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si3r so=oitio" ' City afiY t� ill[' �, 1iit "
<br /> rti pli
<br /> -8uI1�fE1 b ,�
<br /> N011E' 'bEED ttE7`RiCT10NS. ,lin�erst ne 'u 'c1`rtan�s tlia bits`� 1r�iii ni M1 o.:.tied.re�ti'li;�iop��RtiP �rYiay:F�:m�re l�fttie .
<br /> than County'regulaeons=The:undersigneli;es 6nj'es,•;stes so,�isib( ;forig6mpllance with any opplicable.:cleetl;restriCt<Cns.
<br /> UNLIGENSJ:Q.CONT,RACTOitS ANt�CONTRACTQRat2TE43FiONSrIILtT1ES if tltovu��e_ra $ Fttndoorltrkcr;trtrconiractcrs>to undertatie;W�PMC;#ity: `
<br /> may:be<required:to'be'Ifbensed in acx ordance•with state:arid:local;regulatiorls'li`tha contrdctor is n tcltcefl'se a regiiit d.iy?I'Q y; bfh-:ifie`dwiiet:and
<br /> contractor,may,be.cited..for a,misdemeanor.vib a`lion' ri�>rt i if ii �a�lfthe'O�yr)eror:intendeti.co tea0tbr are ui� rtaln as to what'licen5ing gtA tie
<br /> maY; PP1Y. a irifertilei7'inroHi;they are?advised..to coritocfttie'.Pasco Countyi:B011 ing;,Ihspocli�t�'�i�sipn L nsing:�Om�i€�� 4�:'�00�:
<br /> Fuitfiemtore, 11
<br /> if tlie:owrier has:hired.a coiitragoror,,Q i� ,;c rs�,t �(sLadvise t to:have the contractor(S)'st ii:poitiOns;dlhex,; rtitraditkBlo�cktA, • 'is
<br /> appltc tton;fo�whTcFti tlie�i:Vvlll'bt'responsible If you;as a owner:si jn.as.file.ccrtittactor,'tFiaEi�ay��;an4ndit�atior�that lea is o
<br /> not ehtitle�J'fd"enititting':,privileges
<br /> TRANSPORTATION IMPACT/,UTII:iTIES IMPACT AND RESOURCE RECOi/�RY FE�E5 Theyuntle ignedru: e, Santis,.
<br /> that?`ranspoi'tatlon`.Irri(iact'Fees and;'Recayfse:Rec�veiJ= e ;i►aq ([iply)�te6itrttt�lHClfff It _ 'Biiildfn'"gsip8 �s rfdasf) g"6a gas;oP
<br /> expaiislon of wftffng4butliltngs,,as specified h'Pasco-CoVhh.:Ordmang' nuihber 89-o7•hd 90-07as arrie rtde :Th�turTc�e�signt d afsd'undets'taft s;. at
<br /> sucfi'ifees;•as•may:betdue�vtil:be iddhbfloo.' t:the:time:O4Orill(ttlQg t(sl titly{��� F,.ind8isto„Oq;ttiatTrans �rt itioh;lin aat ees:attd%Res tiice;R boV N�_:�:.: -.
<br /> Fees.Mum76 paid.prior'to'receivinga .certificate of occCipancy"or'ftrial:povreP release if the:' ro ect qes noftirivulv�::a'iae "tte f.00c�ip2n:cy or;ftnai"''
<br /> !.-. t.... .,:.:, •.,is a-A'...
<br /> power release,the:feesmust be paid.prior:to.perrnit Issuance:•Furthermore,if,Pasco County:W ter/5ewerfinpA�t fees are dUd'., iey:ntuSt betpaid.oilor.;
<br /> to-permlYtssparictin-accordancewithapplicab4e;Pssco;Coun ;dr<llnancess' '°'•a --,s
<br /> CbNSTAUCTION_LiEN_I:AIIII(CAapte`r.`:7`��;�loi'�����t�','asatttendiin lf.valuatlorrofworii:is-$2;50000:orrtion3,lc�rfify�that`Cjii6 applicant,
<br /> have.•been pm deli:vrltti:a.copyof the"Florida Cori tructiORfL';[ett:LaW+="1.1t ieovVttie[ EFt!Qtectio tiltf@gip patod Y_Mi#'Ftb idebepatlii! j ,Qf`, •,::;.F,� ,:
<br /> AgriculWre'and.ConsumerAffairs:.if the applicant is someane other.th rt'tlid'owner� ;c airy:th E rMa4e�`o t`a ii l a co►y of re.above de3 be l r
<br /> docurhent atid;promiseti►�good-faith to deliver It to2e bwner":prior t ,00tpmencemeh r..
