N��'IC� 0� �I��� ���TF3ICYIOV�S: Y'he und�r�ign�d und�rs4ands th�t 4his permit may��subj�ct�o"deed°rc�stric�ion�"
<br /> wktic�may b�more r€��trictiv�th�n Cgunty regui�tlon�. Th� unders{gned as�urr�es res��nsibility€or cornpliance wi4h any
<br /> a�p3icab{e deed r�strictions.
<br /> �!�l�B��6���� ���lT�4�'�'��� �6�� ���4°����'d�R ���P�C��p�l�.tY���: If �he owner h�s hir�d a c�n4ractor or
<br /> con�r��tor��o t�nd�r�he wor�c, �hey may�� r�qt��red � f�e IEc�an��d in accardance w�th s�a4�and ioc�l re�ul�fi#ons. If�ne
<br /> c�ntrac#ar is nat ffc�nsed as required by lav►r, both th� ovuner and contractor may b� cited for a misd�meanar viol�fiion
<br /> u�der s4ate iaw. If th�uwn�r or int�nd�d ccn�ractor arc� ur�cer��in as ta what licensing fequiremt�n� may appiy fior the
<br /> intended work, th�y are advis�d ta con#�ct the Pasca County 8uilding Inspecfiian Division6-Licensing Sec�on at 72'�-847-
<br /> �QOS. Furth�rmore, if th� ovuner has hired a confr�ctor ar cantractr�rs, he i� advised to have fhe contract�r(s) sign
<br /> por�ons of�#�� "`c�rttr�ctor Bloc�" of�hi� application for wh'tcf� 4h�y wlll be respon�ibl�. if you, �s �h� own�r sign �� #h�
<br /> contractor, tha� m�y be an indic�a4lon 4haf he is no� properly licor��ed and is nat enti�led ta p�rmitting privilegc�s in P�sco
<br /> Cau�fy.
<br /> �'�i�S�O�:'T�'Ti��3 Ifi�fJ��C1'/l�'�i9.i71�� 4i�id�ACT�a6��R���U�C� ���0�'�Rlf����: The und�rsign�d und�rstands
<br /> tha#�'ran�porta�ion lmpact Foes �nd Recours� Recavery F�es m�y�apply to t�� construc�i�n of ne�r bufidings, chang�ofi
<br /> ca�� i� existing buifidings, or expansior� of e�s4ing build3ngs, as sp�ci�r�d in Pasco Caunty t�rdin��ce num��r�J-07 ar�d
<br /> 9p-07, as am�ndod. The undarsigned also understands, that sueh f�ps, �s may be du�, will b� identifed a�th� time of
<br /> �ermiYfin�. It is fur#her uncfers400d t�at Teanspor��ion In�pact F�es and ��saurc� Re�ov�ry Fe�s musi be� paiat prioe�o
<br /> rec�iving a "certiicate of occupancy" or finai power reieas�. ifi th� project d��s not invoive a cefif'rcafie of occup�ncy or
<br /> fin�l power r�lease, th� fie�� musf be paid prior to p�rmit issuance. Fut#hermor�, if Pasco County Waterl8�w�r lmpac�
<br /> €��s�r�due,#h�y must be p�id prior ta permit�ssuanc�in acca�danc�wi�h applicablt�Pasca Co�anty ardinances.
<br /> ��F��TV�HJC�'l��4 E.If�� L�lfl9�C6���a�eY'�13, �'!�rl�����eo���, a� arvra�dc��: If valuation of warl�i��2,600.00 or maro, !
<br /> c�e�i�r tE�t t, the �ppticant, h�v� ��en provid�d witE� � capy of �h� "Florida Gons�rtaa�on Lien L�w—F#omeown��'s
<br /> Prot�ction Guide" prepared by the Florida Department of Agricuikure and Consumer�ffair�. tf the �pplicant i� someone
<br /> oth�r�han#he"ouvn�r", t c�rt�fy th�t! hav�obt�ined a co��ofi th� above t�escribed document and promise in good faiYh to
<br /> da3iv�r it to th�'bwner"prior�o cammenc�ment.
<br /> ��P9F6�,C'��R'3/�4�4N��°�A��IDAV�F: I c�rtify#hat all#he informatfon in thts ap�ritcattan is accurate and fihat al)wor�
<br /> wili be dano �r� comp(iance wi�h ali a�pllcable 3aws r�gufa�€ng canstruc�tlan, zonirtg and lar�d dev+�lapm�n�. Apptica�i�n is
<br /> hr�reby mado fio ob4�in a p�rmit to da wori< and in�fiaila�ion as indicafed. I cerfify fih�t no work ar ins�allation has
<br /> commenced prior to issuance of a �er�nit and tt�at all worlc will be per�ormed fo meet s2�andards af al! lauvs re�ul�ting
<br /> cor�s#ructiart, Courrfy and City cod�s, �aning r�gula�ians, �nd fand dr�v�loprnen� ragul�4iot�s in tFte jurisdiction. 1 also
<br /> c�r#ify 4hat I undarstand th�t the regulations of other aovarnment agenci�s may appiy to the intended w�rk, and th�t i4 is
<br /> my respons�bili4y to sden#��y wha#�ctians I mu�t take ta b�ir�aornpliance. 8uc�agencies inalude f�ut are no�limifed to:
<br /> - Departm�n4 �f Environmenfai Protec4lon-Cypress B�yheads, W�tland Ar�as and Environm�ni�ifiy Sensifive
<br /> Lands,WatsrNUastewater 7r�atmc�nt.
