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<br /> �10'T�CE Ot�DEE1�RE�TRICTtOMS: The a�nd�r.�lg��d under�t��ds°:tt���t�l�.��rm[tmay be,subject to°de�d"resBrlcttons° -
<br /> whioh m�y he�more r�sl�ictive�tharr C+au�ty�gula#6ons: 'The underslgned assumes responsib0iity far cotr�pHanc�with'aeiy
<br /> agpf(cable deed r�st�lc#bns. �
<br /> t1NtICENSED CONTi2ACTORS �N�-Ct?NTRJ�ICTOR RE�P�N�l�lL-tT1E�: If �t� O�S6i' �1�3�"FtI�B[� � t�CiQC��tOS 4C
<br /> contractors#�o und�rta�ke work, they rruay be�c�quired��to.;be;licenaed in aceordana�a.wtth state�.�nd•lo�ai ragulatlans. :if the
<br /> �ont�actor t� n�� itcen��d-as r�qulred�by law, 6oth tha owr�er and��or���ctor m�y��tie�clt�d for � misdeme�nor vi�latlon
<br /> under state Isw. di the �awner ar intended�cantra�tor are-unc�rtatn as to wh�t itcensing.r�qulre�nents�may �ppty�for the �
<br /> fntended work!they�re�dvl�ed to cont�ct#he-Pasco Caunty��Ilding inspectlmn D[visla�n—Ll�ens6ng 3e�tion at 72'P-847-
<br /> ��09. Furthermar�, if the owrr�er Fi� hEr�d�� cait#racC+ar oi� c�ntraetocs� h� i� ao��lsed ta have 4h� cor�tractor{s} sigr�
<br /> portions of th� "cantractor �look" vf thls appli�ation for which th�y w1ll.be.respa�nsible. If yau� as.�he owner si����s tlte
<br /> contrac#o�, ti�at-�rnay b� an ir�ciic�#lon th�t-fi�is nofi.pr�periy �ic�n�od and ls no#entltied #� pecra�tt#litg prlvileges In P�sc�
<br /> County.
<br /> '��AIV��ORTATION INlPACT1UTIL{TlES"CMPAC�`�1Nb-1�ESOURCE REC�VERY�FEE�; T�he under�6gi��d-understands
<br /> that 1'ransportat6on impact Fees�and.Rec�urse R�cave.ry.Fea�may�,�pp1y�t�:ti�e consttuc#on of newv bt�ildinSs,�ch�n�e of
<br /> use in exiski�rg buUdings, or expan�i�r�>of��axisti�i�g'�buildings, �� specifled.in P��cp County Ordinance n�amber �9-07 and
<br /> 90-0�, as amended. _The und�rs�gn�d aSso�riders#�nd�; fF�at�u�h fe�"s,:as,�m�y_b��du�;:wlll 6� ident�#ed �t the�ime of
<br /> permit�ing. !t Is further understoad that Tra�sportatfon Imp�ct F�es �nd-�t�esource Recovery�Fe��.mus� be paid priar to
<br /> rec�lving a"r,eaftEicat�of�o�cupancy"or�fin�t pawer.-Fe9ea�e. :If the proJecE.;do�s not�inroolve a:c�rtificate of��cup�ncy.-or
<br /> final pow�r.rele��e, th�.fees mu�t b� patd prfor to permit i�suanc�. F��th�rma�re;�f.P�seo.Counfy Vtiat�rlS�wer (mpaat
<br /> fees are du�, they.must be pald prior t�p�rmlt�-ls�uance�in accordance witF��applic�ble Pasco'County ordinances. �
<br /> ��NSTFtUCTtOR1 tlEi�I.�W{C�apt�r 71��Fl�ra+da�t�t�te��as arnended}; lf valu�tlon of work Is$��5q0.00 ar mor�, 1
<br /> certi�,► that I, the applicsnt, h�ve-b�►en pr�vid�d with a capy of�the°�Iorida��Construction� Llen Law---�iomeown�er's
<br /> Protectior� Gtaid�° pr�p�red by"th� Ft�Etd��9epartmes�f�f Agrlc.�ttur� and Con�umer-Affalrs. 1�the appl{cant is s�rneone
<br /> other than 4he°owner", 0 certify that!•h�ve,�b�inetl a copy;of.th�ab�vade�scrlbed docurt�ent�and.p�romise�in.gaod faith to
<br /> deliver It to the-'�w�e�'�prior to•c�menenc�tnent. � . � .
