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<br />'t . .. ,',_', -',._", .. -: "," ,': .' :....." " .
<br />. CONO:t"lON~".tfJ.\;~AFFIDAVIT
<br />1\ . NOT1CE OF DSED ..lUCI}\9R;~'t*~ft"'Yi'fj';'~1' t.or'
<br />the under.lgntd _erltMMl. t"t/ .. .~jeral,tlllf.. ,::. .Jee'i.....,.. . .~tMtrJeUonl. Ibleb .ar be lOre restrictlVlt than City
<br />regul.UOll.. hf IIltI1tr.I........;,.,........U',lor..U.. ..lUl .fi ewUeabJe deed restrictions.
<br />, - ..'~ .~ ,:':' ~I:.t",
<br />
<br />
<br />. :it' ,:;. '
<br />
<br />Furlhl!rlDt~, If the owntr hal hired a contraetor or conlr.cldrl; he 11 '.d,lsed to ha,e the contractor(s) sign portions oC the
<br />'eunltlldor SitU..' of,,,",I. IppliuU. for thlell u.e, ,III" ttlpOll.lble. If you, as the OIfJIer sign as the contractor,
<br />you art! ldetleaUIIi 1hat fCMI. taUllf tha the tOIItrllttor, Ir. r.*lbl. tor the work. If the contractor wishes you to sign
<br />BII conlr.clor lat _, be .n lncUC:IUoI tMt .. I. not propttl'U.... antJ I, not entitled lo perlnUng privilege. in the
<br />Clt, of !ephJthlll..
<br />
<br />c. TRANSPORTAtION IMPACT FEES ANO UT1LITt CONNECTION FEES
<br />
<br />D. CONSTRUCT10N LIEN ~AW ' (CHAPTSR 113. FLORIDA STATUTES, AS AMENDED)
<br />I certIf, that I. the appllclftt. ba,. been prorJaea _Ith . eopr uf ',Jorlda'a COnstruction tlen Lal - HoIeOwDer's Protection
<br />Guide" prt!pared b1 the 'lbfl',' DeplrtftlltlofAgrlcaltllrl a...CIIlMer Affalrl. If the applicant i. sOleone otber than the
<br />"owner", I cerllf, that 1 haft obtained a eopf of. the abutt dlecrlbed doeuIenl and prOllle In good faith lo deliver it to the
<br />"owner" prior to toIItIIteII!nt. Ii,.; ., ,
<br />
<br />E. CONTRACTOR t S/OWNER' 8 AFFIDAVI'r
<br />I certir, thal all the tnforlltlon In tbll application t. accurate and thal all .arl will be done in cOlpliance with ail
<br />applicable law. teguJatl~ eontlrtttlOd, lonlng, ana Jana....lapl8Dl.
<br />
<br />""plication III hereb, ..act lo_llIl1l.perltt t..dotorl.... JllltiU.Uon 18 indicated. I certify that no work or
<br />InlllaJlaUOII hI' toMenc:tc1 fllbr t.:l..lIItIetor;...rtlt......,Uilt,.U torl trlU be "rforillH1lo teet Itandards of all laws
<br />regulaUng conltlrucUtJn. tn, tol18t.;.lif'~HgUl.tl-.-; .1Il1.....,....lopMnt regulaUODI InUle jurisdiction. ; I also
<br />certUy that t undttrtt.... lhat.tht tlgdllUOiI.lJt olhergOtetMlatllapnele. Ill' .ppl, to lhe . Intended IIOrk, and that it is
<br />I' rellpcmllblUtr to ..Uf, what leUObItf...t0!...,);to ~tJ.~~1Jence. Such agencies Include but are not lillted Lo:
<br />. Dl!t*t.t of Ind.-taI....U." CfPt... .........tlW Ar... and Bndronaenlally Sensitive Lands,
<br />. .' 'attr/VlltlltitlrftMtMnl
<br />. souUnreat rtodela If.ttt=t D1.tdct ".1feU"CfPttH'h'hac1i, Wetland Areas, Altering Watercourses
<br />. Irll CotPl of _heed "'. !f:Doc:b.~"d"bIIlWat.rt.ra
<br />. De _rllent of IIeIltlll . 'UIUu,t "rtlc:et ....ltoftlMUllealth Unll - Neils, Vallelllter 'reatlenl, Septic Tanka
<br />. US IDdrOdmlllll'lO . . . i..<' ". toe . t...t:. , , -
<br />I 3180 certlfr t .. . .. ..'_11' eFl. t.cfbtult!Clln 'ldOl1lcthfl 'AI or 'ArlltC.', It III undentood that a I1rainaqe plan
<br />81111re881ng II 'ttIIptJIl.tJlf-tOt.'ltlll'belUblIUtl1.bldlJ.prlparec1 b, a professional engineer registered in the State of
<br />Florida prior to ,.rtlt.l..u&dtt.
