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<br /> VYhIC�I RHy bB RYJf@ �'IC�IME 1�1T1 C011lly I�ORS. T}12 1I1�2I51�1B(� �IT� �LS�bl�ll�/ �CX OOfl'�1�102 Widl 2«l�/
<br /> �IICE�718 dB�C11H6tI1G�lOf1S.
<br /> I�JCB� Cp�ITRA�GTORS AI� OOPIiRA�7�OR RESPO(�SIBILI7IES: If tlie ovKier Fras hired a oontracrtor or
<br /> oontracta's to uxJertalae wak 1heY n'�aY be required to be fioer�sed in a000rrfar�oe with stabe ar'�d local r�eg�a6or�s. If Ute
<br /> oontrac�or is not licensed as req�ired by law, bolh the owr�er 2rd oontrador r►�eY be d6ed for a rr�r�eanor violation
<br /> uider s�te law. If the ouKier or intended oorxrf�c6or are uioertain as to what lioensin8 re4�re►T�S maY �P�Y Tor fhe
<br /> irtencied wak.lheY are aduised to oa�Fact tt�e P�asoo Ca+rlY ��►�8 ��Pe� ' .'',edion ak 727�47-
<br /> 8009. FWherrrrme, if Uie au�ner has hired a oontracaor or oontrac6o►s, he is aduised to haue the oontractor(s) sign
<br /> portions of 1t1e "oontr"�Ctor BIocJ�' of Uis appliCation f�or' wtrcf� U'tery will be responside. If you. 2s the dn�ler' sign � tl1P.
<br /> oontrac3or. that may be an irxiceifon ttrat he is not prapery lioensed and is nd endtled tio Pem'im�8 Privi�e8es in Pasoo
<br /> TR/1f�5PORTATION INP�4�CTM1LJ71ES INP/1�."T AND I�SOI�E �VBZY F�S: The uidersigied tndersMarxJs
<br /> ttrak Tra�sportation Irrpad Fe�s and FZeoaise FZeoouay Fees rttay apply to the Qor�Gruction oF new btil�rgs, d�a�ge of
<br /> use in eodsling txildu�gs, or eoq�eruia� of eoastinB biikirgs. as speafied in Pasoo Cou�ty Qidinanoe ntiri�er 891y7 and
<br /> 90-0�7, as arrieiXled. ThB ��ed also u�derstands, Vret such fees� as may be due, will be iderrified at the tirne af
<br /> perrritting. It is fiiUier tixiers�ood thst Trar�spartafion irrped Fees and Resounoe F�eooMery Fe� m�st be paid prior to
<br /> reoeiving a"oertificahe af ooci.perx.y' ar firial pa�er r�elea5e. If the preject does not inudve a oeAificx6e of aocuperx.y ar
<br /> final power r�elease. the fee.s mat be peid prior tn perrrit issuanoe. Futt�rrrnre, if Pasco Canly � Irr�t
<br /> fees are due,lhaY mut be Peid Prio� t� Pemrt i�,�r�oe in a000rcianoe with applicable P�aeoo CarrlY ar+dinanoes_
<br /> (�0�6TRlJCi1�N LJBV LAW (Cftapber 713, RorkJa 9feh�Ees. as arr�endec4: If valuation of work is $2.500.OU or n�one, 1
<br /> oer6fy Uiat I, the appl'�cant, Ftave been prwiCled wilh a oopy of the "Florida Cor�stnx�on Lien s
<br /> Pra�tection C�l.ide�' PrePer'ed bY ihe Florida Depertrrient of Agia�die and Ca�mar' Affairs. If fhe app4c;a�'ti is sorr�eone
<br /> c�lt�'ttnn the "ou�r�". I oertiy that I haue obFained a mPl� d the 2bo�ue described doa rrer# arxi prorrise in good faith to
<br /> deliver it bo tlte "av�er" prior to aorrrr�enaerrent.
<br /> OpJTRAGTnR'S�ON�S AFFidAVIT I oertify that all ihe �omia6on � tFrs applicaGm is aoarate and Bra� all worlc
<br /> will be done Yt aorrplianoe with all applicable lau�s r�e8t�alinB oor�strtxlion� mnirg and 18e�d de�loprreik. APP�icafian is
<br /> hereby rtede � obtain a pemit tio do wark arxi c�sfallafion as irxiCated. I oerfiy fhat ro work a ir�stalk�lion has
<br /> oorrrnenoed Prior to issuanoe of a perrrit axi that all woAc wi11 be periorrr�ed to meet smrxiards af all laws rea,iab�9
<br /> oo�6n�dion, CarXY ar�d CttY aocles� �o�g re9�. and land deueloPment r�egulabors in the juisdic6'on. 1 also
<br /> oertify ttrat I �rxlerstaid that the re8t�a6orts of dher 9wertrnent agendes maY 2Pf�Y �o ihe intended wark arid U'iat it is
<br /> ►TN nespo�ibility �o idenliy wl �at actions I m�at talae to be in oo�tpliaioe. Sixh agerxies ir�rcle but are not GrriEed tio:
<br /> - De�pertrr,e��t of r�uirorrr�ental Proteaiar{,ypr�ss Ba�rheeds. vlknand �s and Emrirorrr�aly Ser�sitive
<br /> l.ands, V�hterM�steweter TreatrnBrY.
