<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 />
|