���,� ��33 �R��t�S. '"he unders�gned understands that this permit may be subject to "deed" restrictians"
<br /> ,��, �, �e r�e re�re tlt� Cauniy regulat�ons. The undersigned assumes responsibility for compliance with any
<br /> fteed - -
<br /> � ��g � CONTf�CTOR RESPONSlBtLITtES: If the owner has hired a contractor or
<br /> ��n��c�s te i�lre�k, t�y rtrY 1a� �� b0 ���ns� m accordance with state a�d local regulations. If the
<br /> ����, ������ ��,,, ��t, the c�er and contr�r may be citad for a misdemeanc�r violation
<br /> �„�, d° ��. �; �e oa�►�r �r ireta�ed c;�actcx aTe e�ncertaia as to what Ncensing requ�rements may apply for the
<br /> r �� ',= rk. �rey ar� a�s�i 4o contact the P2sco County Buiiding Inspection Divisian--Licensing Section at 727-847-
<br /> �x�,r�c �#y,��e ;t th� o�r�e� i�as hired a contractor or contractors, he is advised to have the contractor(s) sign
<br /> �;� gt�� ' �c�c,' o� ��s �pt�at�cn for which they wi{I be responsible. If you, as the owner sign as the
<br /> ���F�� .;,ai r�,av �e a� irx�ca#ion that ne �s ��c property licensed and is not entitled to permitting privileges in Pasco
<br /> �c�s� . . .
<br /> ��q,-np� �,���{�ACT AND RE�OI�tCE RE�OVERY FEES: The undersigned understands
<br /> �� -��,�� � p� �.#�,�c�trse {�ecv�r5r Fees rnay appty to the construction of new buildings, change of
<br /> �se tr ex� � hei�dr�. cr e�-of e�a'sti��9 buikNa9s� � gP��fied in Pasco Co�nty Ordinance number 89-07 and
<br /> ��,�? � =j'�,e • .a1�o �d�ersta�fs, that such fees, as may be due, will be iden�fied at the time of
<br /> �e�„�r��,n� ,t is fwther � that`Tr�ortabon Impact Fees and Resource Recovery Fees must be paid prior to
<br /> .��,�„ a •' ,� �cy° crr fina{ power release. If the project does not involve a certificate of occupancy or
<br /> =,n�t ��� re�a�se, �e �s ma�t be paid prior to permit issuance. Furfhermore, if Pasco County WatedSewer Impact
<br /> t;
<br /> iees are+�, �+ ��e p�icd pri�r tc� P�ermit issuance in accordance with applicable Pasco County ordinances.
<br /> �� � L�f t� �pter 713, Florida Statutes, as amended}: If valuation of work is $2,500.00 or more,
<br /> ���, tt�t i, � � t, hau� been provideC with a copy of the "Florida Construction Lien Law—Homeowner's
<br /> *'fflFB{�tt)t� ��ild� p�i bY the F1or�da DePartme�t of Agriculture and Consumer Affairs, If the applicant is someone
<br /> y ��r ���`, 1 c�r � 1 h�ve �tained a copy of the above described document and promise in good faith to
<br /> � it 1D i�►e ° 4�+�'� P� � ��i.
<br /> �"� � g!�l�1k'�"iT; i oertify that a!! the information in this application is accurate and that all work
<br /> ,,,,,�� ��� c�r�n� v�h a{I ap}�iicab4e laws regulating canstruction, zoning and land deveiopment. Application is
<br /> heretjy� made � obt�n a P�mit to do work and ins#alla�ion as indicated. I certify that no work or installation has
<br /> �arnmenced prior to issuac►ce af a permit and that all work will be performed to meet standards of all laws regulating
<br /> cons�ruetion C�rsry anci City cades, zoning regu#at'tons, and land development regulations in the jurisdiction. I also
<br /> cerzi#y tt��t i understand that the regulations of other government agencies may apply to the intended work, and that it is
<br /> t my re�p�lAsibitiry io ident�fy what actions I must take to be in compliance Such agencies include but are not limited to.
<br /> - Dep�rtment af Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
<br /> Lands, WateclWastewater Treatment.
