e �
<br /> a ' I
<br /> Rl�i10E+��DEEt!RE�'�RIC�'IOM�: "9'he a�nde�r�i aed nnde��ands�-ttt�k-this;. �tm��ma�y.be,sa�bject��°d�ed"restrlcttans° _ !
<br /> _. _ _9 . . �,_..w... ;
<br /> . :
<br /> v�hich m�y be�mot�e•�e�t�ctiv�-th��t Ci3�anty�:reg�latCar�: "i'h�und�r�ign���ss�me�r�es�in�itiitity'for cor�p4i�ncs iivith�a�riy ,
<br /> appliaabie d�ed r�strictia�ns. . . .. = � "
<br /> �i��.IC�N��ID•Ct�ld"P'R���'+D�t� &1�I�r C�►R1�aA�'��-E�E���+�N�gf�l�ITI��. =!fi the �euner h��fiir�d �.c�ant��#or or
<br /> co�t4ract�rs 90 undertake work,they m�y be:cr�quired.t�-te,lfcens�d in�ccordance.wi�tt staQe��.�s�d�local cegutatlons: �If the ;
<br /> �o�tr�cQmrt i� not Itcensed as�requlr�d�lay I;c�, batt� the �vner�nd contrabtor ena,y���be�aited-for°��en�sdeme�nor vlafa�on
<br /> und�r state #aw. ff the owner or 9ntended=contra�tor•�arg,�unr.e�taln as to enrha#1lceneing.r�quirexnents m�y:appiy=ia�r•Qhe -
<br /> intend�d vdork�they are ad�ised tb co�ctttte-P�s�o Cuun�r�ulldic�g'lnspectlon Dtvlslon—LO��nstng See�on�t 727-��7-
<br /> �00�. Faar�h�mnor�, lf the o�m+�� fi�s tilred�� �ontr�ctar br conte�actors. h� i€� �dvised t� have the contractor(s) si�n ,
<br /> �or#lan� vf the "contractor Bloat�' c�f.th�s,�plic�tion fac.vtrhich ttt�},v wiit b�.r�rsps�nsib{e. �lf y�ee�-as..#he cs�ngr"'stgti�as ttie -�
<br /> conBc��c4�r, Qt��t�ma�b��an indtca,�l�n that'fi� 6s e�o�properly licen��d and i��not�a�titted to��ernt6tt#n�p�ll�ges� !n Pas�
<br /> Caranty. �
<br /> `T���i�c�1��'�'TtON�i1�IP�C'F!U'�i�;�'t�����MI�,���'A[��-�E���9�lC�I�C��►��Y��EE�; 'f�e under�igned under�ta�nd� _
<br /> th�t Yr�n�por��tton Impact�'ees and.Recaurse R+�co�€�ty.fees maj�;apply�.ta:tt�e conahvct�gn�f r�ew.bulldings.°ahar�g��mf
<br /> us� 1n �tt6�ting bu!ldings� or:�p�stomof-�exts#i�i,g't6aiidings, �� sp�cifi�d.in Pasca County Ordin�nce number 89�7 �ind
<br /> 90-0'�. as �,me�ded._,'�he�unde�sign�d alsta�nder�tand�; that:�suclt fie�s,�:as:ma�y:be�due;>wltl��be ider�iified a#the-#ime a�
<br /> pe�rr�ttt6ng. t#is��tfier underst�ad 4h�t Tr�nspoc��tivra �m��ct 1��es and�f�e�ou�ae Recover��Fee�.rnust b� paid pNor to
<br /> rece�bin�a.°�ertffic�te:of�oacupa�cy"or fin�i��.p�ww�,r.=.��teas�. :�-th�pro�e�t::���s no��ln���v�.a:cert�tcate of o.ccupancy..or<� � .
