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�t4T1C��F[�EEU RE�TR6CTION�; 'The ur�d�rs�gta�d under�ta�r�ds°:th�t:thls.�aerrnit.may.be.,s�b�ect to°d�ed"restr(cftons" . <br /> which m�y b��more r�strictive=th�n Countji�gul�tian�. �TF��u�d�rsigned�s�trm�s r�spornsibi{Ity f�c compliatnc�with atiy <br /> app!leabte daed ceslricttons. � <br /> t1Nl.tCiENS�D GAWTI�a4�T�R� AN� C�NTR�I�'�'t}R �E���N�I�t�IT11�S: -Ef the ow�o�r has--hie�ed � c�ntracE�r or <br /> c�ntractors ta�under�ak�work,th�y may b�;cequlred.�to.:b�;licen�ed I�.�ecordance.with stat�.and•loca) r�gul�tlons. tf the <br /> �o�►tractor 9s n�t li�ert�ed e� r�qtai�ed�by I�w, 6oth th� ouvr��r�nd conts�ctor m�y b� clted f�r a misrlemoanor viof�tian <br /> under state lavv. if the own�P a�r Intended�contractor are�unc�r#�in as �o wh�t ticenstng.requirements may appty�for the � <br /> intended work, they are advlsed ta contact the_P�fficc��ounty�a�iiding lnsp�ction Divi�loo�--Lic���ing S�cti�n at�'27-647- <br /> ��08. �urth��mor�, if the awr�e� ��s ht�d a ccsi��r�ctar �r carittr�ctors. he� Es arivlsed to have the contrac#�r{�} s(gn <br /> portioros of th� "conkractor �lock" of thls �ppllcatlon for�rhich Qhey w+911 be responslble. Gf you,.as.th� owar�r sign as th� <br /> cc�r�tr��Qt��, Ehat rn�y bg �� Ic�di�at6�ra that he #s not.p�perl� Ilc�nsed and I� ��t e�titled ta p�rt�iitting pr6�lleges !n Pasc� <br /> Caunty, <br /> �'�N�lP�RTAT`ION IMPi4CT1UT��.17e1E��-(MPA�'�AND I�ESOIditCE RECOV�RY�EEES: The undersign�d und�rstands <br /> th�t Tr�ns�ort�tion tmpacE Fe�s�and.Ft�cot�r�e Reco��.ry.Fe�s r�ay��pp�y ta tf��cc�ra�truct8�n o�n�w buildings,chang�c�f <br /> use ira �xisting bufldings, �ar exp�n�i�n�rof�exlsti�i.g.`6uilddngs, a� �pecHfled.in Pascq County Ordinanc� number �9-07 and <br /> SQ�07, a� �mend�d..._Th�und�rslgned ai�t�und�cs#and�; tha#��such fe��,-���ma�_6e�du�,;w111 be ld�ntlft�d at the##m�of- . <br /> permitting. !t Is �rther und�rstood th�#Transpor�a�6on Impact F�es artd Resource R�c�aery Fees rveust be paid prior to <br /> rec��vin� a "�er#tific�,ts of�o�cupancy" or f9�a! power�r.�l�ase. :lf�the proJ�ct,do�� no4 fnvc�Bv�a.��rtificate �f mccupancy.,or <br /> final p�w�r r�feasa, the-fe�s rr�t��t 6e� p�id prfor ta pe�rr�it issuanc�. F��ttt�rrra�re;�if-Pa�co�G+�unfy'1Nat�rlSewer Impac# <br /> ��es are due, they.must b�p�id prior to permlt fssuance-ira accordanc�w1th��rpplic�bi�Pa�co�County ordin�nces. � <br /> ���STl�t��Tl�l��.IEN 1.Ait�tChsp#er 795�El�rZd��#atu#��r��am�nd�d}: tf vatu�tton of w�rk ls$2,50Q.Q0�r m�re, l <br /> certify that I, #h� �ppllcant, have-be�en pro,vided�with a copy of the� "Florida��Constructlon� Lien .L�w--Homeavrn�r's <br /> �eot�cttoca G�aide° prep�red by th� Flo�ld��epackm�nt of Agrtc�tture and Con�nnr�+�r�Affiairs. i#'the appl4c�nQ ts Somea�ne <br /> �#her than the"�wner�, i��rt3fj►that t h�ve.abtained�a`copY:of th���bave.r��s.crib�d docurr��M°and.p.r.c�mis�in;goad faitft.to <br /> deliver 9t to the'owne�'�.prDrar to�comm�ncem�nt: ' � � . <br /> ��[�TE2d�CT�RlSl�Y4tN1ER'�I��FID�,YIT: 1 c�rtifjr#hat all.fhe.�n�€�rm�tlon in th�s a�pp#laattvn is ac�ur�t�and th�t al!v�rork <br /> will�be done in cornpliance with all applicabi� lavus regul�#ing �onstructlon� xonfng and.�land d�vefoprner�t. Appl(cation is <br /> �ser�by �ade ta obtain .� ��rmit #o do w�rlc.�nd Instail�t�t�n �s Enc!{c�tedr :1 cerR�fyt that na wgrk or ir�s�t(atlon has <br /> cammenced prior to issuanc� of a permit and that.al( work wfii b� pertormed to meet standards aif att i�ws r�guiating- <br /> constructlan, Caun4y and Ciky codes, �oning t�gulatlons, and land devei�pm�r�t t�gul�tton� In the jurisdlctton. 1�al'so <br /> ceri3fy that I uz�dersf�nd th�t the regula��ons of c�ther governm��t ag+�ncl�s m�y�apply�t�#h�intended w�rk, a�d that it is <br /> my responsibility to identffy-what,actions 1 must t�ke:to b�tln>cotYlpflance: Such ag�ncies lnclude but-are.n�t Ilmited to: <br /> - i2eparttnent of E�vironmea�tal Protectiasn-Cypre��.'Bay�ead�; Vite#1�c�d Areas and Envtronm�n#a1�y asnsitive <br /> 9.,�rtds�V9later/VN�st�vw�ter Tr�atment. <br /> - �outh�nr�st �9orsd� W�ter M�nagement .District W�tlst (%Ypr�s�-..�ayheads: Wetla�nd �reas, Altering <br /> Wat�rcaur�es. <br /> - Army Corps of Engtneers-Se�walls, Docks, N�vigable W��erways. <br /> - D�p�rtment c�f Ne�ith�_& Ret��bll�tattve S�rvice�l�rtvi���tnn�nf�l �lealth L1��tYl�elis, Vl�astevitat�r Tre�trn�nt, <br /> Septic 1'anks. � � <br /> - US Envie�r�rra+e�tal Protectic�n Ag�n�y-Asb�stos�b�t�mer�t... <br /> , - F'ed�r�i Aviatlon AutFtority►-Ruriw�ys. <br /> E under�tand ttiat th�following.r�strlctians appiy to fhe us�of flll:� <br /> - �Ja�of fil!is not all�wed in Flood Zon�"V'u�?e�s expressly permitted. <br /> - If the �ill material (s to �b� use+d in ��lood Zo�e `A', if ls understaod that a dra(naga plan addressfng a <br /> °�ompens�ting�a�um�"wlll b� subr�ltt�d �� T, a or ��m3tting whiah Is pre�ared by a pr�fessIonaf englneer <br /> ll�ansed by#h�St�te of Florida: <br /> - If lh� �ip materia) 6s tg b� us�d ln Fl�a�d Zc�e `A� i:��r�onnsct�on-ev�th-a {�ermittet� building using stem watl <br /> � , �o�astr�ctian, i c��#ify�h�t filt,wJ}l:be t�sed o�°t�y.