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<br />-..-.---.OCT-13-'94 THU 10: 12 ID:
<br />
<br />TEL NO:
<br />
<br />~318 P02
<br />
<br />CONDITIONS OF PBRHIT AFFIDAVIT
<br />A. NOl'JCB 0. DaD RBSTRICTIOljJ
<br />11II ......... IIIIrItIDfI tat W. ,emit .., be IIIbjlCt to IlJtecll'tltr!ctJe.' IfbIcb IIf .. .. rtltrJcU.. tIIu Cltr
<br />rlpJIUGDI. ftt -.ugua ..... rttpoallbiUt, for CCIIpU.. ,Ub ., appllelbl. died lII~. .
<br />a. I 8 R8 AND CONTRA 8 BILIT
<br />If tile ~ .. Urll1 I _tractor or CCIIItracton to undtrtUi IIOrl, ~f III be npJrlll to be ......... viti
<br />.tall .. 1ocI1 npJ.UodI. If UIe aIIltnctor Je lOt l1C81l1Id II ntWld bJ I., both tile ~ .. ~ ., ..
<br />dUd for I 11...... ,lollUoa under ltate I.. If tilt 0IIDIf or IDteDded atrlCtor an -.rt.IJa II to ..t UClaI..
<br />ngut~tI.., .,,1, fDr tJae iIltlllded IOrt, ther are a4Yilld to coatict tJIe Clt, of IIpbJrWllIdICIDt Dtperta.t, (IU)
<br />781-"11 .
<br />
<br />rurtIIInon, if ~ Mer !all .Ina . contractor or CGltnctor., lie I. ..fl", to ... UII ClOItnctorCI) lip portiGal of t.M
<br />'CalltrlCtat ....~ of WlIppUuUaa for Ifhida tiler uUIIe rllpOl8lJtle. If JOU, . tile --1111 .. tilt .wct.or,
<br />JGU In WtcaUIIg u.t JGU, r.tller tJIaa t.b8 eaatrlCtor, ilt rllPOlllibJe for tile IOrt. If * ClIDtractor .... JOI to 11..
<br />II CGItnc:tor tIIIt ., be .. 1adJeaUOIl tblt lie it DOt properl, llC1U1d u4 11 DOt .UUII1l8 ....tt.bl JdtUlgla 11 till
<br />Cit, of ......111. _ .
<br />c. 'l'RAIf8POR'tATIOH IMPACT FOB AND UTILITY COHNBC'l'ION FBBJ
<br />D. CON8Tp'wION LID LAW (CHAPTER 713, PLORIDA 8'1'A'1'U'J.'a, AS AIIIIIDBD)
<br />1 ClrUfr tIaIt, ,ppUClDt, Ute lieu prodded ,Ub . CClpJ Df -florlda'. c.truct111l Lt. .... . ~t. rroucu.
<br />Gule1e' Pl1Plttl1 br tM rlortdl DlpartMt of Agriculture and CoaMe.r IffaJ.n. If till appUcut It _ otIIIr tMa tile
<br />'...1, I c:utUr tllat IIIIn Dbtllll8G . copr of tile Iboft ducrlW ~t IDd prCllltlb ... fd~ to GIll_ Jt to till
<br />10IQIl" prlor to ou I~Dt.
<br />
<br />B_ ~.JI~BR'8 AFFIDAVIT
<br />I certJfr tllat alllii la W. IPpllcattClft i. aecur.te mJ tlaat all wrk _ill be ... 11 ..1_ ..~ all
<br />."u... 1.. np1ttIag c:aIIItrucUCIII, _iog, _ JIDd .'l1op1e1lt.
<br />IppllclUaa 11 Iltnbr .. to obtain. pettit to do IOrk ad llllWlattoo u iDdlcatld. I cert1fr tMt . ..1, or
<br />iDltlllaUaD -- -onB_ prior to luueDce of. peoit lid tllit IU_11111 .. perfOftlllJ to _ ..... of III ..
