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<br />813 869 3322
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<br />1-10')-1 S~ '94 rUE 1.3; (15 I D:
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<br />TEL tlO=
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<br />tt00'3 P02
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<br />CONDlrIONS OF PERMIT A,VIDAVIT
<br />A. NO'tJ.CB 0.. na& JtE~TRICTJ:QN8
<br />tbe \U\Otttlgat4 \JP4etatJp&s t Eh . perin Nf be ivbJ.ct to 'el,ed r..trlcUooe' vbleh -, belOt* [QUiett.. ~ C1tr
<br />(tOUt.Uac.. !be uo4u.lguM ..._ relpon.llbUlty tot cc.pliancl! .Uh II1J ,ppUeabJe .4 ruttlcUCIDS.
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<br />B. WLIgmS~Qltt.Bl\CTORS AND cO!ftRAcTqlt USPONSI8ILXTI~
<br />If tb8 ower btI blrtd . ~tracto' Ct tontracton to _rtue VOl., thy .y be ttc;lult~ to be le.lId In aceorbnct with
<br />Btate 11I4 loal "",laU.. If the contractor 18 Dot HC8D.ed u requirea br hW, bot.b the olmU ID4 eontractM ., lie
<br />c:lte4 for. .114__( vlIJlaUon un4er state lew. If t.be OWIt or Intended CDIltrlttor arl UDCtrtllD .. to "hat. ueenliQ9
<br />r~h_t.e II' appl, for the In\t1l~ec1 work, they lre advlltc1 to ~t"Ct tile Clt, of JepbfchU1I Iulld1n9 DeputllDt, (8)3)
<br />198-6611.
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<br />httbe~re, if tbe OIfI,\tf b18 blte4 a contractor or ~ntractotl, be la aat'lf1~ to bt.. tbe cootnctOl(') algn portlou of the
<br />'Contractor tectlou. of tlll. IppllcaUcn tor wblc:.b tiler .ill lit fUpclUlbl.. 11 JOU. '1 tJIe ower tlgG II tM conUlctoc,
<br />you art lAClClUDg tbli JOU, ratbllf thM the contractor, art ruponslble fOt W IOrt. If the coutractor vl.... fOIl to aign
<br />a6 coQUaclOt tIlat II' blan l~leaUon that be II not ~roper1, llew'" and It not uuuea to ~1.lttl&9 prl,U69U In lb.
<br />ctlr of &e9bfr'ltl..
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<br />c. :rMHJ:lPO~1~~!~.!t..!~Lr.C'!'..JEES AND UT I LXT! ~ONR'~1- IQN FRE6
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<br />D. COflSTRUCTION LIEN LAW (CHJ\PTICR 113, FLORIDA 8TA'1WI8, AS AMlm>KO)
<br />1 certirr tIiit I, tIMI appllrMtt, !lat. btln ptov14e4 witb a copy of 'Florida'l CUllUuctlon. Lip Law - ~" p~tecUon
<br />Cuta.' pupared bJ" tJIt Uorl4. DePlftHtlt of Agriculture And Cona.x Affair., If tbe ,ppUeut i. ~ otJI_ t.b1A tIlo
<br />'CltI1lr'. I emU, tblt I N" obt8ln9d , copy of lb. Ldlo" delcdbec1 dOC\lMlt IDa pl'OlIlb. In oooG faith to dtlhll' it to t.lle
<br />'eMllt- ptlor to c.el1euent.
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<br />E.
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<br />IptllicaUOft it bttlbJ Iida to obtain.. pettit to dG .ot~ atI4 lnlt61hUon II ln4lcat94, I cerUfr tlIat DO 110ft Of
<br />. iUltallltiOD baa COIIeftceO prlor to 180uence Of a ,.rtit ana tbat all work viII be perfOtlld to ...t atan4at4* 01 ,II laW8
<br />requllUD9 coutrUcUoo, City cod". IOl\lng l't9'llaUonl, and land 4,..lQOlent rtgulaUMI i~ tbI SudI41c:tlgp. ' 1 allO
<br />clctUJ Uit 1 un4u.tInCl that tbt ngulaUon. of otb.l' OOler..utaI .Iaet.. Ii' apply to the lnteo4lc1 ,o:k, aDd that it Ja
<br />.,y reBpOOIlblUtJ to 14eotUr wh,t acUon. I auat takl to be 111 coapUlIllce, 8\)tb ,ganclu hd. but an ftOt 11Iltt4 to:
<br />. ~Utae1lt ~r ~,lr~~lJt~Uon ~ CYPJ:'-u Ba,hea~, w,Uw AtIU an4 MrlrollleJlullJ 8enttthe ~l)D4I,
<br />vlttr/Vaattlater YreatleAt
<br />t ~t Flori44 "atu MonI,M8I1t Vllt[W .. Vell., CJ1l(UI 8aJba,~, wetland areal, Ilte.rlnv "at.er~ut8"
<br />. of 1 .. .....U.. Docte, In19abl1 vatuway.