#a�#�e�rea wlthin-��#�m�v�Ii. <br /> - If �311 rr�aterlal is to be used-in any a�a, 1 Ge�rttfy ���� us� of su�ch f�] �a�l not adversely afrect adjacent <br /> pt�opertles. lf t�s� �f#i�i is fe��nd to adv�efiy.a�e� a��,�.�t p�a�et-ki�s, �e o�mer rnay be clfed for vta�atirtg <br /> the condttion� of th� builiding.petmit 1���e{f �et ti-►e a��ed p�rm'rt ap�l�al�on, for lats less than.one (1) <br /> acr�whlch are e#evated-by fill,an enc,}�'r�egr-�d dre4r�a� p�an[s requlrad. . <br /> Of i am the�CENT iFOR TM@ QWNER, i;.prom[se tn gaa�d faifh� trrcrrm th�owner af tIte ��rmifting conditions se#fiarth in <br /> ihis afFidavi4'prior ta comnnencing construction. 1 undersffirtd fi�at a-separate permit may be requirad for electrlcal work, � <br /> �lumbing, signs, welist pools;. aEr condl#Ir�nln�g, gas, �rr oth�r Insta�;a�I�ons r�ot sp�ciflcalJy lncit�d�d-in.fhe appticat�or�. -A <br /> permft issued shall b� construed to be a�llcens�fa p��d svlth the work and not as authority#o.viala4e,�cancel, a[#er, ar <br /> set aslde�ny pr�visle�ns of t��_#�chnlca!codes;�nor shal! 4ssuartc.� af� peemit prevenf#hs�uqdIrig Offlcia!from thereafter � <br /> ��quiring�a�rrectior�nf�rrors in plans, canstrucEian ar vtolat�ons of any cod�s. Every permit Issued shali become invaiid <br /> unless the waark authorized�by �uch p�rmit-#s-commenc�d�withtn sfx rrtonths of permlt lssusnc�, or if v�ork authorized by + <br /> I the��r�a3t is susp�n+d�d-ar ebandoned for a pert�d af-s��{�}-mont�s after th�t(rne ths�wark=ts comrr��riced. An ex#er�sian <br /> may be requested, In writing, fr+am th� �ullding.Ofliclal for a p$flo� not to exceed ninety�(90) days ��d will demonstrate <br /> ���stifi�bE��aus�fot�th�ex�ensla»: !f work ceases for nlne�r(g0)cons.ecutive d�y.sr_th�job=is-consEder�d aba�doned. <br /> '.'�ARt�IM� Tl� O�N'f��R: YOU�_FAl1.URE.YA,R�C.OEt�3 A Nl3TIGE-0� COMMEMC�MENT-MAY•RESULT 1�9 YOCJR <br /> F�1�YIi��TWiCE�t�R 11UIPi�A�dEMEtdT�Tfl Y�?Ui�:R�ClPER'TY. t�°.YE9.�]-IN•��ti1Q=TQ OBTAiN=FiN�it�£1N�,;�CK3�SULT <br /> 'd�ITH Y UR LE D O /�R1�1'�TO�NEY�� FC1RE4 E�OR�11t�G:� OUR� �CE'OF. �Q E N"f: <br /> =LORIE7A dURAT�{F,s:i.�7.o�� - - l -'��„ <br /> '�VVP9E�OR AOE1dY 1CON7'�GTOFt � <br /> Subssxibed�nd swmm fa{or a(flrmed}b�far�tne thts Subscribad aad'swom-t {or affitmed)�befote tne ttcl� . <br /> 6y ,by -_ - . <br /> '�Nho Is/ar�personally hnown to.me oe hasihav�produc�d UYho.Islara peraonally knavm�hl m�or haslftave tx�� ' <br /> a9ldenUBcatlqn. �s k'��:-_ <br /> . � <br /> RIoffity F'ub11C _ ' �e's='��aiit <br /> Cc;r.n`s�%�r,h`�:= �_-�.+�,�:� <br /> !�?:�'�?.�.^:���.,w���-�r"��.�e-�:�= `-��e�Vs+�-, w-.+e�.:��r_ars:�r��c <br /> I <br /> I ._ " _ . -' ...._.� " _ " _. .. .... �.-.._.___J <br />� <br />