<br /> _ Southwest Fbrida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
<br /> - `�' 1�Rla�cour�e,s.
<br /> - Army Corps af Engirreers-5eawalis, Docks, Navigabfe Waterways.
<br /> _ �epartfnent af Heatth & Rehabilitative Services/Environmental Heatth Unit-Wells, Wastewater Treatment,
<br /> Sep#ic Tar�cs.
<br /> _ t1g Envi�ta► pro�ectsor� Agency-Asbestos abatement.
<br /> - Fec�eri# Rvia�licm A�rity-Rurnvays.
<br /> � understand that the fotlo�wirig �es�rrctians apply to the use of fill:
<br /> - Use of fill is not albwed in Flaod Zone "V" unless expressly permitted
<br /> i# the fill materia! is to be used in Ffood Zone "A", it is understood that a drainage plan addressing a
<br /> "compensatir� voEume" will be submitted at time of permitting which is prepared by a professional engineer
<br /> ` �rs�ci b the Stabe � Florida.
<br /> � Y
<br /> !f the ftlt material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
<br /> ' constructian, I certify that fi11 will be used only to fill the area within the stem wall.
<br /> ' - If fifl material is to be u:�ed in any area, I certify that use of such fill will not adversely affect adjacent
<br /> r properties. If use of fi11 is found to adversely affect adjacent properties, the owner may be cited for violating
<br /> ` the conditlons of the buiiding permit �ssued under the attached permit application, for lots Iess than one {1)
<br /> acre which are elevated by fill, an engineered drainage plan is required.
<br /> ir � am the AGENT FOR TtiE OWNEI�, ! prom�se ;n good faith to inform the owner of the permitting conditions set forth in
<br /> m�s affidavit pr�or to commencing construction � understand that a separate permit may be required for electrical work,
<br /> plurr�bi s�gns, wells, poois, air conditioning, gas, or other installations not specifically ine�uded in the application. A
<br /> � perr�it ' sha►! be canstr�red to be a license to proceed with the work and not as authority to violate, cancel, alter, or
<br /> "' set a� y prov+sions of ttte technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
<br /> requ�i `carrectiQn of errors in ptans, construction or violations of any codes. Every permit issued shall become invalid
<br /> unless work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
<br /> � the per �s st�spended or at�andoned for a period of six (6) months after the time the work is commenced. An extension
<br /> ;� may be rsquested, in writing, from the Building Official for a period not to exceed ninety (9�) days and will demonstrate
<br /> � justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned.
<br /> WARNING TO OWNER: YOUR AILURE TO RECORD A NOTICE OF GO ENCE ENT AY RESULT iN YOUR
<br /> PAYING TWtCE FOR {MPR V TS TO YOUR PROPERTY. IF YOU INTE INANCING, CONSULT
<br /> WITH YOUR LENDER O Y BEFORE RECORDING YOUR N F M EMENT.
<br /> FLORIDA JURAT (F.S. 117
<br /> z
<br /> " OWNER OR AGENT CONTRACTOR
<br /> Subscribed'and sworn to (or this Subscribed and swom to (or a med} before me this
<br /> by ✓o �t t b Y
<br /> Wh i personafly known to me or has/have produced Wh� perso known to me or ha ave produced
<br /> � as identificatic�n. as identificabon.
<br /> i
<br /> � �
<br /> � -� ~-- Notary P�blic .�-- Notary Public
<br /> I • ---
<br /> �� ) �
<br /> Commissi n No. � o�� Commission Na D D _�Pc�
<br /> Name of l�otary typed, printed or stamped � Name of Notary typed, printed or stamped
<br /> •�'�""�� KRISTEN P. JOSEPH '""""""'"
<br /> '"��"�' KRISTEN P. JOSEPH
<br /> �' '�.:= Commiss�on # DD 882627 '��'� � � " D 882627
<br /> :� '" Expires April 21 20�3 =*• .*: Commission # D
<br /> '%�'� ���aQar � yFaminsurance80' 385-7019 �+�P; ExpiresApri1�1,2013
<br /> " ��A,i,�"t "�ded i � y Fa� Insurance&n 385-701b
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