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�9�TIC�O� ���D ���'T�ICT�O►�5: 1'he under�igned und�rs�nds th�fi 4hi�permi�may be subj��t�o ude�d" r�stricf�ans" <br /> vuhic#�may��rr�or� re�tric�iv�th��Co�snty reg�al�#ior��. Th� undersign�d assurr�es resp�n�ibili�r foc cs�mplianc�wi�h any <br /> applicabl�deed r����ictions. <br /> �9��l��6���� ��[�'��,�"�Q�� �6�� ���!"C���'�2� R����E�4�l�l�lT6E�: !f t�e owner h�s hir�d a car�tra�tar or <br /> contr�ctors to und�r�ke woric, #hcy may b� required to b� iicansed in a�card�nce wifih st�te and (ocai regufatiar�s, tf�h� <br /> aontrac#ar is no4 licensed a� required by law, bofih the owner and contractar may be cit�d for a misdemeanar vialafiion <br /> under s4ate 1aw, �##he own�r or ln���ded con�ractc�r ate unce�3n �s to vuh�t licer��ing requiremer�fis may apply far the <br /> in#ended work, fih�y ar� advised 4o cont�act the Pasca County Building In�p�c#fon �ivi�ion--Licensing Section�t 727-847- <br /> �OQ�. �ur�hermare, if Yhc� ownae �ras �rfr@d a contractar ar cantractors, h� i� advis�d to have the contractor(�} sign <br /> �ortian� of�h� "contr�ctor�iock" af fihis appiication for which th�y will be r��ponsible. i�yau, as th@ own�r sign a� fihe <br /> con4rac4ar, tha4 may be an indicra�ion th�f �e is no4 properly licensed and is na4 ontitl�d ta permifting privileges in f�asco <br /> Coue��t. <br /> Y'�6�S�ORT�'�'l06� ONi4�ACTlIl7"I1.ITIES 16��AC`��1��R��OURC� R��OlO��Y F�E�: The undersigned und�r�i�nds <br /> that�'r�nsport�tion {mpact Fe�s�nd Recourse Reco�ery Feas maY-apply fo 2he construcii�n af nev�b�tiidtnga,chan�e ofi <br /> us� in �xisting buildings, or oxpansion of exis#ing buildings, as sp�cifi�d in Pasco County Ordin�nce number 69-0'� �nd <br /> 90-07, as am�nded. The und�rsigned also understands, that such fees, as may bc� due, will be id�ntifled at�h� #ime or' <br /> p�rmi�Ying. It is further unc��rs�ood �haf i r�nsportafiion im�aof F�es ar�d Resourco Rocovery F�es must be paid pr�or fo <br /> rc�ceiving a "certi�cate of occupancy° or flnal power r�leas�. If the prcrject daes not involve a certific�4e of accupancy or <br /> fn�l power ref�a��, th� fee� mu�t be paid prior 4o perrr�4t i��uancc, Furihermore, lf Pascra County V1ta4ertSewer imp�ct <br /> f�e��rc�due, they must be paid prior to permit issuance in�ccordanc��rith�ppiicable Pasco Caunty ardinances. <br /> �Cd�1��"��8��'9L�6�_LdEb� LAlf�9 4C6��p���793, Fl�P�d���tu�o�,���rrea�de�p: If valuation af wor�is�2,500.00 or mor�, ! <br /> cer�ify fiha# 1, �he �pplicant, i��v� b�en provided vvith a copy of thc� "Florida Construc�on Lien C.�vv—#�omeot�ner's <br /> ProfiQction Guide" prr�pared by the Fiorida Department of Agriculture and Consumer AfFair�. if ti�e �pplicant is someone <br /> other th�n�he°ovun�r", I r.�r#lfy th�t i ��v�ob#�ined a copy o�4h��bove tiescrib�d d�cument�nd promi�e tn gaad�aith�o <br /> d�iiv�r i�40�h�"own�r"prior to commencement. <br /> �Q�9Y6�CY0�'�/C7tSif6��E�'S A�6�1D�Vi'T: I c�rtify that a11 the inf�rmation in �his applica#i�n is accurafe and that all work <br /> will be done in campliance with all appli�able lav�rs r�gulafing construction, �aning and €and d�vetapmen#. Applicatir�n is <br /> h�raby rriade �o ob�ain a permi� #o da wor{� and insfiaila�ion �s indicafed. I corfify that no work or ins2alla4ian has <br /> commeneed prior to issuartcc oi r� �erm�t and tha4 all wacic wiil be per�armed fo m�et s�ndard� of �1! tauvs reguia�ir�g <br /> cans4ruc#ion, Cocanty and City codos, zoning regul�tions, and land d�velopment regulati�ns in the jurisdicfion. I aiso <br /> cortify that i und�rstand that th� regulafiions af other govornm�nt agencies may apply to the int�ndad w�r�, and �h�t it is <br /> mp respansibili#y to id�n#i#'y uvi�a#�cfions t mus#£�#ce ta be in corrtp3'tance. S�ch ag$ncies include but ar� nat iimited#o: <br /> - D�partrncn4 of Environmental Protection-Cypress �ayhe�ds, Wr�tfand Ar�as and Environment�{ly Sensitiv� <br /> Land�,Vlt��er/W�stew�t�e Trea�m�r�t. <br /> - Southw�st Florida Water M�nagemenfi Di�tricfi-We1is, Cypress Bayheads, Wetfand Ar��s, Alf�ring <br /> Watercourses. <br /> - Army Corps of