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NORICE OF D� �: The �ndersigied uxlerstarbs Urat tFrs pemit rr�y be s�ject to "cieed' restridions°
<br /> ' �� �Y be rnore resOric6ve fhan Canly regii�or�s• The indersigied � responsibility for oarplianoe with any
<br /> aPP�ipble deed restric�ons.
<br /> UN.JCB� C�ONTRA�CinRS At� OOIYiRl4Cii0R I�SPOFISIBlt.171ES: If the anRier has hired a oontractor or
<br /> oon6'actors to �.rxierhalae work, Uxy maY be ►�eqiired bo be lioensed in a000�danoe with sFate and local negtiatior�s. If the
<br /> contr�ctor is not lioensed as req�ired by law, both the owrier and oontrada rrey be dted for a rrisderr�nor violadm
<br /> �ncier state law. If the arner or intended oorttraceor' are uioertain as �o v�t�at koe�in9 req�irerrer�Fs may �IY for the
<br /> intended work, U,ey ar�e aduised m oonlac:t a,e Pasoo ca�rxy B�Idr� �nsnecUon Divi�ar�-�io�in� section ac 727-Sa7-
<br /> 80D9. Futt�rrrore, if the auKier has hinad a ooritraclor or oortrac6ors, he is aduised to ha�ve the oonUador(s) sign
<br /> Portions of the "carNr'dGtor' &oCK' d ttrs appliCation for wtlich Utey wiA pe rnsponsible. tf you, as ttle ouKier' sign as the
<br /> oonhactor. that may be an indcafion fhet he is nd properfy lioensed arxl is not endUed to Per►�ittin9 Privileges in Pasoo
<br /> ��Y•
<br /> TRAP6P�T'A71pN INPA�CT1lJTIU7IES INPA[.T /1PD � I�GIBtY F�S: The uxiersigned v�der�ands
<br /> mat rrar�sportEtion ��rpa� r-ees and Reoouse FZeowery r-ees may appy to t},e oor�struc�on of new ai�av�s, atier�e of
<br /> use in eodst�g txildir�gs� or e�ansion d e�asting biikings, as speafied in P'aeoo Canly OrUinaioe rxirber 8�-07 and
<br /> 90�07, ffi arrerxied. The �derag�ed also inder�ancis, thet sudt iees. as may be due, w�71 be identifled at tl'�e tirte af
<br /> perrriUing. R is fiiV�er uxlerstood U'�at Transportation Irr�aCt Fees and FZeeanx Reoo�uery Fees mut be peid prior to
<br /> r�eoeiving a"oer6ficabe aF ooa�enc,y' ar firral po�n� releese. If the project does not inuoltie a oerti�irate of ooaiperx,y or
<br /> final power releas� tfte fiaes m�st be Peid Prior �o penTit i�anoe. Futherrnore, if Pasco Canly Nlkber/Seu�er Irrp�act
<br /> tees are due, theY m�st be peid Prior to pem'it issuenoe in a000rdanoe witli applicable P�soo Canly arclrrdnoes.
<br /> OON67RlJ(.`iION LIBd LAW (C�6er 715. Florida 9Feh�6e6, as arr�ldBC�: tf v21u2tion oFwork is $2,500.00 or rtDr�e, 1
<br /> certifY tl�t �, me aPP�kxnt, haue bee� prwided with a oopy af the °Florida Cor�strt�dion Lien s
<br /> Pruteciion Qide" P�eP�ned M tlie Flarida Dep2rtrr�ent oF A�ia�tue and Cors�rr�er Wfairs. If tl�e appGcarY is sarreone
<br /> olt�er than the "wane�", I oertiy Urat I Fraue ohtained a c�opy af ihe aba�ue descTibed doarrent and pronise fn good faifh to
<br /> deln�er it to the `anR�er" ptior to oorrrrianoerr�ent.
<br /> �OM'RACiY7R'S/a1M�BrS IIFROAVIT- I oertify tliat all the irdorrrtation in Urs applicadan is aocxrate and that all work
<br /> will be done in oorrplianoe wilh all aPPlirdble lains re0ulafir�g ��ctlon� zonirg and land de+�elaprrent Appicaban is
<br /> her�eby rrede to a6tain a perrrit �o do worlc ar�d ir�stalladon as ind�cated. i oerUfy that ro waic or installadm tias
<br /> oorrrnenoed prior to issuanoe af a perrrit and thet a11 woric will be perfomied to meet starxiards of ali laws negila6nB
<br /> oors�n,cti«,, caurly and Citv oodes. mnine regWatior�s. and �and de�elopment regu�abons in me )�isac�on. � also
<br /> oertiy tl�at I viderstand thet the regWaUons d other gaerm��ert � rr�Y a�lY bo fhe inEerxied rwrk and tl�at R is
<br /> �'�Y ��a�nY ���Y what ac.fions I must tatae �o be in oorrplianoe. SZxh agerxies include bu[ are nd IirriDed �o:
<br /> - oe�ertr�x of ��,� �«►� �yr�ds, v�d a�es �,a r��y s��e
<br /> Larxis� V�dterM�sbe�neter Treebrent.
