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<br />__J:,~_'::.._i.;::J:L_J...<_!:'-~:i_L}J.}:-f_,';.,__.I__ 1,1."_) :,_;~
<br />
<br />'h~ undersignrd undrrslands Ihal Ihls parlll ~~y bu subJrcl Ip 'dred rr~lrlcliDng' uhirh ~~y hr "~rr rrglriclivr Ihan Clly
<br />rrg"lall~ns. thr undrrslgned assumus rU~Ponslhllllf~~orcompllan[r nilh any applicahlr devd rr~!ri[!ion~.
<br />
<br />JJ. 1..1!}1~1. CEr\ISED CONTRACTORS OND CO.l:.!TfJfJ!;]J.H LJU;.,8.C.r}!\IGIIII_LlrIF_X;.
<br />
<br />II Ihp owner has hirrd a conlraclor Dr conlraclors 10 undrrlaku "ork, Ihry nay hr rl!~uirrd tD hr )icrnlrd in accordance wilh
<br />shIp allrl local regulations, If Ihl! conlractor h nol IlcrnH" a~ rr~uirrd by J;itf, !Jr.lh !I,,~ r,unrr .,nd cc,nlraclor nay b(>
<br />cilrd lor a nisdeneanerr violation under slalu la,,-.' rr thl! [""ll!r e'r inlr.nded conlraclr.r arr. Ilnce.rlail' ~s 10 Ithal Ijcrnsing
<br />rr~uirr~r.nls IlaY apr,)y hor Ihe inhl1lled IIork, Ihrr are arlvisrd 10 nlll.ad Ihe tily [" i'rpl,,'rhills Puilding IJrparhrnl, IlllJl
<br />"OU-t,~II.
<br />
<br />Furlhrrnorr, II Ihl! OHn!!r has hlrud a conlraclor Dr conlraclors, hI! is adviSl!d ID havl! thr. conlraclor!sl sign pprlions DI Ihl!
<br />'Conlraclor SecllDns' or Ihls appllcallon ferr uhlth Ihl!Y ulll hI! rrsponslblr. II you, as Ihl! Dunrr sign as Ih(> conlraclDr,
<br />you arp indlcaling Ihal yo", ralhl!r than till! contraclor, arr rrspe'r1sibll? lor li,t, 11,.,1:. II 11,1' ([."Ir~cl['r lIishl?S yc.u \C. sign
<br />as c[,nlraele.r Ihal IIay b!! an Indlcallc.n thai ht' Is nol pn,pl?rly Ilcl'nsr.rJ ~nd is r,r'\ I?nlilll'r1 !r, pl'IIr,jllir'g privilrgl's in lI,e
<br />Ci Iy (.1 ZI'phyrhi 115.
<br />
<br />c. HlANsponTAT ION I MPACT FEliS ANIL!J..lUJ..JY Cm".LIJ~J~,LLI]r'LJ:J::I~fl..
<br />
<br />0,
<br />
<br />~l1.!:!J3TRUC-r I ON LIEN LAW
<br />
<br />(~HAPTEn 713 t I=LDn I DIl SrrHUJr=:!" (IS AI'lENUEU)
<br />
<br />Guldr' prrpared by Iht FI~rlda Depart.enl Dr ngrlcull"rr and Consuftl?r
<br />'~lInut', I crtllly Iha(" hay. obllln~d ~ tOPY'~1 thu abDve describer!
<br />''''''lI.'r. pt ior 10 touI'nt!!lIl!I't. I
<br />
<br />I (l'rlily Ihal I, lire applitahl, I,ave bl!l!n provJ'ded wllh a cnpy of .F/orida's [(.nstruelir." til?lI I..." - 1l['Ill'o"nrr's Prolpelion
<br />/\lfairs. II II,I? ~1'l'liroHlI is 5r'H[;nl? oth('[ Iltan Ihp
<br />dC'C"",C'1I1 ~/olll'rr,.,i~r' ill ql.o,1 I.lil" lp dr.llvr.r II 10 lhe
<br />
<br />.. : '. ': ~ ~ ~, ~ I ; .
<br />
<br />. .
<br />E. ~UNTnIlCTOn'S/OWNER'S AFI=IDAVI~
<br />
<br />I cl?rtlly Ihal all 1I1l! Infbndlpn In this applicallt.n Is acc"ralr tInrllhal all 1M I; lIilll'I' dc'nl' ill ([."pllaIlCI? lIilh all
<br />appllcabll? lalts r"9ulallng tonslruttlon, zoning, nnd lalld dl?vI?lopnelll.