<br /> - Soufhwesfi F#c�rid� li�Ta�er Man�gement ��stric�-We(Is, Gypr�ss ��yh�ads, 1Nc�fiiand Areas, P,l#�ring
<br /> Wat�rcours�s.
<br /> - Army Gorps of Engin��rs-Sea�ral#s, �ocks, i�avigable Utfaferuuays.
<br /> - Depar�ment o� Health � Rehabilitativ� �enr(c�sl�nvirQnm�n4a[ He�(th Unit-We[Is, Was���vater Treatment,
<br /> Septic'C�nks.
<br /> - US�nvironment�f Protection Ag�ncy-Asb�st�s abatement,
<br /> - Federal Avlatian AutF�arity-Runways,
<br /> t unct�rs�and��a�t�e following res�rict�orts apply to#he use af f�ll:
<br /> - U��a o�fill is not�!low�c!tn Flood e�ane"V"unless expressly permitted.
<br /> - !f fhe �ill mat�ria! is 4o be used in Ffoad Zos�e "A°, it is undsrsto�d f�at a drainag� plan address�r►g a
<br /> "comp�n�ating valumc�" wili b� submi#f�d at time of pe�rnitting which i� pr�pared by a professionat engin�er
<br /> licensed by fihe Stafe or'Fiorida.
<br /> - !f fihe �1J ma�riai is fo b� us�d in Fl�od �car�� "A„ Jn connecfion wi#f� a p$rmiffed building �asfng s�em vua!!
<br /> cansfiruction, I cerfify that fill will be us�d only to fiili the area within the stem walt.
<br /> - !f f!! maf�rial is #o b� used in any area, ! c�r#ifiy fhat �s� of such �il wi!! nct adv�rsely a##�ct �djace�tt
<br /> proper�ias. if use af�ill is�`ound �o adverseiy a�fec� adjacenfi propsr#iss, �he owner may be cit�d Yar vialating
<br /> the condi4ions o�the building permiY issued under the att�ched permif application� far l01� less Yh�n on� (4�
<br /> �cre�r�ich a�c el�va�ed by F�il,an er�gin�ered dr��na�e plan is re�u'sr�d.
<br /> if i€�m �h����6�� Fs�R i�G� OFfi�1�1�R, I promise in good f�ith to inforrr7 the awner of the permitting conditions set fiar�h in
<br /> thi� affidavit pric►r to commencing canstructian, ! understartd �ha�a separat� permit may be r�quired gor elecfrical war�,
<br /> pltambing, signs, wr�lls, poois, air candi#ioning, gas, or othcr ins#�ilations not sp�cificaiiy inctud�d in the appiica�ion. A
<br /> permiF issued shaU b� constru�d ta be a lic�nse to proceed with the wor�and not as authority fio violatc�, cancel, alY�r, or
<br /> s��aside�ny provisions of th�technicai codes, nor shall issuance of a permi�preven�the Buitd�ng Of�cial�rom th�rea�ter
<br /> rc�qui�ing a corr�c�on of errors ir�plans, con�truc4ion or viol��ion�of any codes. Every permit iss+ued s#�all become invalid
<br /> unles� the work �uthorized by such permit is commencsd wi�hin �ix mon4hs o#permif Es�uanc�, or i�worEc authori�ed #�y
<br /> th�permit is su�pandsof or ab�ndonad for a p�riod of stx{6)months after�he time th�trvork is commQnc�d. An�xtonslon
<br /> may be requesfed, In writing, from the �uilding Offici�l for a period no4 to �xceed ninefy (90) days and wii! demon�trate
<br /> jusfi�abi�cause f�r the e�#en�ion. If wortc ct��s�s far n(r���y(90}can�ecutive d�ys, the�ab is consid�r�d abandoned.
<br /> @3t�"A���9t�9� `�C� ��li�R��3: 'Y��1� �c41L9JF`�� �'f� �d��t?�� Q� �ff�i���� C�� ���fl�������#�!`� ['�I�� �l��U�.°�' !R9 Y'�?�J�,'
<br /> ��,1(�i�9C�tf�i�� ���[i1f1���i�Ef��N�'�'��Y+�t��t����l�6�TY. l�Y�1� ({�'P�N�`P��(�'TAiM �If�A1�9�li�C,COR9�l9L'f
<br /> 44l9`�H 1f1DUR �E Q� �9�`r�'� � ���OR� R�C�1RD�i'!Va VOIA� � tC QF C�{t� � G�i�`��N'�.
<br /> Fl.OR1DA JURf1T(F.S. .03}
<br /> S bscribed and swam to ar a�irrne
<br /> _ ... ��.�:�.�'
<br /> --�-- cc�z�A
<br /> ( e re me#h1s 8ubscribe s r n E a{a c a f fi r m e d}b e f o r e t n s#h�s
<br /> b
<br /> W�ra is/are personaily knowm to me haslhava produced Who islare onaliy known to me or has/hav�produced
<br /> as Idenflficatian. as Iden#t�catian.
<br /> Notary Pubtic -- - iVotary Pubfia
<br /> Cammissinn No. Commissic�n Nff.
<br /> Name of(Votery typed,pdnted or stamped Name af N�4ary fyp�d,printed ar stamp�d
<br />
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