<br /> CONTRACTOR'S/OWNER'S AFFIDAVIT 1 certifyathat aYltNtltilformtiQthts;apjill'taeort is1iirate and tfiet all'worlcwilbe:done.In:corppliat;9�wJtIY.
<br /> all a piica"tiie'laws;regulatii�g`co"ri,wuptiun,-zoning',pttlt.land himpllcatlo,:is l reby na e, :o Ndi;`epenni o Wo d : C�Jatibn:as.`y
<br /> in JIdWd l;ceftify:ttiatiio:>ivoHr cf installae0nhis+i 'et iicx3d`prlor tti�tssu is of n rrfi aind�h t 11':ipti f+ill`:f eperfmm�e°d tb ties t#o}4`i`;i jai -
<br /> lawsiregulatlng.constriction;.Countyand'Ciry"c�des�zonihg,reguladons,•aatdland-d6Velop�ili %ulaonsirr:iti uri dii li:Iralro cetiifj►that'1
<br /> unddtstand:thgt the:tegulationsvofother government' 'd 's�may applyy Eo tfie Intentled woork;arid'fat itfls my n3spori§tbiti[y to_ident aV�rtt t adtoQs:R�;7.
<br /> musttAe to bOwbomplianee Suchragendes iridude bUtare:notlimltedtor
<br /> Departti,ent of Environmental P�'Qt coon-Gypre. s. Ba9heads,a W. tland:,A eas .and..En ironfneiital y Sensfive:,
<br /> ,, •• �,' 7 - �t�,';�. Nye::�,_-.;:
<br /> �. ,.�T,a:J rt.rr:�•Y"�� "y.�Sr1- '..i':;' _ cr.t': rn.4._,rk''' �-. •'.��r.:,,'s;':,LaAi.� 1i''•}.�ak' ARM
<br /> _,�:: .,.
<br /> Southwest. Florida-'11Uater :iVlanagement Di trict�..el s, C eat( :: 111�t1a s Af at~n
<br /> Watercourses.
<br /> a.
<br /> Army C"orps of Engineers=S.eawalls;¢D•pcks;.Navlgabie.Watelways.
<br /> n n,;, ;
<br /> �: S 1�vt�+ mental a ast C
<br /> Uepartrn'etit'of F4eaCth &Aliabilatty ervices/ leait#i_'Unit`-ViI`'lls�. 11` "ewdtel treatriten
<br /> f;.
<br /> Septic Tanks.
<br /> US`Environmental Protection'Agency-Asbestos•abatement.
<br /> FederafAviation Authority-Runways.
<br /> (understand.that:thefollowingresMctions apply-to the yseeff:,fill:,.;,;.:. .:y :+:;�
<br /> Use.of.fll is not alloweitin' �od lbne"�"untess`expres'slyperiiiitted:..
<br /> if the'fill- material is to be:used:ir►y flood: Zocie aA",:.:it:is. nncleirstobd;"thAf,e drslirt ge;;plan:addressing a
<br /> °compensating volume°wilt be°s Siiiit�ad et='tifin'a`'if' 'ei 'i ing tiich��i � Y ared iy A pp essidnii e�gi ►'aei:
<br /> licensed.by the State of Florld , ,':,,,_ :1•:.. .: ;V ;r :>>.
<br /> If the.fill.material is. to be..used-:In-Flood:Zgne:W in-connection,with::; permitted'.b A ding-.t using stem'wall.
<br /> MR��Nill b� setl rtl eta f l t :Bar
<br /> ea�� it�ti�eisfcr�;
<br /> ='ebiibtcuction,•I°certitytthat 1. y !. ,tt._ -,.,,.,... rJ.. . s.. , ,.
