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<br />. COHD.tT:lOH8~O"..~P.IIH.t't.,\AFFIDA VIT
<br />}\. HOT.tCE Olt D~ED RKS*tnlt't.t()If~,("J)l\~.~'~~'.~:~~,,{,: ....,..
<br />'he Imdul'gnec1 tlllder,tltlC1. t..t tltl. ptnJti<",''''!'ubJec~ilto~,'r..tddion.. which .ay be lOre restrictive lhan Cily
<br />reguJltIOd'. tbf ondtr'I~,,,"""~"lJltf.tof;~Jl '.Iib anr applicable deed reslriclions.
<br />. ~f"'''''' 4o'.a..: _" 11 .
<br />
<br />B.' UNLICENSBU. COM'tMC'tOns AND COH'l'W\ttOlt JtESl'ONSl8lLITIES
<br />If lhl owner h~' hit" . taltt.ctot Uf.~tr.ctor' to unlatt."\lDtl,.thfr ..,'be'requlred lo be licensed In accordance .ith
<br />slallt and 1tJC:.l tlg1tlaUCIhI.. If Ute tGiu.clor 18 not UttMtd~;.. t.1rtc1 br lint, bolb the owner .~4 r.ontraclor II' be
<br />cltec1 tor II .I....nor ,lolaUm unc1.r .l.l,'litt~ U l......fur.lnl8tc1td.c:onlratlor 'rl unc@rtaln~as' tOllhat licensing
<br />t~9ulreltnll III l;pl, tOt lbe lnl.nata lOr', the, It. tdtl~'lo tOnl'ttthe ellf of leph,rbllll Building ,Depa,rllent, (81])
<br />181-6611. . , . ....' , . "
<br />
<br />~. ; ,.1 I":'
<br />
<br />Furlher"t~~ If the owner hal hired . conlr.clot nr contraclor., he Isaa,lled to hi'. the conlraclor(s) 81gn portions of the
<br />.conb'ttot SotU..- of 'U.J.'ppU~Um for Itblch the, ifill be tUpclI1.lble. If you, a. the owner sign as the con'~aclor,
<br />fOU arl lddlcatlni that fbU,rather thin t~ tonlr'tlot, 'tl ,..fOfttlble'r,r'lh. lIOr1. .f the contraclot wfshp.B JOU'lo sign
<br />III todblltlor that ta, be an llII1lclU. lbat .. I. not plopttl, .lJttnled II1C1llnot enUUed to perllltlng prhUege. in the
<br />en, fJf JephrrhHltt. . ..
<br />
<br />c. TItMfSPORTA'tlON IMPAc.r FEES AND UT.tl..ITY CONNECTION' FEES
<br />
<br />v. coNSTRUCTION LIEN ~AW \ (CHAPT~R 113. FLORIDA.8~ATUTES, AS AMSNDED)
<br />I cerli" that I, tht .pplicant, he,. btIn protlaea .Jlh . eopf of 'tlorJ'a'. ConstructlOh Lien Law - HoIeownert.'Proteclion
<br />CuMe' prt!partM1 b, l.. 'lbtJd.hplttIMbof.iAgdc:tdtar. ......CaII1IItr Affalrl. If U...ppllcant 18 801e0118 other tllan the
<br />.owner., I cerlJI, that I .... obtained. top; of'lbt .bote ".erlbta doc:uIent .nd'pr0l1..,iln good faith lo deliver it to the
<br />.owner. prior let toMntlllttnt. ., OJ'; ... ·
<br />
<br />E. CONTRACTOR'S/OWNER'S AFFIDAVIT
<br />I certi" that .11 the inforlltlon In t.l. .pplle'llon II .c:tUr.te and that all worl will be done In cOlpllance willi all
<br />IIpplle.ble Ill.' t@gdJ.lJRf tOft.lratllod,~.anlngt and Jand:....lopfent.
<br />"ppllcltlon I. "'rlb, .. tdflbtal.. Pltll~t'tc1o IOr'l~JIII~U.Uon II lndlc~tec1. . I cert~(, that, no "or~or "
<br />Inlltall,lUon .1' .....\.rt6t~lo~...!or~. ..tll\i~~.I~,lIprrtdU hI,..r1otalll1J~ ...t .tIIIl1lrc1a;.of aU:la.s
<br />regul.tlng conlhucUonl tnt ~.~~..:!~I~U.;,:w ,..~""l...(retli"U..llftt~)utt'dlcUon~~~tJaIICl"
<br />rl!rUr1lblt I _rlt_lhat'the t.l.Ulili'btol"t"j1tfilAt.11oo_1u'IN"'ppl,~lo'lfii"lntetn1ec1lfOr', andlhallt is
<br />If rt!lIpottllbJHt, lo IdelHt, .t"tU_jlt..tt.bh,to~,I'j,_l1ancl. Such l19end.. Include but arl,not U.Uec1lo:
<br />. DepilrtBl of Intlr....t.el _laU. ... t,..... .....; ItUIIht At... IJIll IntlrontentJl1r Bendlhe LandI,
<br />,;" ',',' ',;1;; ,. J,V.t.u/llfltllltu "..taent'
<br />a Southwelt Flodda lI.let 't' 1J1Udt~ ,;i' "'U.,"\t,;tiM~..,.....;, V.Uanc1 Arlal, Altering "atercOUrl81 '
<br />· At tor of "e~ .1.....1.~'~".1t1. ..tltt.,. "
<br />. Depllrt8t It .. lUl "~"rt ttI . bt1t_W,leallh IJall - VeUa. lIaltnater Ireallent, 'SepUc: lanll
<br />. US IadrOlileltl"lo ,jo~.", ",., ,,j....~t...._,.. \ .'
