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NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to°deed"restrictions"
<br /> which may be mvre restrictive than County regulations. The undersigned assumes responsibility for compliance witH any
<br /> applicabie deed resMctions.
<br /> UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
<br /> contractors to undertake work, they may be required to be iicensed in accordance with state and local regulations. If the
<br /> contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation �
<br /> under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
<br /> intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
<br /> 8009. Furthermore, if the owner has hired a cont�actor or contractors, he is advised to have the contractor(s) sign
<br /> po�tions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
<br /> contractor, that may be an indication that he is riot properly licensed and is not entitled to permitting privileges in Pasco
<br /> County.
<br /> TRANSPORTATION IMPACTNTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
<br /> that Transpo�tation Impact Fees and Reaourse Recovery Fees may apply to the constructlon of new 6uildings, change of
<br /> use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
<br /> 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
<br /> pe�mitting. It is fu�ther understood that Transportation impact Fees and Resource Recovery Fees must be paid prior to
<br /> receiving a "certi�cate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
<br /> flnal power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer impact
<br /> fees are due, they must be paid prfor to permit issuance in accordance with applicable Pasco County ordinances.
<br /> CONSTRUCTION LIEN LAW(Chapter 713, Florida 3tatutes, as amended): If valuation of Vvork is $2,500.00 or more, 1
<br /> certify that I, the applicant, have been provided with a copy of the °Florida Construction Lien Law—Homeowner's
<br /> Protection Guide" prepared by the Flo�ida Department of Agricuiture and Consumer Affairs. If the applicant is someone
<br /> other than the"owner", I certify that 1 have obtained a copy of the above described document and promtse in govd faith to
<br /> deliver it to the"owner"prio�to commencement.
<br /> CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that ail the information in this application is accurate and that ali work
<br /> will be done in complfance with all appficable laws regulating construction, zoning and land development. Application is
<br /> hereby made to obtain a permit to do work and installation as indicated. 1 certify that no work or instaliation has
<br /> commenced prior fo issuance of a permit and that all work wfll be pe►formed to meet standards of ali laws regulating
<br /> construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. 1 also
<br /> certify that I tinderstand that the regulations of other government agencies may apply to the intended work, and that it is
<br /> my responsibility to identify what actions I must take to be in compliance. Such agencies inciude but are not limited to:
<br /> - Depa�tment of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
<br /> Lands,Water/Wastewater Treatment.
<br /> - Southwest Florida Water Management District-Welis, Cypress Bayheads, Wetland Areas, Altering
<br /> Watercourses.
<br /> - Army Corps of Engineers-Seawalls, Docks, Navigable Waterways.
<br /> - Department of Heaith & Rehabilitative Services/Environmental Nealth Unit-Wells, Wastewater Treatment,
<br /> Septic Tanks.
<br /> - US Environmental Protection Agency-Asbestos abatement.
<br /> Federal Aviation Authority-Runways.
<br /> I understand that the following restrictions apply to the use of fill:
<br /> Use of fiil is not aliowed in Flood Zone"V"unless expressly permitted.
<br /> If the fill mate�lal is to be used in Fiood Zone °A", it is understood that a drainage plan addressing a
<br /> "compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
<br /> licensed by the State of Florida.
<br /> If the fiil material is to be used fn Flood Zone "A" In connection with a permitted building using stem wail
<br /> construction, I certify that fill will be used only to fiil the area within the stem wall.
<br /> If fill material is to be used in any area, I ce�tify that use of such fiil will not adversely affect adjacent
<br /> prope�ties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
<br /> the conditions of the building permit issued under the attached permit appiication, for Iots less than one (1)
<br /> acre which are elevated by fill, an engineered drainage plan is required.
<br /> If 1 am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
<br /> this affidavit prior to commencing construction. �asnoerother installatonsrnot sp ciifi ally nclud d in he alpplicaton�rA
<br /> piumbing, signs, welis, poois, air conditioning, g
<br /> permit issued shafl be construed to be a license to proceed with the work and not as authority to viotate, cancel, alter, or
<br /> set aside any provisions of the technical codes, nor shali issuance of a permit prevent the Butiding Official from fhereafter
<br /> requiring a correction of errors in plans, constn.iction or violations of any codes. Every permit Issued shali become invalid
<br /> unless the work authorized by such permit is commenced within s(x months of permit issuance, or ff work a�ithorized by
<br /> the permit is suspended or abandvned for a period of six(6)months after the time the work is commenced. An extension
<br /> may be requested, in writin n�sion. Ifhwork oeasesoforininety(90)rc nsecutive days,the job is�cons de ed balndonedstrate
<br /> justifiabie cause for the ext
<br /> WARNING T� OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUL CON ULT
<br /> PAYING TWICE FOR IMPRO A��NTSEY BEFORE RECORD� G UU 'NO ND OF COM' ENCEMENT.�
<br /> WITH YOUR LE D AN
<br /> FLORIDA JURAT(F:S. 117
<br /> OYYNER OR AGENT � ` CONTRACTOR before me this
<br /> before me thts Sub rib and swom �� ��r
<br /> gub and swom to(or affl ) . 3 2 by
<br /> 3 ► bY Who is/ re personaily known to me or has/have produced
<br /> � �g/ onall known to m or s/have produced as identlficatlon.
<br /> ----=����'----� as IdenUficatlon.
<br /> ✓l�/� t/.��C , Notary Public
<br /> � '���,,�(1;,2 - Notary Public
<br /> Commission No. ,
<br /> Commtssion No.
<br /> ed, rinted or stamped Name of Notary lYPed�Printed or stamped
<br /> Name of Notary typ P
<br /> � TOD� KLUKO�W�KI
<br /> ;��y�,� TODO KLUKOWSKI :� •� �������
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<br /> • EXPIRE8 O�oN�bN 15.201d
<br /> . EXPIRES D�amber 15.Z016 �.e+a
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