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<br />FEB-15-'95 WED 14:13 ID:
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<br />TEL NO:
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<br />11233 P02
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<br />CONDITIONS OF PERMIT AFFIDAVIT
<br />A. ~ OPft'I!~!fTIp!8
<br />!Ill... t .., lib'," to '~ RltrJct1C111' lIIIlcIl III III a. nttrlctl" taD City
<br />rllglllu.. 1IlI....... _ I'IIpaIIIWlltr for CllIpJJIDCe _ltIIlD, ."tJCIb1. W nltrlctk...
<br />
<br />B. L R8 AND RACTOR RBSPON I ILI'1'IBS
<br />If tile -- ... I ClIIIItnctar or c:aatnctort to work, tIIIr _, ~ to e4 III ICCOrduce witll
<br />.tate IIIl1local ,.Jell.. If tile coatrlCtor I, lOt JiCUAd .. fI8U1n4 bJ 1., llotll tile ... ... coatnctar IIf be
<br />cited for III...... ,lollll. lIIIlSer .tlte III. If tile ClllIIU or lattaded c:aatrlctot ItIlIIIllUtI1a II to ....t II-.1ng
<br />reguir..b..,., for tile JDtIDGe4l1Ork, tiler are tddted to coaUct tN CUr of IIpIlJrWla 1DW.IIg~, (813)
<br />781-6611.
<br />
<br />FurtIIerIoq, If tile - .. l1rel I coatractor or l.'GDtrICtot., III 1. IdYl_ to .... tilt QIIItnctor(I) lip porU.. of tilt
<br />'Cootrlctllr 1IctiGaI' of WI ."UCltiOII for IWcIa tlltr llill Ile ftIPCIIIibl.. If JaI, II till ... IJgI . till cmtrlCtor,
<br />JOIlItI hlGJClUat tMt JIlU, rl_ tIIIIl tIIJ l.'GDUlCtor, If. r"'lbll for tile 1lOrl. If tile caatnctor ..... JW to .1,.
<br />u c:aatnctar tall IIf III.. JDdIatllJll tall at I. IIOt properl, HCIIIIIIIIlllJ 1a DOt aUtll4 to PJnlttlDg ,rbU... la tile
<br />Cltr of ~Ilt,
<br />
<br />C. TRANSPORTATION IMPACT FIlS AIfD UTILITY COJOJBC'l'IOJt P'EE8
<br />
<br />D. CONMION LID LAW (CHAPTER 713, FLORIDA STATUTBS, AUAIIBlWBD)
<br />I cutlfJ oat , u. .I..t, .. ilia ptOflb4 .ltII . COPf of 'Florida'. CcutrucUoa Lt. La - 1-.'1 ProtlCtllll
<br />GlIJda' ~ IIr tile rlorlda lllpertleat of Igrlcultare u4 c....r Mfun. If tile 'lIPl1C1Dt It ..1IIIlI otJler tIIa till
<br />'llI/IIr', I CIltlfr tllat I .. obtIiIII1 . copf of till ... ducrillt4 docaIeDt 11I4 _.. illOOCl feJti to WiYlr it to tile
<br />'OIIDIr' prIar to . .~t.
<br />
<br />E. ~'8 AFFIDAVIT
<br />I c:ertlfJ t 11 till, 'PPUClUoa I. lCCUf.te ad tJltl .U lIOl:& .111 III doat ia QlIIPUuct ldth III
<br />appUCIb1. 1M 19ltt1Dt ..tnct.lIJII, 1OlWIt, IIIl1 IIIIlJ dmloplelll.
<br />
<br />AppUQUoa Ja ..., .. to obtIia . lletIit to do lIOrlllld 1IIIUlJ.tJOlI .. ill41Qted, 1 cert1fr tat GO Illrk or
<br />ilIIta1l... .. ~ prior to IIIl111lC1 of . pen1t IlId Ult allllOrl: .Ill be put.... to _ I~ of ill 1M
<br />regullu., CCIIItructJoa, CUr.., IOIIIDg regul.t1Oll1, IIId llIId dmlClllllftt nguJallCllllla ~ 'urlldJlctloa. I 1110
<br />ctrtlfJ UIt I ~ tat till regul.UoaI of otIIer ~tal ..... .., 'lIPlr to tile iabIW ., .., tilt it i.
