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A. NOTICE OF DEED RESTRICTIONS
<br /> The undersigned understand that this pertnit may be subjed to"de d restrictions"which may be more restrictive than Counry regulations.The
<br /> undersigned assumes responsihility for compliance with any appli ble deed resVic6ons.
<br /> B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONS BILITIES
<br /> If the owner has hired a conUactor or contraetors to undertake w rk,he may be required to be licensed in accordance with State and local
<br /> regulations. It the contractor is not licensed as required by law,bo the owner and contractor may be cited for a misdemeanor violation under
<br /> State law. If the owner or intended contractar is uncertain which licensing requirements may apply for the intended work,he is advised to
<br /> contact the Pasco County Building Inspections Division,Contrador Licensing Section,at(727)847-8009.
<br /> Furthertnore,ii the owner has hired a conVactor or conUadors,he s advised to have the cronVactors sign portions of the"Contractor Block"of
<br /> this application for which he will be responsible. If you as the er sign as the cantractor,you are indica5ng that you,rather than the
<br /> conVador,are responsible for the work. If lhe conVactor wishes ou to sign as conVactor,that may be an indication that he is not properly
<br /> licensed and is not entitled to permitting privileges in Pasco Coun
<br /> C. IMPACT FEES/UTILITIES IMPACT AND RESOURCE RECOVER FEES
<br /> The undersigned understands that Impad Fees and Resource Re very Fees may apply to the consVuc6on of new buildings,change of use
<br /> in epsGng buildings,or e�ansion of epsting buildings. The unde igned also understands that such fees as may be due will be Ident�ed at
<br /> the time of pertnitUng. It is fuAher understood that Impad Fees a d Resource Recovery Fees must be paid prior to recei�ing a"Certificate of
<br /> Occupanc�'or final power release. If the project does not invotv a Certificate of Occupancy or final power release,the fees must be paid
<br /> prior to permit issuance. Furthertnore,if Pasco Counry Wated ewer Impad Fees are due,it must be paid prior to permit issuance in
<br /> accordance with applicable Pasco Counry ordinances.
<br /> D. COPISTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as mended)
<br /> If valuation of work is$2,500.00 or more,I certify that I,the appli t,has been provided with a copy of the Florida ConsWction Lien Law-
<br /> Homeowners Profection Guide prepared by the Florida Departm nt of Agriculture and Consumer Aftairs. If the applicant is someone other
<br /> than the owner,I certity that I have obtained a copy of the above- escribed document and promise in good faith to deliver it to the owner prior
<br /> lo comme�cement.
<br /> E. CONTRACTOR'S/OWNER'SAFFIDAVIT
<br /> I certify that all the infortnation in this application is accurate and lhat all work will be done in compliance with all applicable laws regulating
<br /> construcfion,zoning,and land development.
<br /> Application is hereby made to obtain a pertnit to do work and ins allation as indicated. I certify that no work or installalion has commenced
<br /> prior to issuance of a permit and that all work will be perfortned t meet standards of all laws regulafing constructian,County codes,zoning
<br /> regulations,and land development regulations in the jurisdictian I also certiTy that I understand that lhe regulations of other govemment
<br /> agenaes may apply to the intended work and tha[it is my resp nsibility to identify which actions I must take to be in compliance. Such
<br /> agenaes indude,but are not limited to:
<br /> • Department of Environmental Protection: Cypress hayh ads,we0and areas,enNronmentally sensitive lands,and watedwas[ewater
<br /> treatment.
<br /> pe
<br /> s Southwest Florida Water Management Distric[:Welis, ress bayheads,wetland areas,and altering watercourses.
<br /> • Artny Corps of Engineers: Sea walls,docks,and navig ble watenvays.
<br /> . Florida Departrnent of Children and Family Services,En 'ronmental Health Unit: Wetls,wastewater Ireatrnent,and septic tanks.
<br /> . U.S.Environmental Protection Agency: Asbestos abate ent.
<br /> • Federal Aviation Authority: Runways.