<br />
<br />, '
<br />/\pplicallon is hl'rl'by ~~dl! t~ oblaln a pur~~t I~'do HDr~ alld IlIslall~li[\n as Im/icall'd. I 'trlilf Ihal liD IIDrk or
<br />In,lallallDn has co..unctd'ptIDr ID Issulnc. of a permll and Ihat all work nlll Lr. I'lr,ro,nlrl 10 ~rr.1 slandards 01 all laws
<br />r"gulallng cpnslr"tllc'n, City' U;dl!s, lIlnlnq re9"'alle.ns, anI! lalld dl!vl!lc'pml!nl r!!'l"lalir'"5 III tl'I? lurlsdlcllc,n. I also
<br />CNIHy lI,al I IIndl'rslanJ th~tthe fl!qulatlon!l or Ol/lrr ljoV!!rlllllwlal ~ljl?llr.iI.'5 '",y al'I")"lr. Ihl' ir"t-hd~d 11['r~, and Ihal II Is
<br />"y respohsil,illly h. Idl!ntlfy Ifhal adloM IlIIust lal:!! 10 bl! In ([lmpli~hcl!. [;IIl:', aljH,cip., Il,rl1l1l1' 1'111 ?II! 11I.1 lillllrd 10l
<br />
<br />'"
<br />~arhl'f,t e.1 rnvj,.~nlll!n(al nUQulallon ~ Cypruss lIi1yhuillls, III! II "III' /\r~as al"l [/I'/irr'Jiff,p/I!irlJ, St-lIsilj;,~ '-H,ds,
<br />,!1;'if' Ual~rilla5tulfall!r Trl'i1blll.'ll1
<br />'~c.ulf1~!:,st Fhrlda l/ater'llanaqu!!nt District ~ Ilells,' Cypress Bayhea"s, 1/r.lIiHld Orr.;,s, r.llr-riltq !lalrrnours!:s
<br />, nrm'L!:k!P'spr EnQi"pers .. SUlfalls, bods, /favigable l1alerllays
<br />I ~..!l!!!..!..rr,! cd II1'alth L Rehablllhtlv!! S!!rV1CI!5, Environlli~nlal IIl!allh Unil - 11':'115, lIilslr;l/alrr Irl!ill~"n:. Srplic Tan~s
<br />' US Enti~.I'''Drntal Protpdlt'n f1ql?nCy ~ f1sbl!sto!l ilbalelll'nl
<br />
<br />I also crrlily that, if f1ILutt'rlalls to be used in FIc,od Ze,nl! "n' or "Il,rlr..', it is IIrllfc.rdc'e.dll,~1 a d,ainagl' plan
<br />addrrssing a 'cDllpr,nsallng Vblu.!!. "ill 'bl! sub.llll'd "hleh Is prrpand by a flt'c,lr,ssiC'll,,1 t.t'!jit,tl!l rt'lJisl".-r.d 111 Ihl! Slall! Dr
<br />Florida rrior ter pl'rllt Issoanc!!.
<br />
<br />n prrllil Issl/rd shall bl! t~nstrued to hi! a IIcensl! 10 proe!!l!d ,lith Ihl! "r,rk ;,,"1 nrol as allll,r., il)' Ir, l'i1.Ja![', callcel allrr, or
<br />sr.l asidl! al'y prtovlslc'hs ot the luchnlcal ce,des, f10r shall issuanc!! 01 a I".rmll I'r~vl'nl !In' !'lIildlt'l} l1rrl(i~1 Ire-" Iherl'llll'r
<br />rrqulring a [[.rntliDII erf !!trors In plans; conslrllclltrn, c.r vlolallons 01 allY c,.elr,. r~'r.rt rl'l~il issll','.' :I'd" brel,tr Invalid
<br />unless Ihr tH.rk alllhe,rlled by such per.1I h t['lIIn~ncl!d "ilhin six 1I0nlhs r.1 15SII.'IIO:C-, (,r i I IIC" \; allll.,., I ;ed bf Ihr pl!r.11 Is
<br />SIISprrrdl'd Dr a!,ar,donrrl fo,' a petiOlI Ctr six IOlllhs alll'r Ihl! li.Jr 11.1' IID"~ j~ CfoMI!f1u:lI. [Ifor '1(1 dat ('~le;.sjptl pI liae, flaY bl?
<br />alle'Herl lor "'I! pl!rllil "llh fee chargl! cd $15.00. Thl! !!Xlrnslc,rr shall br rt'III11'slrd inlHill!lIj Ic, Ihl' !:l'ilding ""ielaJ, nn
<br />a"provrd Insprclir.n ~usl be Jc.gged during each sh lItonlh prriod, c,r Ih~ prr,jpcl IIi" 101' ((,/oslll,.,!:!! ab,;!,dr.r,[.d.
<br />
<br />l-IARN I NG TO Ol-J"'ER I' ,YOUR J="A t LUIlE TO RECORD () NUT I CT OF eUI'II'IEI'1l :Et-1ENT "lAY
<br />RESULT I'" YOUI~ PAYING TWICE Fpn IMPRDVEI1ENTS TU YUUII "rml'ErHY. IF yOU
<br />INTEND TO OI3TAIN FINANCING~ f:PNSULT l-lIT'" YOUn LENnEn un nN (lrTor~NEY
<br />BEI=UHE RECorWING YO n NOTICE UF CIJI'H'IENCElvIENT. :IUU~; Ur'\)En ";2,::10 HI vnLUE
<br />/JU NUT NEED TO RE ."/)A1. ~ 'T A "NUTlCE DF emll',OICE" "
<br />
<br />
<br />5IGNIHIJnE ,.~ SlGNrHIJ/lE
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<br />En bn AGENT . mI.' If!()CTUn
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<br />)ATE__ ______, __ -f!=:?~-=?-Z::..----___'_._~____,_
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<br />IOTAIlY m; TO !l.(nr u\ ;P,.~, 7 (7 ,<rtJ.J!k.
<br />l~It-IEr. on AGENT 1_)G'VC/V'-(fJ~. L . C;
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<br />D()TE__ ___~ _q?~=- 2?::________ _________
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<br />~g,~~~~C~~~Jl:~__t~t~~~g_~!~~
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<br />IV tOl-II'l1 55 I ON EX,., I nES______________________
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<br />/'IY COI'II-1I f3!:; I Or.! EXP IllES _________________._
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<br />.. ~)o. f.......:1,. It-
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<br />0FF!CIAl SEAL
<br />B ;: R Costello
<br />My C'." 1...:iS'cion Expires
<br />No,', 2. 1994
<br />Comm. No. CC ;54525
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<br />t . "if J
<br />..\S}. "-A.-
<br />... '4"~ OF foJ':..
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<br />OFFICIAL SEAL
<br />Barbara R, Costello
<br />My Commission E~j)i, es
<br />Nov. 2. 1994
<br />Comm. No, CC 054525
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