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<br />
<br />CONDITIONS OF PSRMIT AFFIDAVIT
<br />A. !mUa or fi J118TH~~IORI
<br />11II .....,., .... t WI pen1 III be .jeet to .d114 reltdctlw.' Iblch III be .. d8tdcU" tIIm Clt,
<br />replltl_. .lIIl1erI1p1l1..... I1IJIOIIlbllltJ for UllplllDCt 11th 10' IppllC1b1. .. Ultrlcu..
<br />B. UlfLI~8.BD COJft'RACTORS AND CONTRACTOR RBSPONSI!ILITIBS
<br />If till ... Melli a _tractor or c:ontractor. to .rt.. work, talr ., be rllQll reG to JlllIc.'IMIIlla ICXlDCdIICe ,ltJa
<br />.tate _ local qp1IUCU. If till CODtractor I, lOt U~ II rlQUlnd hr 1., botlt tile .. ... atnctar III be
<br />cltltl for 11I__.r 'lollt1ara IIIIIItr ltatela. If the 0IIIIl' or ID-.w _tractor an ...tIht . tAl at 1l~11l9
<br />requl~tI ., wlr for tile latea4ed lOll, tJler In _1_ to CGItact till eit, of IIpitJrWlI IulIGIII...-t, (113)
<br />788-6611 .
<br />Jurtllulon, If till .. .... .1n4 . c:onUlCtor Ol' coauaetarl, he 1. .lm to .. tile aaDUICbtr(I) Ii.. ,.Ucu of the
<br />.CllDtIlCtor 1IGtI.-I~ of WllppllcaU. for .Ida tiler 1111 be rllpllDl1ble. If JaIl, . .. _ alII . till ___,
<br />fOIl HI iatic:aUDg tIaIt p, ntller tbu tile coatractor r are ",pcuDle fot tile lOll. If till CGDtnctor liIIlII JUU to lip
<br />U CGDtnetar tIIIt ., be III iDI11eaU. tbat III II Dot properlr UCIDMll _ II DOt IIIUUIl1 to pmlttJag pd'U.... 11 till
<br />CUr of IIpIaJrUllI.
<br />C. TlWf8POIQ'ATIOH IVACT FEES AND UTILITY CONNBC'1'101f 'DB
<br />D. CON8TJWCTI~ LIBN LAW (CHAPTER 713, FLORIDA STATUTBS, AS NllUlDBD)
<br />I ee.rtlfJ tIIIt I, tile." CMt,"" lieu prOIIW .lth I copr of 'rlorll1l'. CODItACUIlIl ItS_ ... .. _r'. Protectlara
<br />Guide' preplfec1 br till 'wlt. ___t of Agriculture anc1 CaaIuIet Iffun. If till IIIPU_t 11 __ otIIIr tIIIII the
<br />'0IDIl., 1 ..wr OIt 1 lint obtalDecll ClOPl of the .. c1l1Ctlbe4 aoa-t ... ~ II goal fdtll to tell_ It to till
<br />leNOir' prior to CU.'lIC\WIlfIIt.
<br />
<br />B. ~'8/OWN~'S AFFIDAVIT
<br />I c:erUff t tIIIIDfolllUOII ID tlallappilc:atlOD Ie lccurate 11II1 tllat all 110ft ,Ill be ... In __ .1~ all
<br />appliClbl1 1_ ,.I.t1Dg catncU.., 1CMIiDg, _ 1. t1elllO(lll8t.
<br />AppllceU.. I' ....., .. to obtaiD . limit to do IOrl 184 iD8ta1I8UIID II lD4lc:ated. 1 cut1fr tat 110 _1 or
<br />lDltallitlal .. 4JV..m ,dot to i8I1IIDCI of I penlt en4 tIIIt all 101:1 IUl bll*fOll8l1 to .. ...... of IU ..
<br />regulating .....tnct1I1l, City CCM1ee, IOIllog ragulaUOOI, _ 111I4 4etel~t ngulatlClllIa till jurWlctJaa. I 1110
<br />emUJ tIIIt I WI6atItaal1 tblt tile ngulaU_ of olller gogrDIIIItal apadu .., IPPlJ to tIIIlDtIIIIII .., .. Pit It II
<br />III fIIPOIIIibllltr to i_tiff .t ICtlanl I IUIt tab to be iI CGlpl1l1e1. 11dI~. lDcl_ lilt In lOt Illltlll to:
<br />· Duln.t of IDYlro.BItll _hUon .. Cypr.. ..,...., Wlt1II4 kill uc111lwm..at.llr ...IU" ,..,
<br />. ..ter/lllWtlt.r !nebat .