<br /> I understand that the following restrictions apply to the use of fill:
<br /> . Use of fill is not allowed in Flood Zane"1/."
<br /> • If fill material is to be used in Flood Zone"A,"it is un erstood that a drainage,plan addressing a"compensafing volume"wiil 6e
<br /> submitted at the Ume of pertnitting which is prepared by professional engineer 6censed by the State of Fforida.
<br /> . If fiil material is to 6e used in Flood Zone"A"in connecti n with a pertnitted bulding using stem-wall construction,I certify that fill will
<br /> be used only to fill the area within the stem wall.
<br /> • If fill material is to be used in any area,I certify that use of such fill will not adversety affect adIaceM properties. If use of fill is found
<br /> ta adversely affeC adjacent properties,the owner may e cited for violating the condi6ons of the Buildng Pertnit issued under the
<br /> attached permit application. For lots less than one(1)a which are elevated by fill,an engineered drainage plan is required.
<br /> If I am the AGENT FOR THE OWNER,I promise in good faith to info the owner of the pertnitting condiGons set forth in this affidavit prior to
<br /> commencing construction.
<br /> I understand that a separate pertnit may be required for elecUical work,p mbing,signs,welis,pools,air conditioning,gas,or other installations not
<br /> specficalty inGuded in the application.
<br /> A pertnit issued shall be consWed to be a license to proceed vrith the wo and not as authority to violate,cancel,alter,or set aside any provisions of
<br /> the technical codes nor shall issuance of a pertnit prevent the Building Offi �al from thereafter requiring a correctian of errors in plans,construcbon,or
<br /> violations of any codes.Every pertnit issued shall 6ecome invalid unless th work authorized by such pertnit is commenced evithin six months of permit
<br /> issuance,or if work authorized by the pertnit is suspended or abandone for a period of six months after ihe Ynne the work has comme�ced. M
<br /> extension in writing,may he requested from the Building Official for a period not to exceed ninety(90)days and will demonsVate justifiable cause for the
<br /> extension. if work ceases for nineiy(90)consecutive days,the job is consid red abandoned.
<br /> WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF C MMENCEMENT MAY RESULT IN PAYING T1MCE FOR IMPROVEMENTS
<br /> TO YOUR PROPERTY IF YOU INTEND TO OBTAIN FINANCING,CO SULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING
<br /> YOUR NO710E OF COMMENCEM T.
<br /> SIGNATURE: � SIG
<br /> OWNER G NT CONTRACTOR
<br /> STATE OF FLORIDA STATE OF F ORIDA
<br /> courvrr �AS Cr'� couNn Hillsborou�h
<br /> �
<br /> The foregoing instrument was aclSn}wledged before me this--�u�r The foregoing instrument was acknowledged before me this
<br /> (date),by ��(�A 1 L !C�n1N��1� (date),by ��� �'�� �
<br /> (name of person acknov�A d i who is persona nown to me or who (name of persan acknowledging),who is oersonallv known to me or whn
<br /> has produc d�/�o������a has produced
<br /> �L � � 1 V l C /V�f'cl (tvpe af (type of
<br /> _ id ntifi a_��_n�i.a_�n" , identfiption)as iden'hfication.
<br /> �;�:';'�,P,. MP,RILOU I.LARSON A ��,ar o��
<br /> �I/,':��% rIISSion,#EE 152656 � NO�rY Public
<br /> �='`�,:' �I�� NOTA �l Ch�i State of Flprida
<br /> ��';°•i:::a,P;`�UIreS�� „ �,f' eal: � . 8
<br /> � �f;r;g;^„�' EandeiihraTroyFanlasuroceAOu-?857019 MyCommfssio�n Qu�n
<br /> y '�o�f�� Ex EE115715
<br /> ,�..,,�.x,-��-����`s'm' p(rea 08H3/2016
<br /> wpdata/bcs/forms/buildingpermitapplica6on�c93043032 .:���G� � �Rev.B/8/11
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