<br /> C�tVTR�iGTOR'�/+DWd�IER'3 AFfiC►AV#T: 1.ce"rfify that a1P�h��.3nf.ormatic�n.1�thi.s�ppllc�tbn is accurate.and that s}!work
<br /> will�b� done in cmmplianc� with aii appiicable laws regulating constructlon� zoning and.land�development. Appl(catior► is
<br /> t�er�by rraade f� ob#ain .a permit to do wor4c.-and lns#allatic�n as indt�ef�dJ� `� c�r�lfy that n� ws�rk-_or ins�ali�tion E�a�
<br /> cvmmenced prior #o Issuance of a permit and that-all work wili b� performed�to me�# standards� of all laws r�gui�Nng-
<br /> s�ns#r�ctlQn, Coun�}r and Ciky codes, zoning regutatlQns, and land devei+�pm�r�t r.�galafi�n� le� tFo� jurfsd(ctivn, i �6so
<br /> �e�tffy that i undersf�nd fhaf the regulati�ns of other gav�rnrn�nt ag�ttcl�� may��ppfiy�#o the in#ended woric, and that it is
<br /> �ry r��pansibility#o identify�wh�t.actions 1 must t�ke to bedn:.cogt'lpliar�ce: S.uch ag�ncl��Incl�ad�bwt are.not Iirnited to:
<br /> - i�epart�nen# af �nviranmental Protect��n-Cypre�s.�Bayh�ad�;�V�e�and Area� ancl Environr�er�tally S�nsi#ive
<br /> Lands,V�laterlVUastew�ter'Tre�tm�nt.
<br /> � - Southwest Fl�rid� Wa�ter Man�g�rn�nt� :4�6stri�t Weils, �YPress.._�ayheads; Wetland Areas, Alterin�
<br /> tNat�r�ourses.
<br /> - Army G�rps of Englneers-SeawaUs, Dacks, IVavlgatile Waterways.
<br /> - D��aartment of Health� & Rel�ab111#�t#v� �etvEc�slEr�v�ronm��fa1 Fle��th Uiait Wells, llVt�ste�uater Tte�finent� .
<br /> . SepQic Tanks. ,
<br /> - US E�vlr�r�m�nE�i Pro��c#ton Ager�cy Asbestos abatem��t.
<br /> ; - Federal AvPa�tlon�Authority-Runw�ys. -
<br /> i �:nd�rstand ttiat#h�following.r�strlc#Ions apply to th�use of flll:�
<br /> ; - �ss of fi111s nat allowsd ie�Ftood Zone`V�c��tess e�essiy permitted.
<br /> - If th� fill m�teria)�is to.b� u�ed in F4aad Zcr� `A`, �t €s understood #h�t a drainage plan addressing a
<br /> "comp��sating voSum�".will b� sub�lft� �ti t:,�r�e c�f �Csr��tl�g��v�ich is prepared by a pr��s�Ona# e�g(��er
<br /> Iicensed by#he St�te of Flo�da. �
<br /> - (f the flN materl�l !s�to bs used � ��od Z� °,�.' �.�r c��-���tiQn �rith-a �rmt�ted �i�ding u.i�g s#ern wa!!
<br /> constructfon, t certify that�i-�1-��s�ed c�'�y`��ffe�a���rri�ir.-;�s�.em�Sra�.
