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''` t�C�T�E pf pEEp RESTRICTtdP�S� The undersigned understands that this permit may be subject to "de�ed" `���� ,�ns"
<br /> y be more restrictive than Counry regulations The undersigned assumes responsibility for compliance�witk� any
<br /> deett res#rictions.
<br /> C�l�tTR/�,CTpR� �4AiD Cdt�TRACTOR RESPOMSIBILITIES: If the owner has hired a contractor or
<br /> to �m�dce rn€oa they rnay be required #o be licensed in accordance with state and local regulations. If the
<br /> � not 4i�ed as �equired by law, both the owner and contractor may be cited for a misdemeanor violation
<br /> �'�� {� at � owner or intended contractor are uncertain as to what licensing requirements may apply for the
<br /> # is�# wro�ic, they are adkrised tc contact the Pasco County Building Inspection Qivision—Licensing Section at 727-847-
<br /> gUpg. Furthermore, if tfi�e ciwner has hired a contractor or contractors, he is advised to have the contractor(s) sign
<br /> por�io�s ofi the "�tractr�r 61ock" af this application for which they will be responsible. If you, as the owner sign as the
<br /> contractor, that may be a� ind'+cation that he is not properly licensed and is not entitled to permitting privileg�s in Pasco
<br /> 3Rpr! SpQR'CIs►TI�! tMPACTN77L.tT1ES {MPACT AND RESOURCE RECOVERY FEES• The undersigned �a�ferstands
<br /> � Transportatroc� Irnpac,�t Fees arrd Recourse Reeovery Fees may apply to the construction of new b�din �ge of
<br /> use r�► e� b�, or e�sion af existing buifdings, as specifred in Pasco County Ordinance numb '. -�`T and
<br /> �-07, as a�r�3, '�he undersigned also understands, that such fees, as may be due, will be identified a# the tirne of
<br /> pe�ng. It is fu�t►er understood that Transportation Impact Fees and Resource Recovery Fees must be paid pnor to
<br /> rece+ver�g a"c�''t�fica� of occupancy" or final power release. If the project does not involve a cer#ificate of occupancy or
<br /> fi�a# powe� reiea�se, tt�e fees must be paid prior to permit issuance Furthermore, if Pasco County Water/Sewer Impact
<br /> fe�s are du�e, fhey rriust be �aid prior to permit issuance in accordance with appiicable Pasco County ordinances
<br /> CC)ldS1R�iO1V L�# EAW (Chapter 713, Florida Statu#es, as amended). (f vatuation of work is $2,500 00 �r m�te, I
<br /> c;�rtif�r that (, the ap�+ca�t, have been provided with a copy of the "Fiorida Construc�ion Lien Law—H � uvr�r's
<br /> Pr�tsc�ior� Guide° pr�areci by tl�e Flo�ida Department of Agriculture and Consumer Affiairs. If the a�lican# is`�r►eor�e
<br /> f c�er�an t�re "awne�', I c�rtify that I have obtained a copy of the above described document and prornise in go� fa'sth to
<br /> to t#�e "awn�" pricrr to commencement.
<br /> SM)iIYN�ER�S A�FtDAV1T. I certify that afl the informatron in this application is ac�urate and � �roric
<br /> � complianae with a!I appficable laws regulating construction, zoning and land devebpmer�f. Ap� Ps
<br /> to vbtain a�errr�it to do work and instaltation as indicated. 1 certify thai no w�rlc or in ' t�as
<br /> priar to iss�,Eance of �a permit and tfiat aA work will be performed ta meet st�nda�ds af aN lav�+s reg�la��;
<br /> �'Qn. Caunty and City codes, zoning regulations, and lartd develapment regutatioris in the j�r�sdi��� � a�
<br /> cert�y t9�at { under�sta�d that the reguiations of other govemmen# agencies may appl� to the intenderJ wvrk. a�nc tt�ai ii is
<br /> . rny respo+�s#biiity to id�►t'sfy what actions I must take to be in compliance. Such agencies ind�tde twt are r� ki�ted to�
<br /> - Department of Environmental Protection-Cypress Bayheads, We#land Aseas and Envirc�ramenta� 5��►+��
<br /> Lands, Water/Wastevwater Treatment.
<br /> - Southwest Fiorida VVater Management District-WeAs, Cypress Bayheads, 4N� A�s, A�'ir�
<br /> WaEtercaurses.
<br /> - Army Carps of EngineersSeawalls, Docks, Navigable Waterways.