<br />. D! to. B 1fiJll..!t.!.,"l~.L IJ1dx9l*Dtd IleIlth \fIllt .. WeUs, vutewater Treatlel\t, Septic lanka
<br />. ~ ~1 rtlQlQul t10tlC~ .- Aebttlo, abettlll!Ot .
<br />I iho ~rtUfi.t, If ffIfii{iilil 1. to be ~t4 In rl004 IoDI 'A' or "A..te.', It It ."tOOC1 tJlat · 4r,lUlg' pl.n
<br />IMlQllpt . .COIPIDI.tiag volu..' ,nl be aubllUla wbleh II ~ttp.,.oA bJ a proftlllJOllIl anglntet feg1tt~tt4 In tht 8utl of
<br />~Jorl~1 prlor to petlS~ 1..uAA(@.
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<br />~ per.1t ls.ueclaha.ll " OOU8tru~ to be 8 Hewe to procetd 'II1th tbt 1I()rk ,nd IlQt .1 authority to .lol.ta, etnee1lltU, or
<br />tet IIlde ID! provl'lonl or tbt technical coGe., nor sball i..uanee of a peratt prevent tbe Bullalog Officlll ffOl tba(Olftet
<br />requIring. correctlOQ'ot erfort In plana, conalructlon, or viol,tlone of ant code. Jvory petl1t ll.ued ~1 becoII 1Dfalid
<br />unlen the 'IfOt\ IlIthoched br IUch per.it II ~~ 1I1t.blD ,Ix IOOtbe of i..1A8IlCf.. or If vort .lJtbodl~ Df tb8 perot Ie
<br />81l.pen4e4 or ~ for I pedexl of III JIOrltb4 e[tet lbe tlM tht work 18 tA;lIIen~. Ooe 90 48, Utwl08 Gf lbe, IIlJ bt
<br />aUowe4 fot U. pe~tt with r.. ebert- of .15.00, !bt uhtltlon tbaIl be tequute4 in ,:dUng to the DIlU410t OffIcial. An
<br />.ppro,e4 l~ptOUOD Mt " 1099t4 GudOV ..clI 81. IOtItb pdlod, Oi the pro,.ct 11111 bl COQI14ue4 ..t4.
<br />DlUllIG to CUll: YOOIt rAlLUlJ 10 UCORD A 'OTleI or C(MJ(IaCJMM KAY RE811tT II YOOIt rinMG !VICB fOI lKPIJVIlD18 to 'tOOR
<br />'BOPmY. If 100 man JO omlII "U'PCtI(G, tonULt VUY '<<Xbl J.PDd ()Illl AnORIIY Bll'ORIl RICOIbUIQ 10011 )(OflCl OF
<br />CLWIP<:IKD'l. J088 UIIDP U,SOO 11 VAloUl 00 II~ XIlD TO R&CORD PD POSt A 'M01IC1 OF f.UODCIMIJIt'.
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<br />naT( or rtORIDI aTAfI Of n.oalDA
<br />coom Of coom 0'
<br />Tbe fore901ng'ln.irua9~t vae-acknowlodgBd The fotigofng in.iruaent waiiC1ckOawlodVod
<br />before .. t.bl. " , 19_ by before lIIe thi8 "h ~_, 19____ by
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<br />
<br />(Ii._ .~, Printed or StuPedr~'
<br />KQ'l'Ml' rUlLIC
<br />__.~"'.'._f~ 1-
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<br />who 115 peraonally knCM) to ' ~ or wbo hoa
<br />prod~ced
<br />a8 id~tlf1C8tlop and wbo'dIc/dl0 Dot
<br />take an ottb.
<br />Tsivnit\iiir- __.,_J,___ --
<br />(Hue TYpea, I'd.nted or Btdped)
<br />!<rr~Y PUB~lC
<br />
<br />Wii01i' per.oneUy 1mo"itto~ lie or wbo bat
<br />proou",,"
<br />a. id.lltl11caUon and who did/cirrnot
<br />.t~Jt. an oilth.
<br />
<br />(81'gniluii)
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