<br /> - If fill materlal is to bs use�d !n �sy a�, I �,3� e1� L� cr� s�rc� €�4 r� rro� a��v�rsety aiiect adJac�nt
<br /> propertl�s. if use of frf( Is ft�r�tt� �e��-�`�e� �-� pt��cti�� €� �e� tnay be cl��f�v1t��ating
<br /> !he condkfions of fhe bui}dir�g p��it k�s�t�f t�e� �-ae ��e� p�",� �'�;i�tan, fa�r i�ts less than.one {9)
<br /> �cre whlch�re el�t�ated by fa�[� an�rt�t�r�d d�a�t� ��tt 1:re�u�ted. .
<br /> if P�m the A,GENT'�OR THE tJiNN�R, i;�k�e kt �fa�tt�t to �arm the o�vn�t af lh�e �ermliffng condi�ons s�F forth in
<br /> #his affidavft°prfor ko aornmsr�clrtg ca�str�t�td��a. i �ndststend t}ast �-ss�arat� perm�f may b�e requtred for otectrical wark,
<br /> piurnb�ng, s€gns, w�13s, po�s, atr car�i��i�, g�s, ar uti�,r Irst�a�ans not sp�Ffk�liy I�fuded-in.#he appllcat�on. -A
<br /> permit Issued sha�ll be canstrued to be a lF�en�e t� p�ro�a�i �vft� f�e�rk and na#as s�rth�arity to.vlmlate, cancel, alter, or
<br /> set�sid�any pravlsions of fhe.t�chn#ca� txtdes. rt�r sh�i� �ssu�rtce of a ��tmlt g�eve��t�Build€rig t�Ic#al from thereafter
<br /> requtring�cor�ectton nf ercors tn pt�ns, construotit�n or viaiatt�ons of arzy c�ades. Every p�nit Issu�d shatl bect�me invalid
<br /> unless fhe werk authorix�d by such permit-is-cammenc�d �It�hin s�x months of p�ntt tssuance, or if work authorized by
<br /> the permtt Is susp�nd�d�or.ab�ndon�d�r�per�od of si�e{6}rnonths ����tt��tt�e fihs�work-ts commencad. ,4n extensEon
<br /> may be requested� In writing, from the �uilding_O�ic(al f�r a pafit�ad rtot to �xce�d nit�ty (30) days a�d wlil demonstrate
<br /> jE�s#i#i�bl�c�use f�r.��he�xtens#o�: if work ceases for n(ne�y{9�}car�sect�tive day-s�-th$�ob=1s consldered aba�dor��d.
<br /> , t .
<br /> b�/A�PIlNG TO AWNgR: YOU�_.FAlLURE-T�.REC.O�t�A NQT1�E �9F CAM!l4KENCEME[�T�lldtA'Y-RE�ULT i�! Y4�UR
<br /> �AYtN�'11iViCE IFI�R lMPRt1VIEMEIV't'S TCi�(OURPRdPERTY. I�°YOU•Ii��E�iD`TQ'OB�';+�41N-FiN�[t��1NG;�CC3N�t�LT
<br /> �6111TN YAUR LE D :O �AN��'fT01tN � FAR� �ECO�t�9 G:� OUR�� �C��OIF`. .- . E NT'
<br /> =!o���sA,�uwa�4�.s.�1�.o�r _- . � . _ -
<br /> c�WPlER OR Af3ENT CONTE�/iGYO �°— �".._ •
<br /> Subscrib�d and s�m M{ar�t�r�ned}6efore me�Is Subscrlber!'and'swotn ta(or a�lrmed}•beiare me ttils
<br /> by .�y... -
<br /> Who is/aro per�onaity known to.me or h�s�aue produced Who Is/ere personally kt�own•tp me or has/hav��raduced
<br /> as Identlflc�Non, as ldar�.�ca3ic�
<br /> Pto#ery Ptabllc . - �.-,�:-��ye
<br /> ^._s�-+i�ea-,i;�:_� ^ea�'�;��►#�.
<br /> !�r-��'��-�r�°�.erx�c�'�-�:"��c 4�a-�:�.w�r-r�r,�i.�r-�s�-s"saraar sc
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