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<br />WARNING TO OWNER: YOU <br />PAYING TWICE FOR IMP <br />WITH YOUR LENDER <br />FLORI DA JURAT (F.S. 1 . 3 <br /> <br />OWNER OR AGE <br />~SUQl;cribed and m tc! for rmed). betore,q>e trns <br />11f. UC'- (,J. l.~ E." .rc.... <br />)0410 i~ar rsonally kno'Mllo me or has/have produced <br />~. OJ" Ld. V<.l-I&- as identlication. <br />"""........".,, <br /> <br />..........~..\\o c. NI8.s::~." ~~.. _ Jry Pu~.- <br />... 'b.." ........ ''J _ ~ UW\i <br />~.. <:)l - .... ....' ~ <br />: .' NOTARY... Coml\ission No. <br />g f PUBLIC ~, d- c.... ,..::J ~ jf<j-., <br />- -~.~ <br />% "My Comm. Expiresl ~r Notary typed, printed or stamped <br />'; ~ ... April 29, 2009.. <' ~ <br />~ 't..-:. -.. ...~.. $ <br />~ /"^ .......... .:> <br />'. <...In ~ .... <br />"'" "'ON C00 ........ <br />"""'11.,. """, <br /> <br />... <br /> <br />CONTRAC <br />Subscribed sworn I!> wr affirmed) beforjl me tl* <br />]1Ao.4 I~. 'Z4 Wi I (..' ~ fC.. ~"- <br />Who isla", persoq,ally kno'Mllo me or has/have prodUced <br />~ ,. tftV' l,..~ as identification. ,\'111111'"" <br />"" I" <br />....... 0 c. N18.s. "'" <br />~c:~==:::> ...... ~'\ ........ ~-,~ <br />/ ... Notary Public $ Q~ ... RY... ry -:.. <br />- $.... NOTA .... ~ <br />Commission No. : : PUBLIC : ~ <br />~'J c.. !,. : : _': : <br />- "-J..t..."'^--' : ~M Comm,Explres: 0 = <br />Name of Notary typed, printed or stamped :. 0 ...Ay U9 2009" <' S <br />\ "Yh -. .pn I .."1'... .. $ <br />", /'^ ......... ...:' <br />'. Vn .\:.. <br />"" "'~ON cov ....... <br />""""11111"""\ <br /> <br />'. <br /> <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. TIle undersigned assumes responsibility for compliance with any <br />applicable deed restrictions. <br />UNUCENSED 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 cortractor 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 comct 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 IMPACTIUTIUTlES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understand. <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 UEN 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 Rorida 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'S/OWNER'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 an 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 government 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 I <br />"compensating volume" wiD 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 Rood 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 pemit 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 /> 0 <br /> ::u <br /> m <br /> '" <br /> ....... <br />N CS) <br /> CJ) <br />0 ....... <br />... <br />N "'1J <br />C) <br /> ....... <br /> CS) <br /> .s::. <br /> w <br />