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<br />
<br />i6hsilf.
<br />,... [.,l[~9t
<br />Gaunty,
<br />RAN~ TIClN IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned Understands
<br />/i ;,i"tI1~J,Tr~.!1~ 'ClIl Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
<br />';,if'T.~~~J9~*iS ulldings, or. ,expansion of existing buildings, as specified in Pasco County Ordinancen.umber 89-07 and
<br />'!'(:~9:071as '.."",' </e~; The undersigned al~o understa~ds, that such fees, as may be due, Will be idehti~ed at the time of
<br />p~:tl11itung.iU~J~,(u~her understood that1;ransportation Impact Fees and Resource Recovery Fees must be paid prior to
<br />re$eiVinga~~~~ifit:ate of occupancy" or flnal power release. If the project does not involve a certificate of occupancy or
<br />finFlI power rei~~se" the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
<br />fees are due,Jh~ymust be paid prior to permit Issuance in accordance with applicable Pasco County ordinances.
<br />CONSTRUCTi(jN 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 "oWher", 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 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 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 Gorps 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 beeited 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 ~hat a s.eparate perm~t. may ?e requir~d for elect~ica.1 work,
<br />plumbing, signs, wells, pools, air conditioning, gas, or other installations not speCIfically 1n~luded. In the application. A
<br />permit issued shall be construed to be a license to proce~d with the work a~d not as authorl~y !o vlol~t~, cancel, alter, or
<br />set aside any provisions of the technical codes, nor shall Issuance of a permIt prevent the B~II~ln9 OffICIal from the~eaft~r
<br />requiring a correction of errors in plans, construction or violat~o~s o! any codes, Every ~ermlt Issued. shall become. invalid
<br />unless the work authorized by such permit is commenced Within SIX months o.f permit Issu~nce, or If work authorized. by
<br />the permit is suspended or abandoned for a period of six (6) months after the time th~ work IS commenced., An extenSion
<br />may be requested, in writing, from the Building Official for a period not t~ exceed nrn~ty \90) da~s and Will demonstrate
<br />justifiable cause for the extension. If work ceases for ninety (90) consecutIve days, the Job IS conSIdered abandoned.
<br />
<br />WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
<br />PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
<br />WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE 0, F C OMMENCEM~ENT. ,
<br />
<br />FLORIDA JURAT (F.S. 117. ) 1\0 /I ,n 11.0 ~
<br />CONTRACTOR dVLVr~
<br />sub:;crlbed and swom.Jp.Lqr:.afflrrne~ b~e llJeJhi&
<br />Lj-fl-o 7 by ~ I &f~ll{. ~..:::>
<br />Who Istare personally known to me or hasthave produced
<br />as Identification.
<br />
<br />,
<br />i
<br />I
<br />~,".JI~~QFr(j~ED'RESTRICTIONS: The undersigned understands that this permit may b~ sUl>jedto"8e~i:l,j;f~~triptidn~ri
<br />\A(191),m 'ft;Wre restrictive than County regulations. The undersigned assumes respdiisibiiUy forCdmp.li~tlC~WltM~hy
<br />a' "ncat)~~trictions. -,,' , ,,\ <,
<br />:gNTRACTORS AND CONTRACTOR RESPONSIBILITIES:, If .th~dY(ner. hashife~~..~ohtfacior/6f .','.:
<br />g,ertake work, they may be required to be licensed in accordancewiths,t~te~[)ai~b~Lf~~~I~.tI.~ns,dtth~
<br />'.Ii.c.ensed as required bylaw, both the owner and contractor m~YibeiPit~~ifqr'~f1:ii~a~m~~BtjrVI(jIEl.H(m
<br />,",i{the owner or Intended contractor are uncertain as to whatliq~nsin~te~Uif~rii~.nl&m~Y~~pJYfbf tH~.
<br />'~Mare advised to contaol the Pasco County Building InspedionDiViSiori"LiCe.nslb~.~~qti6~>~tt2t-84i~'
<br />r~, if the owner has hired a contractor or contractors, hels,advisedJbh~ye .tIiE!'CO~{r~qt6f(s)sigH ,'.
<br />fltractor Block" of this application for which they will be responsibl~., if 'you,aslheown~tSig.n a.s the
<br />.' e.Y be an indication that he is not properly licensed and is hot entitled to perhiltting prlVlieges ih, Pasco
<br />
<br />
<br />Notary Public
<br />
<br />mmlssi No. :'::.. JACQUELINE BOGES
<br />';', Commission DO 6,1~
<br />"i Exoires oecember 12, 2010
<br />Name of Notary typed, printed"tw'~'\flt5fi'linsu,.nc'''.J\I,_/ul!
<br />
<br />
<br />Notary Public
<br />
<br />IM'QI 'EllNF BOGES
<br />;. '" Commission DO 621833
<br />, " '. " FVp'ir9'> nl>t;:l>mhl>r 1?, 201Q
<br />Name of Notary'1y~g.,.;-printeiicDfir5ta/Rfledrrance 800-385-7019
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<br />"J s ~ 0 -' g l 0 -- Co / -- (p 7 ~ --D
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