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- NO710E OF DEED RE8TRICTIONS: ThB ix�deraigned tmdetstat�ds that tt�is permft may be subject to'deed' restrk�ions' <br /> vvhich mey be more restrictiv8 than Catxriy reguletions. The �x�dersigned assixnes respo�ly for cortipfianoe wilh any <br /> appqc;abte deed resUictions. <br /> UNLICEN8ED CK�NTRACTOR8 AND CONIRACTOR : if the owner tiss hired a cor►trac�or or <br /> GorNractors !o undertake wak. �eY rt�ay be �equied b be Yoe�ed ir� acoondarioe with st�e eM bcal r�egt�fions. If the <br /> � is not Nc�d es required by iaw, t1otl1 U�e owr�er' snd oonbacfor mey be cNed ior a mbdexr�eanor vio�tilon <br /> urxler state law_ M U�e owner or �ded cot�ador are �oertain as to vrhet iOe�in9 � may apply for U�e <br /> k�ended work 1heY are advised to oontac* tt�e Pasoo Ca�ntY BuNdn9 I�pection Oivisiort—Lioe��sing Set�ion et 727-847- <br /> 8009. FurU�ertnore. rf ihe owrier t�as hired a oonlrac�or or 000traclws. he is adrieed � have ihe �s) s�gn <br /> portlor�s of the `corf�racmr Biock" of ffiis appNca�On for vrl�Ch itley wi1 be respor�ible• If Yau. � the owner Sign es the <br /> oonbador, tl�t may be ��on fh�t he ia not properly Moensed and is not e�tled to pe�rril�rg priuieges (n Pasoo <br /> �Y- <br /> TRANSPORTA710M M�ACTAITNJT1Ea IIPACT AND RE80l1RCE RECOVERY FEES: The tr�de�ai8ned tnderstarx� <br /> that Tronapatatfon Nnpect Fees and Reoarse Reoarery Fees mey appy 6D 6�e oal�on d new buldings, drenge of <br /> use in ex�n9 bWldings, or exPer�sfon of �(n9 buA�s. as sp�Aed h Pasco County Ordirrenoe rxrnber �-07 and <br /> 90-07. as emended. The � alao underatar�ds.lt�at si.rh fees. as ma�t be due. wAI be identlNed ffi H�e dme of <br /> pertrdMing• ft is fisU�et unders�ood �at Tra�poR�ton Irtipat:t Fees and Reso�roe Reoo�y Fees must be peid pNor to <br /> rec�eivk�g a"oe�e o� oocupanC� or Anal power naiease. tf the q�ojeCt does not i►vdve a oertitkaie of ooaipenc.'y or <br /> lina{ power r'eleaae, tt�e fees mu� be paid Prbr io perntU �noe. Furthemiore. ff Pasoo CouNy VI�edSewer irtipat:t <br /> i�es �e due,lhey rrp�st be paid P�ior b Penr� isauanoe in a000ndar�oe v�tlh appYcable Pasco Cant�► adirrenoes. <br /> L�x uw �cnaa.r rs, F�orw. saaias, as ama�a.�: If v�non of woAC is s2.soo.00 or more. � <br /> Cerdfy th� 1, the epp�t, 11av�e been p►ovWed M�Ih a oopy of the 'FlOrkla Col�strl�on I.ien s <br /> Protectlon Guide' prepared by the Florida Dep�irnent of Ag�ioWpme �d Cor�rner Aifahs. If the applic�nt is someOne <br /> otller tl�att tAe'o�wna�'. I Certify tl�at I heMe ablai�ed a copy of the aboMe desatbed doamerrt end pro�Nae in go0d �th to <br /> deYv�er � to rie "owne� prbr to commenaemerN. <br /> AFF'�A111't': 1 oe�lify �at aN tl�e i�orrns�ian in Utis a�pRc�tion ia aoax�de and that aN wak <br /> wiN be done h camp�noe wMh aN aPP� ��B �, �8 �d lend da�elopment• AppNcation is <br /> heieby mede !O obtedn a pen1� to do �k aAd irlst�a�ion � indicabed. I ce�fy Qret no work or Ir�aUof1 tias <br /> oorr��0ed Prfor tD isst�anoe of a pBrtNt end U�at aM work wiM be pe�famed � rtieet standa�ds of aY laws r�egulatlng <br /> oo�strudio�. CouMY and CMY aodea. m��9 �tlor�. end 18nd dB�eioprt�ent negu�lior�s in ttte ju�sdidi0n. I also <br /> certlfy tl�at I understand �et tAe negt�latlo� of olher goMetrrnerK a� rr�Y ePPb �01ha inlended wak, �nd tl�at ft is <br /> mr respo�ibWty to idenMy wnat ac�ions � rnust caice to be n o�. such ag�►cies induae a,c are na lirrr�ed co: <br /> - Departrnent Of F�1AnOmrerlfal Proledion-Cypneas Bayt�s. W�Btla�W Ar�eas sa'1d EnvirarnerNally