<br /> fina! po��c r�leg�e,the�fees mr��t�ie paid pri�e..t�.permit is��anc�. ���th�rmar�;i�-Pasc€��Caun�r:lNato:iSewer. irr�pact
<br /> �'���are du��they.mu�t be�ptaild:prlor_ta:permit-I��uanc��in.�ca�rdanc�wit6t�appilcable Pasco.Cotanty oed�n�nce�. •
<br /> �C�P��T��I�'6��3�19.9Li��Y�!QCh�hr��9�.�'I�rlt�������at��,�s am�ndg�): If valua�on of work!s��,500A0-ar rnare� t -
<br /> o�rti�r Q�at I� the �ppiic�nt, have-b�en pr�vi.ded wtth-s copy�c�E�tfie-°E4o�1da-.Co�structior�� LRen�Lawr--Homeowner's '
<br /> S��ot�oQlan Guide" p�ep�red by th� F�n�ida Departmen�of�►g�iculh�re and Co��r�m�t:Attairs. �f 4he �pplica�nt� someo�e
<br /> aath�r�han the tlo�me�', 1�ertlPy.that 1-k��ve.obtaine�a�AY;�f..th�.�bode.d��crl�ecl���cuir�ent°and:pnomisi�:in:gootB.faith�o
<br /> d�{idep i#ta►.the:'rnvnec�:p�arto•cosi�rrtencemsnt:' � _ � . .
<br /> ���1'6'B��TA6�•�IO�V�IER'�&F�i��ViT: 1.ce�#�fjr:ttiaE atl:th+��_lnlf�rrr�ation.ln�thi��pplla�tbn ks accur�te�.�nd that ai!�ork
<br /> wil!'b�dmne in�orrepiiance wfth ail.appticable laws regui�ti�g�ons�vction� �oning and:•tand�devetopment. Appllcation is
<br /> 6�ereby rr�ade to �bt�in.�.p�rmit to do. wapk:�and�If��tallatton �s tndi+�ef�d:�- °I cetttfy that no v�rork�or tnstatiation ha�s
<br /> comm�r�c�d pr�or ta Is�u�nce of a perrrmlt"anid that.all work wfll b� performed�ta me�� st�ndards=of a�ll taws regut��ing- ,
<br /> cans�cactian, County a�nd City codes, �aning r�gu#atinn�� and 1�nd develaps�ent �g�ala��ns�In the Jurisd(ction. !�a!'so �
<br /> cerfify that 1 �and�er�t�d th�f th�r�gula�ions of�th�r�gov�rnon�r�k�g�nci�s m�y��ppiy�ta tii�int�rrnded wor�c� �nd tha#i�Bs '
<br /> my respon�lb!li�r to Identii�i•wh�t.acttons i must�t��:to b�41e��cot�lPllat�ce:_.Such ag�ncies includ�but�are.nat iimtted ta:
<br /> - �ap�rtme�t of Er�vlranmental=�Protecfion=Cypre��.��ayhead�; 4!4l�8and Are�s and En�tronrvaentatly S��sitive
<br /> Lands,l�later/W�stevirater Treatt�tan4. .
<br /> - �outhvues� �iorida i�lat�r �an�g�m�nt�:�6sfrict�Uett�� CYPr�ss.r.�ayheads; Mlettand Elreas. Alt�ring
<br /> lf�l��@(Y�UCS@S.
<br /> - �►an�Ga�rps c�f Engtne�rs-��aw�lis, Dack�,N�vigabl�l�Jaterways.
<br /> - ��p�r�m�nt �f M��Ith'.� R�t�ablltt�tiv.� Setvi��sllEn�i�onm�n4�l N�a�lktt Un6t We!!s, 1�la�teu�rat�r Ttea�ent, �
<br /> septic Tantis: �
<br /> - US Environmentai Protection Agancy-Rsb�stos abataettent._
<br /> ,. - FederaF�►�lslion-Aull�orNy-�riways.
<br /> .3 und�r�Yand tH�t the faAauving.restrlctl�ris apply tv the use of flll.� .
<br /> - �9s�og fiit is na@�ttadved in Fiood��one"VV"unles��xpressly peemitted.
<br /> -. - if th� fill cnateriat is to b� used:"in.Flood-Zane "A°, (t. fs tanderstoad tha# � drafnage ptan addr�ssing �
<br /> G�omp��sa�Nng volume"wiU be submStEed at#im� �f:p�rmittfng w�iich is prep�red by a prof�ssion�l engin�er ;
<br /> Ifc�nsed by#he�ts�t�of Flotlda: � � - - � -
<br /> - 1�th� fitf rriaterlai.is�#� b� used (n Flacd Zon� 'Aa tn=connec�#on-vvlth�a���rnai�#ed butlding using stem wa!!