Engir�eers-Seawalls, I7oc{cs, i�avigable Wat�cway�, <br /> - Depar�ment �� Heal�h &_ R�habil[#ative ��rvices/�nvironmentaL Health Uni#-Wolls, Wastevuater Treatmsnt, <br /> Septic i"ant<s. <br /> � US Enviranmentai Protection Agsncy AsbesYos abatement. <br /> - Fed�ra(Aviation Authority-Runways, <br /> 1 und�rs�and#hat fh�fal#owing r�strictions app3y fo ghe use of�ill: <br /> - U��a af 4�I1 is noC allow�d(n Ftaad�orte"V"unle�s express4y percn{t4ed. <br /> - If the �ilf mat�tiai is to be used in Flood �orre `�9�1,', f# is t��tderstood f�t�� � d�it��ge pl�rt �ddcessing � <br /> "comp�nsating valume" wili be submitt�d ag tim� of permi4ting which (� prepared by a pr�fession�l engineer <br /> licensed by the Stafie of Florida. <br /> - Ip#�e �it{ material is fo be tased in �bod Zonc� "A" ln connection wifh a p�rmitfed buitding using �tem vuall <br /> canstructian, I ce�ifiy fhat fill will be used only fo fill th�area within the stem waif. <br /> - {# �'il4 maferi�! is #o be used in �ny ar�a, I cer#i�}r fiha� use of such ftll will rtot adverse#y �fi��ct adj�c�nt <br /> praperfies. 1f use of�il is found 4o advers�iy a�foct adjacent propsrties, the owner m�y be cited far violating <br /> the conditlons of the building p�rmiY issued under fhe agtaGhed permit a�p(ica�ion, fe►r lo�s l�s� #.�tan or�e (1} <br /> acre which er�elevafed by fi11,ar►engin��red drainag�p(�n is required. <br /> If I aen gh�A��6�'f FC►R TF9� ���R, I promise in good faith ta inform the ewn�r of the permitting conditions set forth in <br /> #his ��idavit prior to ca+�mencl�g c�nstruc�on. 1 urtdersfiand thafi a separafi� permit rrtay be reguired for�l��trical wark, <br /> plumbing, sign�, weiis, poots, air conditioning, gas,, or o�hc�r inst�ll�tipn� not specific�ily included In the_applicatian. A <br /> permik is�ued shall b� canstrued to be � licens� fo proc�ed with fihe wor�and no#as authority fo viala#�, cartcel, aifer, or <br /> s�f a�ide a�y provisions of the technica!cades, nor shatl is�uance o�a p�rmit pr�vent the �ui(ding O�icia(from thereafter <br /> rc�quiring a correction ofi erro�s in plans, construction or viol�tion�4f any cod�s. �very p�rmit issu�d shall become invaiid <br /> ur�i�� �he �rork aut�or€z�d by such perm#t is cammenced w��hin six mor�fhs of p�rmit issuance, or if wo�C authori��d �y <br /> fh�permlt is susp�ndeci or�bandaned�For�p�riad of six(6)months a�er the time th�work is commenced. An extansion <br /> may be reque�ted> in writing, from the F3uilding OYricia! for � period no4 to exceed nin�ty (90) day� and wiI! demon�tra�e <br /> jusfifiabl�cause for#he exfiens(on. tf worlc cc��se�s for ninety(90}con�ecutive days, the job is considered abandoned. <br /> 4fiF����99�9� �'Q ¢��9�i��: ���F� Fe�IS.�l�� �'f? ���C��� �► �i�`��C� �� ���[��[���[��1�`� �A� ���U�.�` 1�9 �P�'JU� <br /> �AVi6�C T�3l99C� ���t i�'1P�t'�/E�1��41'��'O YC9lDt3 t�f3�PI��@Ylf. I�Y�IJ IN7"��1�'�'0 O�'T�1�1 iF1�9��9�I�G,CAR9�VJL'� <br /> �t!'M"PH Yt�l1R L,1�6elDlE¢2 O��i�9 A'�'�'Oft4��Y��FOR�R��ClR�I�tG�C9,�,���U`Ti���t��E�,��c���� <br /> F�aRtoA suR�T��.s. .os} <br /> 0!!l99iv�R 1�I�GEh1"P ` 90�fTRACTOR���"n���� ,� <br /> SUI}SG�1�@t�@Rt�SWOtR fd{Ot B�IT'ti1�'CI}�7$ e this Subsenbed and swom fo{or a�i efiot�me thi�a L �...� <br /> ��7�'/,r���bY /fy r .. b <br /> Wr a is/are personally lcnow�fo me or has/hava produced Wha isla personal4y known to me or has/have produced <br /> as�dentiflcation. as iden#ific�fian. <br /> ,��/'����i2�e�z�?'' 101��@���� Notary Pubiic ��,`�'�.d�� ����� �___��-,.��..��fsry Public <br /> Co�missian Na._ ����� Cornmission a.�� O (�_��� <br /> �l r� Q�� � �U � ______���?��s.. �ii�G ._._L�-L':�-�� <br /> Name of No#�sy typed,printQd flr stamR �tarne of iVotary typsd,pri�ted ar s#emped <br /> "? �"""""'""`�"` " ���" DE$RA ELAlNE RUFFEtL <br /> ,,,,�"•,, DEBRAELAI ;�`""�.;?�;: <br /> �„oYP�i� s�; <br /> � :�; �;^ NE RUFFELC . :,_Commissian#GG 0453d3 <br /> ��� . :,,:Commission#GG 045343 ' � r Nuvember 7 2020 <br /> .. ;;c. �,:EX�ifes <br /> ;;.���;:�xpAresNovember7.2020 %°;;;4•''� BQndedThruTroyfair�insurancegpQ.3g�.7ptg � <br /> ' ' x,,,„„ 8ond.d Thru 7roy Fa(n lnsurance 800�385�70i9 <br /> ..,..,� <br /> l <br />