAc Notery FubUc �
<br /> CAmmbston No:` GommbsianNo. �
<br /> ;
<br /> Vame ot M1iotary iyped,printed or atamped Neme ot Notary lyped,pdrted or alamp
<br /> E
<br /> r
<br /> N
<br /> � �
<br /> . �
<br /> --
<br /> ...__ _.. ��_�:�_�_..--�---�_'=--�..��_�„__.. --
<br />
|