<br /> - SaAlwn�e�st Florida VUah3 Management DiShid Vlklis. (arpress �, Nlktland f�s� Altering
<br /> V���terootises.
<br /> - Arrry CarPs of Er�gineer5-Seaurells, DocJcs, N�gable V1�rweYs-
<br /> - Deperh'r�ent aF I-lealth & FaeFnbilifabMe Servioes/Erivirom�erNal Fiealth Urrt V1kl�s, V1�weter' Tteatr�ent,
<br /> Se�tic Tanks.
<br /> - US Erruirorrrerfal Prntec�ion Ag�r-A�os abei@errer#.
<br /> - Federal Aviation Ai�thaily-Ftuiweys.
<br /> I uiderstaid �ak the fioYowv�g restrictions a�ly to the use oF fiN:
<br /> - Use affitl is not allan�ed in Flood Z,one'V' Wess �ressiy perrrifked.
<br /> - ff ihe fdl meterial is to be used in Flood Z,one A, it is understood ihat a ctair�e plan addr�essing a
<br /> "oorrp�ens2ting vdure wiN be s�rritted at tirre of perrrit6ng wi�h is pneper+ed b9� a Profe�ional enAineer
<br /> lioensed by the State of Flpjda,
<br /> - If the fill rrieEerial is �o be u�ed in f-lood Zone A in oorrie[lion with a perrrilEed txiking iatir�g st�n wdl
<br /> oor�on, I oe�rtiy that fip will be used ar�ly to fill the area wiUiin the stem well.
<br /> - If fill rtt�6erial is to be used in any area, I oertiy ihat use aF such fiN w�71 riot ad�nsrsely a(iect ac�aoerrt
<br /> properties. If use of fill is fotnd to aduerselY 21f'sd ac;aoer* PrnP�, the owr�er rrgy be ci�ed for vidabng
<br /> tl'ie oorxitions of the biilcing pemit ��xier the at�died Pem'rt aPP�ic�Uon, tor lots less ihan one (1)
<br /> acxe v�trd� are elev�ed by fill� an en8ineered drainage Pian is nequred.
<br /> ff I am the ACBJT FOR Tif Cal1�H2, i parise in good faifh to inbo�'rn the an�� oF the PerTrittin8 ooncitions set forth in
<br /> this affidavit prior to oorm�erx,ing oor�strtx�im. I�nde�and Urat a seperate Pertrit n'HY be required for eledrical wak,
<br /> P��+►ibin9. sig�s, wells, Pods� air ooncidonirg, gas, or dtier ir�tallations nat spedficalN induded 'm the application. A
<br /> Pemit issued sl�all be oor�sfilecl to be a lioense tio prOCeed with the work and not as autl'iarity to violate. Cdnoel. eleer', or
<br /> set aeide arN P� of tlle teCFriiC21 a0cie5, nor SFYaII issu�noe of a Pern'it Preuent the Bu'kir� O�dal frorn tlterea�ter'
<br /> req�rin8 a oort�ection of errors In pars, oor�struction or vidafiorLS of anY c�cJes. EvgY Pemrt iss�ied shell beoorre irnralid
<br /> ir�less ttie woAc aulhor¢ed by such perrrit is oormenoed witl�in suc rrnr�s oF perrrit issuenoe, or if walc aulhorized by
<br /> fhe pemit is as{�ended or a6endoried Gor' a period of sbc (67 rnontl�s alter the tirrte fhe wak is aorr�rianoed. An e�densian
<br /> ►riaY be re4u�ted, in vKiting, 5om the Biiking O�dal ior a period nat to e�aoeed rinelY (9� days and will demor�rabe
<br /> lusfifiable Cai.ise fior the e�d�si0n. If work o�ses for rrnetY (9�j odisea�dre days, U1e job is oonsidered a6andoned.
<br /> VW1fiNNG '1'� CJYN�B't YQl�2 FAlL1�tE 7D RB(�OIiD A NOi10E OF Y I�SIA,.T IN YOIR
<br /> PAYING IVNC.E I '1'�Y�l1t Pla0P6�TY. IF YOU IIYRi�D'PO FlW1NpNC,� f�ON15l�T
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<br /> : Z�, Aug 26. 2014 . v; ; i „ �; Notary Public - State ot Florida
<br /> " o y1 , ��a�� p ��fi'� �'.� � N R ,". • 9 MY Cpmmission ExF ras Sep 13, 2011
<br /> ,'�,,�.� �c°N %;,� Commi,sion # DD 706304
<br /> / d�'� t \ �OFFI����
<br /> ,����� �„„���� Bonded Through Na6onal Noi2ry Assn.
<br /> - . `AY`n,wnr'�tnai
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