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<br />OCT-21~'97 TUE 14:34 ID:
<br />
<br />TEL NO:
<br />
<br />1=1009 P02
<br />
<br />COHOITIO.NS OF PEllMIT AFFID4VI'I' , .
<br />.A. lfOTJ:ca OF DKKD RKSTRICTIOtfs
<br />... ......... -- lOo' W. .....,.... "J,,' to ..... '.."lctI.... ofd"'..,..... notrloU.. IIori all
<br />rtguJiltfdlll. file _reJgoBClI88I11e1 chpOnaibUUr for oo.pUancl ldUl In, IIIPJJcable died I'tItrJCu..
<br />
<br />B. UJI'LICB.NSEb CONTRACTORS AND COHTRAC'1'OU lIESPONSIBILI.TJ:
<br />11110 - ... lilt.. · ....tra.tor or "'!r".... to _.... 1IOt'. tIIIr.., 1>0 ,_ to .. "_ .. _ lit..
<br />..... ... - _Illllll. If... "'lnctor I. .., U_od .. ....1recI .. _. "Ill th _ ... __ .., 1>0
<br />cJlooJ lor · 01-..., .Ialoti.. -.Ill ...ta I... If to. -. or la_ """'-' iItI _ .. to _ ~log
<br />"911_ .., '!PI, Car ... I..... 1IOtt. "'" an ....,... to ..."ct ... a" ar 1IIIbrdW.1oIJdIog -...-.. IWI
<br />78"6611.
<br />
<br />..tt.... '.""'1
<br />
<br />--. If ... - bu '"" · -.cOClor at """-r.. "" I. .4.1", to "" ... -la, eIgo ....u- If lIIe
<br />'Caeltlclor 1ectlaIe' of We ....U..U..lor oWdo ..., 11I11 "" C_II. If,......... _ oIto.. ... _.
<br />,.. ueW..."", ...,.... - lIIan ... ...1,...... "I ro'l'lIIIlbll lor ... 1lIri. If... __ _... III olga
<br />II ....It..... 1iII' ....... In4lClU... tJrat III i. nat _I, u...... .... I. .., oatlU", III ~1Uer Jdllleleo Jt 110
<br />Cit, of IeplJrr.iUI.
<br />
<br />c. TRANSPORTATION .lHPACT FEES MfD u'rIL~TY CONNBCTIOl't FEES
<br />
<br />t t
<br />
<br />D. ~XDlf LX"" LIIw ICHl\Pl"BR n3. FLoRXDA STA'lUr...., AS _,
<br />I tortIe, ..., I. ... ....11_'. .... ...... ,'adtllll .1.. . "'PI .r 'FIorlill" """'""U" U.. III _ "-'1__
<br />CoI'" - br ... '...rilllll(llrtJq, .1 AurI"'ltm .'" _ Ill.in. If lIo 'I'011ceet Ia _ ..... _ lIo
<br />-'. r tortIl, 1iII' , .... ........., · ..., ar ... ..... .....Ibod _, ... _ .. .... ""tllto feU_ lito ...
<br />.0lflIt1'. prior to ~t.
<br />
<br />E. CON'lllACTOR 18 OWNBJP S 4FFID VIT
<br />I "'Uf\' IUIIII ... W-U", III Illia '!PIICltI.. . "'O;:'~ 11I4 lbol .11 _ Ollll>o be .. __ dll all
<br />ipp.liC8JlIB 1.. regulating COIlItruCUIII, IOIIJII9, Ind Jen4 deJ81na-ent.