<br />IF rll{llllllWlltr to l.ufJ "'t ICUOllI I ..t tW to be 10 COIpl1l11C1. .ucIIlfIlIC1. 1ac1.. .t "" DOt llIlted to:
<br />· DeNrt8Bt of IIIfJra.taI ItIalItllII . CJpreII ......, lIttlaDd kill IIId IIld~lr ....ill'll tudI,
<br />Illter/IIItMter rn...t
<br />t t Dl It. 1IIl1l, CrPrIII II"", hUIIId ar..., Ilteriag ..terClC~
<br />· , 1IocU, lad_I. IIItInIrJ
<br />· 'tal IINIlb UDlt . 1Iel1., ......ter __It, 8Iptic lub
<br />t. iNt.at
<br />I I , liter I f, to III _ II FIOlIlIIoDe II' Ot 'I,.tc, I, U I. u1IlIIrlt004 tllal; I dtI1IIIp pllll
<br />1d4rta1It. '~_.' 1m blllIIlIittllSlIb1c:ll. prfP'Qd IIr . prof.lllIII1 qu. f9,1-.1 111 fa 'lIte of
<br />'lorlda prior to ...u JaRace.
<br />
<br />I pmlt IIIlIId 8M11 .. ClIIIItrued to .. . UCIIIII to Proc:eecJ ,Jtb tMllOl't IIIlI DOt It I1It/1oritr to doJ..te, CIIICt1.ltIr, or
<br />lit 111411 ., pMJaJoaa of tile tIcIlD1Cal cada, Dot 11II11 JIIIlIIICI of . pIlllt pr.,.t tile 1IIJl4iag Offlclll fa tMrIIftu
<br />reqaJrJDf I ~ of ID'VlI III p1llll, COIIItructJoa, or dolltiou of ., code. htrJ pealt lIIaIlI ~1 __ Walid
<br />.11I tile IIOd MaorI... br ndI pmlt II ~ IliWa ,11 ..till of I"', or if IOrllUtllurU14 bJ till pIDlt J,
<br />IlIIpIDGed Dr IbIDIaaal1 lot I perl04 of Ib IOIItIIIlftlr tile UIe tile lOr' I,~. ~ 10 .., __OIl of till, ., Ile
<br />dJOlII/I for tlllpait 11th fll cIIIrge af .15.00. nae eat..1IJII_ll be reqautId II Itlt11l1 to tM 111:I_ Official, AD
<br />IfPtlM4 lupecUc. _t Ile 1_ -lag IICII .!l1OItII perW, or tile project .Ill be IlIlIIHIrI4 ~.
<br />11III5 10 CIlIa: - rw. 10 IICllID IIOrICl or ClIIlIICRb DI IISlILr II 10lIJ NO IIJCI III I......... 1'0 IOllI
<br />PIIlPIIrr. I' III II!IID IV fIUU FIUKlK, lD8GI.! Uft 11lII YIIII/I II U JftOIIII .... --lIllll1l1 JJOrICl Of'
<br />ClIIlIIOIDt. - -t2.500 II 'ILIIIIIO lOr laD ro B:lID lID P08t I 'IIOrICI or ~',
<br />
<br />
<br />81": ,.. r. *'
<br />
<br />IIQfDlII: t1IDIIC!'lI
<br />
<br />81IQ or PfrGIIIII
<br />aum or
<br />'lh. foregoiq iutnlJeat ".. acbOVltldgtld
<br />before _ W. , 19_ by
<br />
<br />"IQ or MIDI
<br />COlIn' or
<br />The fOl'egoiDg iDn~t ... acbowledgld
<br />before.. tbia , u_ by
<br />
<br />wAN .1. ~U:r IQIUlfD ~o .. or "110 ba8
<br />produ~ .
<br />.. ideDUficaUIID 8Dd "ho did/did not
<br />tHe .. oatb.
<br />
<br />(Sip.tare)
<br />
<br />(M... 'l'Jped, PriDtItd or 8tuped)
<br />IIOfARY PUBLIC
<br />
<br />wllO 18 per80llauy aDOvD to .. or ltIlo _.
<br />produced
<br />.a idlllltific;at1OD uel .110 didldid 001;
<br />tab ... oetla.
<br />
<br />(ligature)
<br />
<br />(R.. 'J':rped, PdDtec! or Stupid)
<br />IfO'I'ARY PUBLIC
<br />
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