S�sidve <br /> Lands, TreabmeM. <br /> - Soutl�west Flo�ida Waler M�a�nent DisUiat W�ells. G�rpress Bayt�s, VHetland ArBas, ARering <br /> 1Aia�er0otr'ees_ <br /> - Am'N Corps of F�gi��. Docks. Nsvi88b�e V1tat�ways. <br /> - Oepartrnerk of FIeaM $ Rshab�Eatire H�Mh UaiRWeNs. Ntasiewel8r Treatrnent, <br /> Septic TarMcs. <br /> - US F�viromiental Prol9clfon i4�er�cy-AsDeStoe abatBmieM. <br /> - Federel Avieiion Aufho�y-Ru�ways. <br /> t �xideratend tl�at the �ONowkig testflctlOr�s apply to the use ot 1NC <br /> - lbe of � is not allo�wed ui Fiood Zone Y. urdess expre�ly penr�Esd, <br /> - �► a,e � mae�ai �s m ne ueed tn �ooa zone n-. rt �s „nders�ood ms� a drar�e v�n adare�ng e <br /> •car�per�ng vaurr�e� wI� ee suerr�fea � tlme a perm�tin0 wriicn is pre�ed M a prote�on� er�eer <br /> Yoe�ed by Ute �ale of Florida. <br /> - It ihe � rt�ial is to be used in Flood Z,a�e A� oax�ectlo� wilh a pe�rnilied bdic�n9 usin9 s�n weR <br /> c�o�trtx�fon. I certify ihat f� w� be +�sed ord�r to fiN the �ea wilhin ihe s�ern w�d. <br /> - If Ap ma�ed iS �D be uaed � ery ares. I CerUfy tttet use af sllCh fiN wi ncit adlrerSely etiec� ac�ac�erlt <br /> pr�Ope�es. If t�se of AN is tourld t0 adve�sely e�F9ct adjaoent PmPerdes,lhe owner may be CNed for Violetlng <br /> the oondlUons of the biidki9 Pem� issued u�der the �ed pemitt appli�qion, tor lols less ihan one (1) <br /> acne wtach are elevaled by �11. an ergirieer�ed �ainage Wer► � nequired- <br /> If I am the AGENT POR THE OMlMER. t Promtse in good �itlt �o infam the arner of Ihe pemrlting corxAtlo�s set �orth in <br /> U1is et�davit plor �D coflrnelldflg c�atrl�On. 1 ulldelstarld thet a aepa�e PemMt maY be required fOr fl�ectriCal w�Ork, <br /> P�9• �. �s. Pools. ei' condUonkg. 9as. a' otlter ir�il�a�ns not spec(�y ktdlided in the appicatlon. A <br /> permit issued sheN be � W be a Iice�fse �o prooeed with 1he work end nOt � etNktority 4o vi01aEB. Cenoel, aaer, or <br /> set aside an�r Wwisions of 1he tadr�cat cades. nor st►eN i�uanoe of a Pemiit Pnavent the Btiling Ol�el Nom tl1� <br /> requi�fi'i9 a cortec�ion of eiras in piar�a. ao�truetion or viola�ons afi any codes. Ev'ery Pemdt iasued sf�aN beaort�e irnralid <br /> urYess 1he work a��totiaed by such Qem�t is oorrrnenoed wilhin sbt mootl�a of pemiit issuerwe. ar N wwk etAhorized by <br /> ihe Permit ia suspended or a�ndoried for a period of abc (� monU�s aNer ihe time tl�e woric is oornmenoed. M ex�ion <br /> ►naY be �e4ues�ed. in wliBng. fi'om tl�e Buiding OR�1a1 tOt a peri0d rlot b 6x0eed NnalY (96� daI►s end wIM dem0�ha�B <br /> jusUflabte ceuse Wr the e�c6e�sion. If w�ork c�eases for metY t90) consecudve days. the job ls considered abau�doned. <br /> WARt�NG T�O O�YYNER: YOUR F/VLURE TO REOORp A N0710E OF MAY RE8ULT IN YOUR <br /> PAYIN�fi TYYICE POR TO YOUR PRaPERTY. � YOU MITQID TO OBTAIiI FINANCNi�i. CONSIJLT <br /> WITH YOUR LEI�iD� OR /1N AT'R�RIiEY BEFORE RH�RDNG YOUR NOTICE OF <br /> PL .NNtAT (FS.117A3) <br /> ONMER OR A��ENT COfITRACTOR �--�. ^� 'r�y <br /> ' S��eabd �swan b �djbafoQfq is rY1ct.�/ and awam b(or m l hs��ms MAs � <br /> 3 �t Fv i ���..bY ?� <br /> Who IeNis p�on�My IQ�owo b�or� Who ps�so luwwn b me or frtAww qodi�osd <br /> V � `. as identlfC�YOn. <br /> �� w� �� �� <br /> �� <br /> � �. �.N..�, �. <br /> Narne a4 Nofa�� •..,. c ap� Nrns d NaWY h�P�. pM�Md or emmPed <br /> * * MY COMMiSSION # DD 988714 �*" ;'�' ppM S(�{REC�OST <br /> ,Q... <br /> EXPIRES:July12,2014 * * MYCOMMISSION#DD988224 <br /> �f9�OFF��\oP B0"dedThruBudgetNotaiY� EXPIRES:July <br /> � F4� � �YU BII� nuw� SYVM41 <br />