<br />J 3110 certl'r t, liter ,I J. (0 be bltd'ld .1~ tdft. lA' nr 'A,tte.., It II understood lhat'a/dralnigl plan
<br />eddrellllng . 'toIpfml.tJftt.tOl"~;:IfIU be lublIU"', ~hl~,Japr.par'" b, a profllllooal engineer reglaterec1 In the state of
<br />'Iorlda prior let per'U.I"uM~. '...-.' '" .' ",,'
<br />. "perin IlIuec1 ,hall M .....Util!c1'lifM....{tebl' lo ptdtltcfiUh lhllfOd and not as authority to .Iolate, . cancel alter. or
<br />let Islell an, protl.J.""f =j~~t,.~"'l1i!Jttl1nc1 of . petitt prlfent U..Bullc1~n9 Olf~clal frOl therea, (ter
<br />reqdltlng . torttt!U.. 01 't' "1. :p"~i!lMIlttE(l~rM htdlUon. of' Ih,toc1l. .1'lrr~lIfrtlU' J..uea!....U,... ,lm.lId
<br />unlesl the _r. IUthctrlltd bt......:..~..ltJ~~~~IW.,.I' ~lII! ~f .l~.uancl, or, If IfOrlluthorlled br llle perllt la
<br />8ullpended or ..earot" period Ofi.I"~_(i~tl.tUieAllUIitUt. wt.'J~~~ntH. One 90 da, eltenllon of UII!, lal be
<br />a lIonc1 tor lhe plraU ,UII 'It ., tgl; Clf..l$__....aM. gt.IM!!L.~l1 \It tllflUlltet1 In wrl tlng to the BuUellng Ofnclal. An
<br />erpro,ec1ln.pttUOIt IlJU be t_'ttdng,.alfVIMtPllfIIlPlf.lh. project ,HI be conllderea abamlonl!d. .
<br />""R"l" to 0IItI'! .. 'AU.. tolllt'ClD~A~lOtttl~ 'IIAt 118ut.r I" YOUR PAfI"G 11I1C1 FOR I"PROVIHIiIltS TO YOUR
<br />.mlnt. U' tcMnM'IfJ.,' qt,O,.,,' !r~", " ',," ,lbbI' OR AI AItOI"1t BaVOR. RICORDI"G fOOl IIOTIc;BIOF .~.
<br />[111II"". ".1018, 'llIIllIlIUi$lf:.bf~~ ~..,., '..., ,,,.,i. IllS1 . "1IJrIO III "-"0)
<br />. ~L:,'.:." ~~//~
<br />
<br />SiGII"'URI: ONIIIR OR AGHilI . . 'I.' I . 8IGIlA'URt~~
<br />
<br />if).!.9..~~~~ ' ~ ., ~. MAT' U,' PWRID
<br />.\ " l. --OF
<br />L'\ /.~ . ", \.wnl.
<br />V lI~t., .... <. knowledg.d' A"'rhl foregot ';;. edged
<br />. -~~... It.'..... ~., 'tvltltut8 me t by'!
<br />before . ,.~.r;:IJ~.. Y " ,.. f .
<br />
<br />IJib~ S;~>' , _"~""Ilih~ ~i-3 "',
<br />
<br />who 10 personally known to 11I8 or Mho h~8 t"~,~4tMho 10 personally known, to me or who has
<br />produced . , lItoduced . , -- ,
<br />dS Ident.lfic~t:iUIt..nd,,~~o, "\, ~',r~,~t 1"1..,~,.at:k~d"....t~f~8Uon lUld ~/didnot '
<br />
<br />take~c.,~y"'" .4....~. ~A2~ '~ > i
<br />(SlgI!Jture) " (8ignat,atre) ,~
<br />"{'r'c/. '!jJ P J"-'" /" / s ' ,.... ' ,,(,<;4#00 j)~,,, A
<br />TName Type, Prtttted"or st~t!d) ..' ','~':J"dJlte Typed, Print.ed or St8Jltped)
<br />NOTARY PUdLIC 11- tf y~ 9'1: ," ." .. \ . ~~~Y ,PUBLIC /;?"L ~- ~
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