<br />
<br />Ippllutlao it lllrebr .. to obtalD a penit to do worl and JnstaUation U indicated. I Qlrt1fr tJIIt 110 _1 or
<br />IlIIWloU.. .... - prill< III ea.ar. Of . _, MIl "'1 .11 .... will lie ....,.... to _ ....... If 11I_
<br />l'8g\Il.Ung CGIIItnJctlOG, Clt, codh, lOning reglll.t1ona, and JIIId devel..t ngulaU_ 1D till jurlllUctb. II1to
<br />~rtJf, tJaat I _ntand tIIIt the regllJaUona of ot_ goyln.eotilJ .....cJ.. ., IppJ, to till JalllllW _, .. 011: It Ja
<br />If rll(lOlllJlllUty to identify whit action8 I "'8t tIle to be 10 COIPUance. Buell 1IgUeJ. bcllae IIat In lOt lWtIII to:
<br />· Me.t of Ia'JlJmeQtal _IIUon . CDr_ II,.., lIetlllllllteu and lD'ir-.ata11J ....U" ....,
<br />IIaler/llll8tewltll Irlil_t
<br />t ~u..t 'lorf... rater NlIIIQ.~t DietrJct . Velie, Crpree. Baflleada, ltetlml Ana, lJteribg 1IIter~
<br />· ~ of IRIIIIIt!! - .....U8. 11oc:b, liI'1g11111 IIlterw.,. ,
<br />· ~ 1IeI1II1-'lIbU.. llenl"" "'~d 1IHltb IhIt - "111I. ..._ _.. iIIItIc_
<br />· Illod~ 1'JotIctI. !me - ""tOl .balelent I
<br />' or.. ...11 r tIlIl. II fill ...... .1 .. to lie .... " ".... .... 'a' at ......... II I. __ I...... tIIlI
<br />lIMnoalat I "lllIIpOiIaWog IIJ!,., 011I1>0 -11o?i"''''10 _ br . _11IlII ...... ..- ..till_ill
<br />Plod'. pdot' to IIDJt. illUlrlc:e.
<br />
<br />. I - - .....1 .. -Iruoolto III . 11_ to _ "11I ... _ _ nat .. _II to '-' ~ dlat, ..
<br />11I:......., fClIIld.. of !lie -eel -. IllJr 'baIll""""" of I peall pnrut ltelldWag lIfOcla1_lIIIIIeJtar
<br />tliillrIug · llImCIJao Of orrun III phoo. -lructloo, .. 'I<.:il.... Of ..,..... lrerr II3IIIt ~ ~ ___ -.w
<br />- ... lilt ..taarlllll br nolo _ilia - olW. ... ...lIo of i___ or If lilt --1Ir ... JMIIl ..
<br />IIMpIIIded or ...... for · period of Iii ...tb8 1ftII' th tile the IIOr. 11 .......1ICec1. ODI to dQ ......... of till, III III
<br />.U.... '01' tile peralt Idtll r" .f9I of '15.00. fbe IIt....Joo 8IIaJl be fllJUUtef in wrJUog to tile IIdIdlDr 0lf1cW.. II
<br />.DI8lI iDlpect)OII -t lie JCIggIC) during IIIclI ,Ja -th period, or tbe ptaJeet .Ul lie I!OUUenII ,._~..._..
<br />-- '10 CIfDI: NIl PAl'" ro IIaIID A IOrla or CCIIIIICIIDr lIAr IIIBUL' JI __ '11111I MCI ... IIIIDIIIkn. 10 ICIII
<br />....1. II tIlU IftIID IU 08111" '11lUC11G, IDISUlor 111m fOUR LIJfIIII 01 AllftOaJr IIICIII "u; IIIlII DlCl or
<br />lDIIIItuur. - UIDQ '2,500 I" 'ALUlIIO lOr IiID to RICOIID AID POSr A -QICI OF ~I.
<br />
<br />'IGIIUURi: ... .. ACar
<br />
<br />1~~""ltJ~ I
<br />81Wflllll: I -
<br />
<br />I
<br />: I-
<br />
<br />80ft or fI.GIIDJ
<br />a.rr CIf'
<br />'l'be foregoing i..stl'1lllent was aCknowledged
<br />beton .. this , 19--. by
<br />
<br />wbo is pereonally known to .e o!' who has
<br />produced
<br />.. id8DtiffcatiOD ad who did/did not
<br />take an oath.
<br />
<br />(8tpature)
<br />
<br />ca.., T,\rped, Printed or StMpBd)
<br />lfOrAlfr PUBLIC
<br />
<br />SlAR OF PLOIIIJA
<br />~O, Pinellas
<br />The foregoing in8tn.&nt ".. aaJcao.ledg8d
<br />belo!'e - this Oct. 17tb , l'!lL by
<br />
<br />Harry J. Mullen, Jr.
<br />w!:o 18 persona1l7 1m0llD to _ Dr IdaO bai
<br />ProdUCed
<br />as identification and who did/did aot
<br />
<br />~ "t'") ft.f
<br />fI It o1I1i
<br />(8 ature)'
<br />lia R. Westcott
<br />(If.... Typed, Pdated or ItBpBd)
<br />"OTARY PUBLIC
<br />
<br />y.... Julia R. Westcott
<br />..~~ Notary Public, State of Florida
<br />~ .. .. Commission No. CC 687082
<br />"''to,f\.' My Commission Exp.l0119/20m
<br />l~NOTARY FIL NocIlrys.w,. & BondI"!; ..:
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