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<br />E. OONTRACTOR1S/ONNIR'S AFFIDAVIT
<br />I certlfr tllat III till JIfGnItlaa 1a t111IlpPllcaUoall ac:curate ID4 tbat all 110ft ,111 be 4oaI1I _1IDce .I~ ,U
<br />applicable 1. nplltIDg ..tncUaD. 1CIIlDI, IIIl1llDl1 4ne1OllI8Dt.
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<br />Applicatiao i. IIIrebr .. to Obtai4 a plnit to au IOrk IDI1 inata11aUOA U lD41catel1. , I certlfr tat DO _1 or
<br />inatallatloa ... ...... Jlior to ... of a perlit IIIl1 tJaat a11l1Ork ,111 be pufODll1 to _t I"" of III 1_
<br />regulatill9 COIlItnctiOl, eitJ ca4II,,1OIliog .atiOlll, en4 1114 4Pe101181t r:egulIUOIIIlD tU Jurll4lcUal. I U.
<br />certH, that I UDGar,taDd that the ~U_ of ok go'~W ageudll ., Ippl, to the latlll1lrS tJOrl, - tMt it II
<br />IY reapollllbUltr to It11DUfJ lllat acUDDI I IUIt take to be ID ClJlPlllD. 8uCb aguel.. lDCl. but are DOt 111ltel1 to:
<br />t Dlpar_t of Iatl~tallltGulatlOll .. CJprlll Ba,bul1I, Vltlua IrUI 184 1Dt1rOlllllltallr BallU" LID4I,
<br />llter/Vutnater Irll~t
<br />* SOUtlMat Plotit1lllater -=t Dlltrlct .. hUI, CUr... "rIlI"l, WtUIPG kill, AlterlDg ..~ '
<br />t kg Cog>> of Irln . I, JlucU, '"lgable hterllJ. .
<br />t ~t of U. Tlelllbllltltlft 8enlcu, 1Dt1roDRDtal 8811tllllDit .. 1111I, VII_tar lrII_t, 8eptlc tIDU
<br />. US lodn..td ~lcIl ~ .. ....tOl IbItlBt. I
<br />I al80 certlfJ tbat, If r II .terlll 11 to lie UIIl11a Flood loDe 'I' or 11,lte.', it I. UDlIeatclO4 tllat . ttaJDlp ,lID
<br />ac1druIing . .~t1Dg a.1 ,Ill be lu1JI!tte4 &lcIa It pnpue4 br . prof.lonll engm. I'lIl1t1nl11D tile 8tate of
<br />'lorid. prior to .....t ~. . '.
<br />A perlit 1_14 1IIa11 be ClDIIItruIlJ to be a liC1J188 to proceed with tilt ImlllDllllOt U IUthorltJ to Ylolltl, caall1ter, or
<br />let lside anr prOYlllaIII of tile tecbDlcal COl1u, DOl' IIIill 1I811i11C1 of a (luait (lrlflDt tbt, B1dl4lDll Offlclal f_ tlltnafur
<br />rlQUiring . correct1. of mot. In p1_, c:at.ruCtiClll, or tiolltiDal Df III CG48. 19e.q pualt 111_ IW.1 ... 1I,alld
<br />unlus the .-k auU.lH4 br IIlCh penit it tll.8DCe4 .ithla ai& _tilt of 1u\IUca, or if IOtk 1IItIIor1le4 bJ till pmit 18
<br />auapeaW or ..." for . ,.1011 01 Iii atlas after tbe tile U. work II oo..JUWl. 0aI 90 UJ m..lcIl of till, iii be
<br />allOlIC1 for tIaa peult ,,1~ ree cbuga of 'lS.00. ,. tltI8IloD 1ba11 be r.... 1. .ltiDt tile Idllllg Official. An
<br />appro,1C1 1 ' _t be loggll1 .. ,iI atb ,.1011, or iect lill be CGMl ......,.
<br />WWllt 10 YGI PII_ to llOllCl OJ cmIICBIf U I U ,. .11118 CI lI&Ul8II8 10 lWR
<br />PROPIRfI'. If 10 III 9, CCI8ULI Dill nil lmllll-- _1OI1C1 or
<br />aBUCIIIIII .. tZ,500 DO 'a.lel or
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<br />SN:ne. \:j-1-e wf\.S
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<br />81111 OF ~ .
<br />coum or tlrl A~
<br />The foregoing lnatEUlleQt .88 WJjpGllIe4ge4
<br />before .. thla,l.... ~1P , 19.15... by, .
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<br />S '-'tM\e ~4v'-ett ~
<br />"00 is per~ 11' boa to - or who bas
<br />produced ~ -\-^ ~
<br />a8 i ficatiOD ad no did/d1d Dot
<br />tak~ ~tb.
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<br />SDU or ~.( ~ . ','
<br />CDJIIY or or I d "-
<br />fbe foregoing lDltruMDt ..1 .C~OIIj.dg.d
<br />before .. this J- ~' , , 11 ~ by
<br />D~ SkV-U1S . .
<br />who 18 ~riCii811, bOWD to .. or wbo hall
<br />prodUced ~(tWf\ +-~ ~ "
<br />al ideo lcat10a and . did/did Dot
<br />ta ~ (1)'
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