<br /> - Soutlivaest Florida V1EtOet' �rent District Vlklls. GyP►ess BaYF�eads Nlktland /V+�s, Altering
<br /> Vlkbenooiises.
<br /> - Amy C.orps of Docics, I�61e �l�b�v�ys.
<br /> - Deperfinerrt af Fieellh 8� ReFiabilit2five Servioes/Enuirorrr�er�Fal H�aalUt Urit V1�I�s, V1�tan�eter Tneatr►errt.
<br /> Sep6c TarYcs.
<br /> - 1.1S Enuinom'ter�al Pra�eclion Agerxar,Asbestos abekerr�'t.
<br /> - Federal Avi2tion
<br /> I�and that the folloa�ng restric�ions 2ppy to Ute tae of fdl:
<br /> - Use of flll is not allan�ed in Flood Zone "V' irYess e�ressly perrritted.
<br /> - If ihe fill rr�terial is to be used in Fbod Zaie A, it is �nderstood that a drair�e plan ackigssing a
<br /> "oorrperuafing v�durtte wiA be s�3xtitbed at tirrie of perrrtitfing vdiidi is Pre�er'ed bY a Pro��O►�al en9r�r
<br /> lioensed bY the State of Florida.
<br /> - If tlie fill rr�eberial is bo be used in Flood Zor'�e "A in aorx�ection with a perrrit�ed txildmg using �ern well
<br /> oonstruGtion, I oertify ttrat fiM will be usad ariy to fill 1Fte aree �n�tl�in Uie stern wdl.
<br /> - ff fill rt�erial is to be �sed in any aree, I oertify that use of sudi fiH wiN not aduerse�y affed acfaoerrt
<br /> pnoperties. If use of fili is fand to aduersely afiect ec�2oert propeRies, fhe auner rrey be ci0ed for viala6ng
<br /> Ute oo�nd�6ons of Uie b�ildmg perrrit issued urxier Ute attadted F�em'it aPp�ication, for lots less than one (1)
<br /> acfe which are ele�rated by fill. an ergneered �ainage Plan is reqiired•
<br /> If I am the i4�IT FOR 71f UYN�Bi. 1 pro�ise in good faiCi to iriorm the anrier of the pernilting aonatiors set �orth in
<br /> this 2Rfidauit prior to oorrrrendng oor�shnx�ori. I u'iderstand that a seperabe Per►rit meY be r�eq�inBd for eled►ipl wor14
<br /> durt�inH, �. welis, pools. air oondrliorrr�, gas, or dher irstallatia�s not speaficaly induded in the applicatlat A
<br /> perrrit iss��ed shaq be ar�trued to be a lioen5e to pnooeed with the work end not as autFiorily to viola�e, canoel, al[er, or
<br /> set aside arN Provisions of tl�e becfriic:al oodes. nor sMall issuanoe af a pemit preuent the Btildng Oflidal from thereafter
<br /> ret}irirg a mrtedion af errors in plans, oonsGn�ction or viola6ons of any oocles. E penrit issued shall beoorre irnialid
<br /> unless the woric a�tFnr¢ed by such parrit is awrrr�er�oed witliin sbc rtrmtltis of pemit issuanoe. or if walc atlhorasd by
<br /> the pemit is su�ended or abendoned tar a period af sbc (6� rrnrths aRer the time the work is oorm�enoed An eoden.sion
<br /> rrgy be requested. in wrilimg, Trom the &ikir� ORdal for a period not to e�aoeed rrnelY (9� da�rs and will derrnr�rabe
<br /> justiflable cause for the �on. If work ae�ses for rinety (9� canse[�ue days, the job is oor�sidenBd aberKloned.
<br /> VIWiNNG'i0 CJYN�6Z Yd.�i FAlLL�1E TO �Cd'� A MAY R�ILT IN YOI�t
<br /> PAYING TMCE F� INPI�VBNBYi3 T� Y�Ol�2 . F Y�OIJ 1 N FINANCINCw, OONSIL.T
<br /> A
<br /> ROPoD4,ft17AT(F.S, 117.00ij
<br /> QMHt OR AG6�I� OOIYIRAL"IOR
<br /> 51i�evibed �e�nCln 40 (ar alfirtned) befae rre Vfis `'` / and anan (or O me �
<br /> w,o islae personely Iaw�n eo me ar n�lhe�e pm,aed w,o' lvnNn to me ar r�lr,a�e pro�,oed
<br /> as;aa,tifical;Q, � : rL : r � S' as idenbfiw6an
<br /> Nofay P�lic �` �` ( `-d'�+u'�--- Nalay Rblic
<br /> �,�. �,� � a� 7 e�4 0
<br /> ►�rr,a o� ►�om�r �vaea rsirxed a s�n�ed ►�r„e a� t�p �n a
<br /> �.�„ P�e,, AN A MCCOLL'JM
<br /> ?r°, ,`�; Notary Pu61ic - State of florida
<br /> " ;: My Comm. Expires May 13, 2013
<br /> =;�� ,o P�;' Commission # DD 878490
<br /> Bonded Through National Notary Assn.
<br />
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