<br /> � � �onsfructi�n, i cerEify thaf fiil_vuutfl=6$.t�s�d only.fo fiill#�te area bvithln�the�stem wai{. �
<br /> - Ig �q m�terlal ts to be used�In �ny area; i-r�itify :f�e# .usa af such flII urili.not adversely a�fect adj�cenf
<br /> pr�ap�rtl�s. it use:of fll! Is f�uns�_ta aduersety.aff�t ad}�c�iit`propertles,.the owner may be ciEed fo�vio�ating ;
<br /> _ Qhe concif#tons of the bt�ftifit�g;permik is�tted�c�nder#ti�Ga�ached'�ermit ag�l�CatEan, €ar:to#s.le�s than=on� (1) i
<br /> �cc�whicfi are eledat�d�by flit,a�t engineer-sd dratnags,pian f�r�quit�d._ -- . -
<br /> tf I am fhe d�,C�NT�'�R 4H1�OIMNER,,I�.�romise[n good fai,fFt to titfarm#h�awner of the qermifting condiNons set farth in �
<br /> thts affIdavi4`prior��ccrmrei�r�cinc�constructton. I urtderst�nri..fha��a=separafe permit may b� requir�d fa�r eteatrlca�t euorEc,
<br /> plumbing, §igns, weil�� pools; �!r condltlontng,�,gas,;or�ot�ei-.tnstatt��ons noE�spec�ically inctu�led-tn.the apptic�#ion. .A
<br /> '.:permit issued stta116e canstrued to be a={►c�nsa�-to�procea���tl�e w�rk and nat as:�uthority-Qo..vl�Eate,aancel,alt�r. ar
<br /> set�slde anb prov€sions of the technicai cod�s;�nor shalf issuance�of a.pert�tt#.pcevent tt��tuildirig Of�fci�1 from thereafter
<br /> ° requtrin��c�Rectio�af�nors tn.ptans; consteuction or viotations of-any+codes: �very permit issued shaii�b�come ir�valid
<br /> unl�ss the��rk auRhorizscl=by such permlt:�ls.co�nmensed•wtkhtn s�Enonfh� of-perm(t issu�nc�, or i�wrork authorized by �
<br /> ' the permit is su�p��ded-or.abando�ed-f�r�;p�rtQd.e�f�sbc:fB)moMhs.�if#�r#k��tlr�e th��wo�k=�s cannrrten�ed. An eactens[an �
<br /> ° may b� �equest�d, tn wciti�ig;:firom the�Buitding,Offiatal for a pertadannt to exceer!��atrt�ty�(90}days a�d�w�ll demonstr�te ;
<br /> : gustffi�big c�use for�#he�extension�. If w+ark ce�ses:fior ninet�-(90}c�ns.ecutiv�d�ys,_th�j��+�i�considetv�d abande�ned. �
<br /> !�l�RRd�R#� �'� ��N��t YfDUl�..FAlLURl�:-TCi,R�E.Ctat'�Dl:A-:N�?3���:�1�•��191l1�!l�i�C��llE�T:�ft�AY-I�EStD1:T�M�Y�UR
<br /> �s�l(Y��'�i'�iCE����0�11�RAVI�MEi9t�'S�'�fi.�C3Ut�:�'R9PEi�'i'6'1P i�°_Yg.l�=IN'€��:�Q��►BT�iN,FlM��E1N�;��t�[�l�UL'T
<br /> YV1�'�9�' ��tt ii�� ��. c�� 'P4� t�lEl� ��.� .E�C1R�i G�Y�tii3= • ���`:1� =' G� E t"!Vf
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<br /> Subscrlbed and swom (or a e �betore me thts Stibscrlbed'artd'swa to � rnedpb re rrie�3's
<br /> by ,�'U-/�-E�_b�+• ...__ . . . - .
<br /> Who Is/are personaliy imovvnn to.me or has/Ftave peoduaed_ Who.is/are wrrto ma or ttaslh�tre�S� - -
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