<br /> - Departrnent of Hea{th & Rehabilitative Servi�es/Environmental Fiealth Un€�-V�telis, 1�tasiew�teirr�'�e�,
<br /> Septic T�ks. :
<br /> - US Emrirorxr�ental Protection Agency-Asbestas abatement.
<br /> - Federa{ Aviation Authorr�y-R�ways.
<br /> 1 understand t#�at � fioil�rtr�g restrictions apply to the uss of fil1:
<br /> - Use af fill is not aiiowed in Flood Zons "V" unless ex�essly perrrtitted.
<br /> - !f �he fi!I material is to be used in Flood Zone "A", it is understood tha# a dr�nage ���
<br /> "compensating volume" will be submitted at time o# permitting which is �repareci by a�a#
<br /> tic�nsed by the State of Florida. -
<br /> - If tt�e fili material is to be useti in Flood Zone "AA in cflnnection with a perr�tted buiiding usir�g � ara�
<br /> • construction, ! certify that fill wiil be used only to fiil the area within the stem waii.
<br /> - If fil! material is to be used ir any area, I certify that use o# such �iN v� r�at aci�re�y
<br /> '�; properties if use of fill is found to adversely affec# adjacent properties, ths o�+r�ea� r�r tje c�d
<br /> k `�' t�e conditians of the �uilding perm+t issued under the attached perrr�itt a�ca�n. f�r 4ots !� �" �1)
<br /> acre which are elevated by fill, an engineered drainage pian is required.
<br /> I;` I am tfie AGEhtT FOR THE OWNER, 1 promise in good faith to inform ttte awt�rer of the p�g se# f� in
<br /> this a�ciavit prior to commencing construction I understand that a separate permit may t�e ret�e�irec# � �c#c.
<br /> p6umbing, signs, weils, pools, air conditioning, gas, or other instaNations no# specifi'�ca#�y �G� tn t� a' .�.
<br /> � permit issued shall be construed to be a license to proceed with the woric and not as �uity to vivf�e, c�. ��, ar
<br /> set aside any provisions of the technical codes, nor shall issuance o# a pemtit prevent the &�g C)f�iaal fr� �r�'
<br /> requinng a correction of errors in p4ans, construction or violations of any coc�s. Ev�ry perrr�it isst�ed si�a� b�e i€�
<br /> un{ess #he work authorized by such permit is commenced within six months of per�nit iss�c�ce, � if �Ic �ae�i b�r
<br /> the permit is suspended or abandoned for a period of six (6) months after the time the ruar�C is c�n��d. �a
<br /> may be requested, in writing, fram the Bui(ding Official for a period not to sxc�ed nir�y {�) d� a�d wri� a�e
<br /> justifiable cause for the extension If work ceases for ninety (90) consscutive days, the j�b is cv�ed ab�ri�,
<br /> WARNING T� OWNER: YOUR FAILURE TO RECORD A Nf3TfCE �F G Ml�`Y ��' �t
<br /> PAYlNG TWICE FOR lMPROVE E S TO YOUR PROPERTY. If YOi1 iNTEND AiM FNIAI�IG�N6, �T
<br /> WITH YOUR LENDER OR Y BEFORE RECORQING YOUR NO
<br /> FLORfDA JURAT (F S 117 03
<br /> OWNER Oft AGENT - C4�1'TRACTOR
<br /> Subscribed and swom to (or affirm ) fore me this Sutrscribed arrd swom t ebre ��s
<br /> by �t�NN LE vE�..� by � 1. I t-
<br /> Vyy�Q,�s/�g personally known to_� or has/have produced Who isy�;e pe�sor�aNy knavn to rne cN t�sArave �
<br /> as idenGfication. "`°'° �s' �`�
<br /> �� ��
<br /> � ,�„ Pubhc
<br /> Cammi��On o�� ���-� Commission No E�� 2.�0 _
<br /> ,z,
<br /> Name ota ed, rinted or stam Name of Notary typed, prirned or stamped
<br /> `1PS:Y / KRISTEN P. JOSEPW
<br /> ;�� �''- z�sY'^' KRISTEN P. JOSEPH
<br /> :*. .:: Comrrass�on # DD 88'1627 ;;�.• � ��.
<br /> ;,� •!, Expires April 21, 20'f� �: .: Commiss�on # DD 88252�
<br /> i Q :� ' Expires Aprii 21, 20'13
<br /> ��pF �° nded? � 1=a�� Insa20C08 385-701b � •o`a
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<br /> �� '�;p��F.� , ndedi ie���insurance8�. ,i85-7G'i. '
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