<br />· BoutMit PlorIdlllltIr .......ut Dllulct .. 1fI111, Cypnu Bar", hUIIIllIteu. Uteri.. hterCGlnll
<br />· Am ~ I,"'''' .. .....1., Docb, ,.dgabll Vatltle,.
<br />· ~t IIIIItII ~ ....UtaU" 8enlcu, IDdICIIII8Iltal Health IIaJ! .. "111, VII_tar lnatIut, IIpUe ,.
<br />· US ..IIf!:!:..ntll ~ ~ .. llbeltos lbat.ut .
<br />I .ilO C.'IItlfJ tMt, if fill lItIrial II to bI .. 18 ,lood Ioae '.' or 'I,lte.', it II WIl1eQtGal1 tllat . de" pllll
<br />aaarMl1lg . I~ tal.' 1111 be aabdttea lbici II prepaqa br . prof_laaIl "'.... light_ II tIIIStlte of
<br />Floria. trior to .....t __ceo
<br />A pentt 1IIUIl111l1l1 III coutMl1 to 111 . IiCIIIII to pr0cee4 11th thlIIOl1 u4 DOt U I1ItbDrltJ to tlollta, ... .ltu, or
<br />let ula. q pmdllou of till taclmlC11 coG., nor lball iII1IIDClI of . penlt pmat tile 8d14lag OffIcial h1I tllmlftlr
<br />r.,aldag I cornct1Ga uf erron 11 pllll, CODItnctJlIl, or 'lolltlOll of IDJ CCIl1I. herJ (lImlt __ 11II11 .... IMllcJ
<br />unl_ tile IlOrllltllorlle4 br lAd penit II ~ ,IWn It. _till of 1..., or If .. lIItIIoriIIIJ ., tile penJ.t II
<br />....... or _bell for I perlocl of III -tbllftu tile u. tIII_lII~. ~ to GaJ .... of till, _, be
<br />111_ for tile pealt Mlttl f. cIIup of '15.00. !lie __lOll Uall III ~ 18 IdtlDg to ~ Ia1WIg Offlelal. An
<br />IpprovlG 1IIpectl1ll _t .. 1_ cklDg IICb 111 _Ii perlOl1, or the project 11111 hi COIIltutG ........
<br />_UC 10 ~I 111 ru.. 10 BalD 11011(.1 or DIIIICIIII JIll IUUI.! 0 _ PII. 1I1C1 fCI ...... !O 1M
<br />'IRIIJ. I' . IIrIID 10 CIWI '11llEl.R, allULt 1111'1 !WI 11IIIII ClIIIIICIIII .... ... III 1OI1C1 or
<br />CCIIIIICRI!. ..... '3,HO D YILII 00 lOt _10 IICDID lID POll I 'IIICI or ~'.
<br />
<br />81G111t111: MIl CI MIll
<br />
<br />Ileu_: aIlIIIC!QI
<br />
<br />IIln or nGIIIJI
<br />amn or
<br />The foregoing inatrUIIeDt 11.1 aclmovle4ged
<br />before _ W8 , 19 by
<br />-
<br />
<br />nlll or MIDI
<br />aIIIt 0'
<br />The foregoinG ID8truli8nt va. acmowledgBd
<br />before _ this , 11 by
<br />
<br />who ia per8OD011y .... to .. or wbo bas
<br />prOduced
<br />a. identificatiOD aad wbo did/did Dot
<br />take aD oath.
<br />
<br />(Sigut..)
<br />
<br />(...... TJped, priDted or Sta.ped)
<br />ROTARY ~
<br />
<br />who i. personal I, 1m0llll to .. 01' tIbO baa
<br />produced
<br />.. 1dentlf1catiDD and wbo did/did Dot
<br />take an _tb.
<br />
<br />(Sipatufa)
<br />
<br />(1(- 'lypecJ, Prlated or BtuIped)
<br />IIO'1'UY PUBLIC
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