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<br />NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" <br />which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any <br />applicable deed restrictions. <br />UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or <br />contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the <br />contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation <br />under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the <br />intended work, they are advised to contact the Pasco County Building Inspection Division-Licensing Section at 727-847- <br />8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign <br />portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the <br />contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco <br />County . <br />TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands <br />that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of <br />use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and <br />90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of <br />permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to <br />receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or <br />final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact <br />fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. <br />CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I <br />certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's <br />Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone <br />other than the "owner", I certify that I have obtained a copy of the above described document and promise in good faith to <br />deliver it to the "owner" prior to commencement. <br />CONTRACTOR'S10WNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work <br />will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is <br />hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has <br />commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating <br />construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also <br />certify that I understand that the regulations of other govemment agencies may apply to the intended work, and that it is <br />my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: <br />Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive <br />Lands, WaterlWastewater Treatment. <br />Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering <br />Watercourses. <br />Army Corps of Engineers-Seawalls, Docks, Navigable Waterways. <br />Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment, <br />Septic Tanks. <br />US Environmental Protection Agency-Asbestos abatement. <br />Federal Aviation Authority-Runways. <br />I understand that the following restrictions apply to the use of fill: <br />Use of fill is not allowed in Flood Zone 'V" unless expressly permitted. <br />If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a <br />"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer <br />licensed by the State of Florida, <br />If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall <br />construction, I certify that fill will be used only to fill the area within the stem wall. <br />If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent <br />properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating <br />the conditions of the building permit issued under the attached permit application, for lots less than one (1) <br />acre which are elevated by fill, an engineered drainage plan is required. <br />If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in <br />this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, <br />plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A <br />permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or <br />set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter <br />requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid <br />unless the .work authorized by such permit is commenced within six months of permit issuance, or if work authorized by <br />the permit IS suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension <br />may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate <br />justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned. <br /> <br /> <br />OWNER OR AGENT <br />Subscribed and sworn to (or affirmed) before m s <br />by <br />~o is/are personally known to me,..or haslhave produced <br />as identification. <br /> <br />CONTRACTOR <br />Subscribed and s <br />by <br />~ ;o:rrtCII'I::: .J.lt:JSUIli:IllY I\IIUWlI lU lIte'-orJ1aslhave p uced <br />as identification. <br /> <br />~? <br /> <br />Commission Noe" CO? q Si-G:, <br />5lA.21.1 ,rW'~ C"'T()..~I1'tf \ <br />Name of Notary typed, printed or 5 ed <br /> <br />/~ <br />Commission No. CCC 0 ~ QS~t.. <br />5,z.o.('\~ [~~\ <br />Name of Notary typed. printed or starn e <br /> <br />Notary Public <br /> <br />Notary Public <br /> <br />..\\\I~I/~!I, <br />,'..>? . -:'0-,,', <br />::'';'" ?:' ,:;"-: <br />=~ji...d..j} <br />"'/;/0"; ;.: 0<:'...' <br />/""1\\\ <br />~ ~~~ <br />- "d8N <br />~ ::to:3 p;) <br />(s' 1Jj ~ Vi" S <br />OJ g .. ~. 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