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<br />APR-23-'96 TUE 09:01 ID:
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<br />TEL ~IO:
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<br />11029 P04
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<br />COlmll'ION8 OF PERMIT AFFID.VIl'
<br />A. Bm'.ICR C)lI' ~RBS'1'R.I.Q'.l0II8
<br />rile 1IIl1IrtJIUII 1IIl1Iii~ ~ till. Jllmlt .IIif III _,eet to "dlllll ftltrIct1au" lIUci ., III au rlltrleth. t8t cn,
<br />ngullu.t. IIIe 1lIl1ml_ -- ~ibUlt, for IllIIp1h8ce 'Ill ., 1JPl1~. .... nltdcUGlll.
<br />
<br />B. UJrLICD8BD cnrr&acroRs UD COIft'JIAC'rOR HEBPOIfBI81LI'J'IU
<br />If t'- ... .. Und . _tnctat or COItUct<<I to IIIl1IrUb .., Uar ., .. fItIind to III u...a fa ~ Iltll
<br />.Ute .. Joa1 ngaJatlaaa. If tile COlItrKtor I, IIOt liteIIIeIJ a r"rtd ., ., W. till ... .. CMtrICtar .., III
<br />dtlll ,. ...~ rioJlti.. ... .tlte Jaw. If tile __ or iIIUntIed ClIItractllr .. 1ICIdII.I" te.t u.aillg
<br />r~.,....., for tllllatellW .., tM.r an -Qed to CODtKt till Clt, of ~Ula 1II11GJllg -'-t, IIU)
<br />7...."JI.
<br />
<br />FlIrt>>._'" If till! ... .. .inll . CIlIlItnctar or ClIItnctan, III II _I'" to .... U. ClIItric:tor(.) alII ~ of tile
<br />"OIItrKt<< wa." of WI .....ICItICllI for IbJ.s tIIIr .mllt fIIIIIIIIDle. If JIll, . tIII_.. . UII .uactDr,
<br />IUI .. 11I1... tIIIt JIll. ... tIIIII till ClIItractor, III P9"'.lhl! for till... If till CllIIItnatDr ..... JIll tG .t..
<br />II IlIIItrKtor - lip III . IDaCltiClll tIIIt lie it IlIIt pr~l, liCllll8lJ .. 1. IIllt IItlt1lll to ...lUIt frltl1etle ill tie
<br />Clt, of ......111.
<br />
<br />c. 'rRAIISPORTATION IJIPAC'.l' FDa AND UTILITY COlftiIBCt'ION Ji'BB8
<br />
<br />D. CONSTRUC'l'IOIf LIar LAW (CRAP'l"ER 713, FLORIDA S'l'A'l'UrU, AS AHBIlDI:D)
<br />I cuUfr lilt I, tile 1IIPUaIt, 11M .... pmlW 'itll a ClIpf of .,Jorl.... r.tnct'- 1.1. III _ '-r'. PrabctlIIl
<br />QWIe' JIIIIplIn4 ., till rJarua ~ of 19r1caltm. - eone-r IIfl1o. If tile Wli-t I' _ otIlIr IM& tile
<br />"0IIlIIr", I CIrtlf, u..t I an IIIltIiaIlI . ClIpf of till .... ..1... ~ IDl1 ".. 11 ... hill to WI. It to till
<br />"oller' priGr tG e I j T nl.
<br />
<br />B. _'S AFFIDAVIT
<br />I Mitr III ia WI ".fOll i. Ia:IIRte .. tfIat ill .. ulllle .... 11 ClIIpIiIIa all IU
<br />eppUa6lt 1M ..1.U.. ClIIItIlI:tlIlll, 1IIIIJ1g, .. J" ....JefIeet.
<br />Ipplbttaa .It ...., .... to aIItIIa iI (limit ta " ... ... ~ . JJtiat.& I CIrtlfr ~ . ..a: or
<br />IllIItalilt.lal .. ~ prier to iIIUIIICI Df . penlt .. tIIiIt 'u ... all .. ,.,... to .. ....... of III ..
<br />retalltJlr ClIIItrIctiaI, atr ....., IIIIIag ~, .. !all ........ ItIIlatiGM it tlIa JarwlcUII. I....
<br />artifr tIIIt I ....... tlIat ~ ~ of otlIr flDll(6oooIW ....... ., 1WlJ to tlIa lItaIW ..., .. tlat It it
<br />If ( r I'MUb to l.ufy.. ~ 1ut ~ to IlIIa "'UaIeI. ... ....1IeWI1IIt..1It Ual~ to:
<br />· ~ of 1IIrl~ ....atfGI - ewr- ...., lIItlMd Inu ... ~J, IDiU.. ~.
<br />lIIbr,..tMQr !IeItIm
<br />: =E ~~U,:~.;.: ~..,...., lilt... Inn, IJteriag ~
<br />· u_~_ _~bti" lan_, ...~ 11111~ lllit -lIIlJa, ___ ~ IIpUc bib
<br />· .. ~ ~ ....... - llllutlll "'~t
<br />1 . cart." -. If flllllterld II to lie .. II Pla .. "I" or 'I,ete.., it 11 ...... tMt . ....... I1tD
<br />....... I .- . 11_..... all III lllllittlll *dl .It "..... ., a prof_. ...... ftlllttqlla .. ItIte of
<br />Plorida trior to (lIDlt .....
<br />
<br />11I1I lIP .....
<br />c:a.r ar
<br />"... fongobg iD.u...t ... acbowl~
<br />before .. tbi. , 1'_ IIy
<br />
<br />I pmjt ....... ....1 lit CllIlIItrIId to lie . UllIIIIlI to falr:IIIatl tlIa .... .. DOt . ~tf tG ,1oIatI, ...r IItIr, lIl'
<br />at lIMe ., .-1aIlIla of till tIdiIJeIl codII, _ -.II J--. of . ....t frmIt tiI .1_ 1Iff1cla1 fa UiarIaftIr
<br />rl9irJag I amctioa of emn it ,J-. ClIIItncUlIl, or wloJatllIla of III _. ...,....t.........I...-.u.
<br />1lIIl_ till ... --1IIII11r .. plDit ia -.. aWl ,Ja .... of I..... or U at ....... ., tIIa ......t fa
<br />......... or ....... fir iI pIrIaI of .11 .... Ifttt tlIa tile tile ... it~. lIIe...,.... 1If tilt, ., III
<br />11'" flIr ~ llIIIlt IIIIl fee .. of tIS.... . -.el. aIla11 III ,...... IllritJIt tG . ......... Offldl1. III
<br />........ ...... .. .. 1aIIIlI .... .. 111 .. pedal, << tIIa proJICt aU .. ..... ......
<br />... ,,_: - I'Ila IV .., IlIIrlClllP ~~ _ ., liar D _ ....IIID .. JII'Ita I. " .
<br />fDIIIY. I'....".....~, ~ IItI. ~ CI U m.r...... -1DfIa or
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<br />'~: -;;:Z;.._m_;~~fi-
<br />-=_Cl.. .
<br />~ 1:to'^1? ~
<br />mil or .....
<br />aIMr lIP
<br />'!'lIe fo
<br />before .. tht.
<br />-/
<br />" i. PV8ClDIIlly
<br />produced
<br />'1 1 i i
<br />ta ...
<br />
<br />.. il ~11, boa to .. or wIlD baa
<br />produced
<br />as IdtmtiflcatlOD IIId 1Ibo did/did not
<br />tale 8ft oatil.
<br />
<br />
<br />(8iaaabtre)
<br />(R.. !Ded, Priated or 8Ut1ped)
<br />RO'f.IIIY PUBLIC
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