<br />
<br />. A perllt Issued .h1l11 be con.trued to be . 11eenll 10 proceed 11th the wor. and not a8 authority to violate, cancel alter, or
<br />Bet ;telde Inf protlllOdlUftlat t"lC!al,cpau~; IIOf........uuance of a perin prevent lhe Bullding Official frOJ tbereafter
<br />(l!qUltlng . cor~ttun of errol"." pl....t. toIIttlctlOll/uf 'lotatluns of Iny todl. I,ery lItfllt Issued 'lballbecon Invalid
<br />unlesll lhll trorl .ut'*.... br'''' "rtu.JlttJ,n.htlcl','I~.I, IOIIthe of "suanee, or .If Ifork authorbec1 by the perlit is
<br />8uIlpended or ebanctoned fot a perloct'of:.11 ~tIII'fter'.U,,'U..u.elfOl'lt8 toIIl!riced. One 90 da, eltension of UI!, lIay be
<br />allowl!d for the tM!rtltttlUt f"~t1f! bftlJt ' >' !1l ~8 requealed In .rlUng to the BuUeling OffiCIal. An
<br />Bl'pro,l!C1lhllpec:t!0IIItJIlblt.'dt1ftli,,,.,, ! ..lllt proJed 1111 be considered abandoned.
<br />""RftINC to OIfUR: ,,*,"fll' ;,' 1~~_1~ . . MAY RIBUt! IN YOUR PAYlffCt1fICK VIHIIHTS TO YOUR
<br />PROPlm. If l~fI ' ,'t '. . Ilt.bol.'OI U KG YOUR ICE OF
<br />(.UNit . .t 1I01Of;,. . . r. .POSt UtICl F ClHI, .
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<br />STilT! OF FLORIDA " MAT' at FtORIDA
<br />count or PAS CQ .".. coom OF =PASCO -
<br />The forf!golng in.t~t vie ~q~.O"le..oIg"" ",\'hl foregoing inBt~nt lIao acknOldedged
<br />before me thill q ~ ' 19" b1.', , ,before lite this q.f-2= ' 199 g by
<br />-=r< I\i -:-D~ lJ I ~ ~ . ~. ." . '-:p. A Y 'T) A rJ 'Ek..S
<br />'Hho Is personal r known to lie or whe has il..t"WiiOis personally known to me OF 1,119 bas
<br />:~()dd\;et .' . . lIt"edllced .
<br />id~: 1'19.1:1018 ....d trho~did.nut. .. '.. .1deuUficaUuJt and who lUtI/did not
<br />::::::u:::h~~ dr11/o'X '.,~~,.~:::U:iiJA~~~ i !h~~
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<br />
<br />(Name Typed, Printed. or st~d) . ' ...JN8Jlle Typed, Printed or stamped)
<br />NOTARY PUBLIC ..,,1 P/J, ' !tOTARY" PUBLIC
<br />........ n ("'.. KATHLEEN J BROWN" , , ~"". !'v,1.
<br />* ~ * My ?ommission CC449029 "11'1> KATHLEEN J BROWN
<br />"'..~..'"' Expires Apr. 02. 1999 '* * My Commission CC449029
<br />""~ ll~ ",. ~ ExpIrea Apr. 02, 199Q
<br />Of f\. """ Of ,~Q"~
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