<br />reguJlttag _thOU.-, cn, cadeI, lOlIing regul.UOllI, aDd laD<< ovtlos-t ngabUou ill ~ juleaotla. I alto
<br />certifr tMt I .... tblt tbe reguJIUClftI of oUler goy_bl ..... III ., to tile IatIIIII1 -a, .. tat It II
<br />If ....,.lbllJq to IUtUr, ....t leU. I at tIb to be 10 CGlpUIDC8. 8_ Ifeacill 1Dc1l1111 tlat In . Il11t1d to:
<br />· ~ of 1In'1~11eau1.Uon - Cypr.. Bapude, lItUIIId &rea IUIlI lamoa.atlll, ....UII '-*,
<br />Mlter/IUteater lru_t .,
<br />· IGutMIt rloddl Miter ....--,t Dletrlet · WaU.. Cfpna ..,...., Ifttlu4 lnII, IJterllg lateroom.
<br />· Am QIrJI of ~ · ....U.. Doell. lI'igable IIt.ners
<br />· ~ ""iiT~lltlUn IIInICII. "'u-JalleI1~ IlIit · 1Iolla. IIIotMlIt ~ .. ,..
<br />· II ~~ -.cJ - ....toI.~t . I
<br />11110 cert1"o.t, 1 flll_.tall. to be _ ill 'load ... '.1 or 'A,tte.l, It it ~ tat. __ pl.
<br />IdGnu1Ig · .......t1Dg 101.' "l1J belUbl1tted tdlic:lllt preparlll Jtr I prof-.tODll ..... ngJatlnlll till ItItt of
<br />Plorl,. prior to puIlt ........
<br />I pemt ...... .....1 .. CDDItrued to bt . UC1D18 to proceed .I~ tJae wort lAd DOt u atllodtr to ,1DlttI, OIIaIll1ter, or
<br />lit uida .., pcovllJau of till tldutical cudea, JIOr ....11 illUlDCll of . perlit ptmat tile 11I_ Offlo11l ,. ~ter
<br />r.Jr.lllg I ~ of tmn 111 pl., ..traction, or ,1oJat1ou Df an, coGI. ..,,..t.... *11 .. lDtlH
<br />UIlIut eM ... 1Ik1... br 8UdI ptrIit 11 ~.. ..tWo .11_* of ....,.., or If _t IUtIlorbtd ~ ... pait 1.
<br />....... or ~ for . pldocl of Iii -u. after tM till tile ..t 11 c_lalJ. 011 to .., _... of u., III III
<br />allOlld for Ue PlaIt Iltll f. daaqe of '15.00. De utaloa _11 be ~ ill wlUDg to tIaIldlalg OftlcW, ..
<br />IppfMlJ lDIpecUoa _t bll_ l!adng ..ell III alii perlCld, or till projlCt .111 be c:GllYInI .....
<br />"UC 10..: .. ru_ to IICORD A JOIIleI or ~ III IlSULr II _ PII. tIICI III ....... 10 11II
<br />Palm. If 111I .. 10 CIIIU ftllllCllG, aJ8OL'lfltll fOUl &mil 0111 &naIIIr ... .... .. DlCI or
<br />CDIaCIIUr. .. UBI 12,500 II V.LUlI) lOr _ to .. UD l'O81' I -alCS or ~.
<br />
<br />-4~~
<br />
<br />~~
<br />
<br />... or '!:
<br /><DIR or ~Co
<br />'h. foregoiag iutruMDt .... acbo'ltledg8d
<br />beton - tb1. Oct, ~ _, 19....2t. b, .
<br />~bt+Reet-'
<br />1. 1 botm to _ or who baa
<br />prodU
<br />.. 1c1_tiflc:at!oa 8Dd who did/did Dot
<br />~Q, ~ -
<br />,t .
<br />JAMES A. STONE
<br />('''''. 't.fped, ~~c~Jorlda_
<br />IIOtUY I'UILIC Mv comm, expires May 16, 1995
<br />j CC110274
<br />
<br />SlIII or ""*
<br />CXIIIIf or fftJsC!-o
<br />'lb. for89oi8g iD.~ru.eDt ... aclEDollledpd
<br />befOl'8 - tbl. ~,dl.6 , 19?yr by
<br />aJ.r:~ f1t.ow bIlRILP~
<br />ibo 1. r .1 bowA to _ 01' .. JiU
<br />produced
<br />.. lc1eDtlflcatiOJl u4 cIi Ic114 Dot
<br />tate ~tb.
<br />(' t 1'8) JAMES A. E
<br />. ~tli~ ~ta.te of Florida
<br />(N_ Typed, Pr1Qted or ~~ xpires May 16, 199~
<br />lfO'1'ARY PUBLIC . CC110274
<br />
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