<br /> Cf fill material is to•be use8,tn. �iy.':'aree':l certifji.'fhat useµef;stair= ill not�advesely<a#teCt'adjacert''
<br /> of`:fill.:is:"f and .# atlt�eis''1 at'fect dd'ac eht-,properties; tlie.;owner rrt y be;cifotl or:viol2t ng ;.
<br /> •.:Q,,.:.;.ets9..y 1.
<br /> ttt'iesueid•Wri `tlattaFie,d..,perrt�itapPltcatioFr foi':totsles tkor eons-otlthe condt < tY .
<br /> _
<br /> acre'wiiich are:elevated•b. :.fill alt'engineere�).d' : g 'plan
<br /> Y,`'"' infoCtri.ihe er'dittie; rfiittin ;co d on'sset:.forth;inthls:affidavit rio:to.. f.
<br /> If I am.;therAGENT;FORTHEJOWNER;>I Ornritiee irt:gooil faith to gwrt pe g �f iq ,M P
<br /> Jv .M Sirs T_'a.r S
<br /> t'OlSberstaitid.thcira se araEe': itrr a be regi lred`; r:elecfiioalni�vbi ;4piurrib i}g1' i i e efls;;poblln a"iaoon_C ori....
<br /> commencing,cori"sfio4loi: Y:�,• d" eti'to tia..lcensesto roc:eed;�vitfi`tli i�otk a'd;:riot'as; ,
<br /> WSP1.11 :. ..::authgflstgi7ibTate,:FhC9t�ttter;;or set astda anyproiiistns € fie-lethnl . I.�Sor;s0.iasuance.of a perti�lt p[eveetth6:BuIIding:OJN ,altrroiio%reQtid4 o errors to plans;co st&t6lrrorvlolatio bl� � .'J=;vetydpet itFi , ell tieoti a ibvair Yr nioi�C
<br /> authbrized'b such: eiiriit'is`commenced' 'ghln stz.mofift°f. emt(t IssuA;ce,:or if: aliifi"orYze .. e; r 1 5as't ttetf'o itfJd ed:fora
<br /> Y t? p. k bjtg
<br /> tti n1Hs after..the;time th'e.wofk.ts`.66"hi ielyi:ed:`An:extensto m�iywb®:regUe��d,iAwii itirig,f�i `;:tli�euiiding�Ofl teal' �'�a p��riotitti�di{�. �
<br /> excee(1 nine�y:(90jdays`:2i id viiilt?leiiidntt►'ate'juattRa6to Cause forthe.e5ctenstori::ifiwork'ca3esAfor�ninaty9bnseCfie'tYay ;:,;._,jdE3?7sroonsid .
<br /> ab6fidoned.
<br /> z :..r.,, -OtESt1L: '::1N;wCiCi2ss,��.:
<br /> WARNING-TtOWNER. YOUR; Adi+UR '�° zRI=CORD CIt±EaCOMIVIENGE. t'.M,` :•.
<br /> v N: �: ovRaPL dP KTTi:li ou� 't uw. :;
<br /> IRAI16:TWICE FOR.IMPBo.. M Y. ¢�./,�: j��y y. :.
<br /> .gars. _..s,. ..;.i: -,`,A %:i i: 'N •flErURlt~ IC{s�,IR�IIt. Y�NJRti���,Galr^.,<s�MIlAIC1Yl'31Y1'G°�.7
<br /> WiI r d 1R I" hi�&MOR�f,AEI t �---
<br /> FLORIDA JURAT_(F.S:-117.03)
<br /> OWNER.OR AGENT - CONS ►CTOR s ''
<br /> SubscHbed:and swom�to(or'affirmed)`before me this Subs'cTtbed`alttlswom-to'. r'a$iirned��ti" re me:flifs��'..-:c��;`�;?,'•�
<br /> Who'ifslare persorlally>tildtvri'to'me`6rFiaslhave:.protluced- Who.is'/are:persor�ol�linovdi ttltesails7ti�VpTt�tllrciet;'
<br /> as-identificaeor: as identiftcaffon:
<br /> ,:Notary Public °t `ry ... -,..
<br /> N Public
<br /> r ., _. ,. t :. . Ill($ IY :. t .- - ✓ . "�.s a. T.:� ..
<br /> Commission No. Corn sion. o:. '
<br /> Name-of Notary typed;printed or stamped '''Name"of Notary typed,'+prfrlted or stamped:.: �
<br />
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