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<br />.. COHD.t'.l'.tOHS~Ot..~I'.nH.t't.,\AFFIDA VI T
<br />1\. NOT.tCR Of' nSEtJ nBS.,nlC1.t(')HS'('ffl\~.'i,""t~;'l~.'~': ......
<br />rhe uncJulJgnecJ Ullderltlftd. tlllt tht. ptrtJt""r''''!'ubJec.ilto~,'r..trfC:Uonl' ..bleh lar be lOre fl!strlcUve than City
<br />reguJltIOd'. ibf unaer.l....'.......~..IJlt'.tof;tOipl1 .lth an, applIcable aeed reltrictions.
<br />. ,.. 1~;' ,., -. ~ _ -', ' ." . 11 .
<br />
<br />D.' UNLICENSED. COtrtRAC'tOAtS AND CON't11AtTOlt RESPONSIBILITIES
<br />If the owner ,~. 'It" I tonttlclot ut.~trlelor. to un8ttt*'I\lDtl,.thtr ..,"be'requlred to be licenled In accordance with
<br />slalt Ina IUtI. tl91tllUC!tIt;., Iftht toIiUlclor I', not ,UttMtd~;~ tflQ1lht4 br 1.., bolb lbe owner ....~ ~traclor III' be
<br />cltl!4 tor a ......not ,1,I,UUll tml1tr Ilatl'I., . U lhl~"f'br '.ltlMc1o.1'tonhatlor Ir" unc@rbln al to lIhattlcenllng
<br />tt!guhe....... lit IPilI, rOt Ute Intlnc1ec1l1CJr', the, It' Idt.Mdlo ttnltlct lbe tilt of Ztphrrhl111 BuUding DeparUent, (811)
<br />181-5611. . , " ,'..' . . "
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<br />,.' ,.:'
<br />
<br />Furtherfor~~ If the 0Mn@[ hat hired I ~tr8clor or conlr.clotH, ~@ 18 Idvlle4 tu ha,e the contractor(B) Ilgn portlon8 of the
<br />.contrltlor 8etllon.' of'~I. .pplteatlcn for Which lhe, Mill be tilponllble. If you, al the owner lign aa the tont~actor,
<br />you ar~ Iddlc:allng lhal fbU, 'rat'wr lhtn the tunlr.c:lot, 'tl r..~.lbl@'rot'lhl lIOr'. If the contraclot ,flbRo roo'io 81gn
<br />811 toIttrador that II' lit In I.UcIU.. that h, .1 not propttJ,.l1ten.ltC1 and llnolenUUed to perlUUng prhUege. In the
<br />cn, fJf lephyth1111.' '.
<br />
<br />c. TItAHSPORTATlOH IMPAC.r FEES AND U1'.t1..1TY CONNECTION' FEES
<br />
<br />v. coNSTRUCTION LIEN tiAW ' (C"^PT~R 113t FLORIDA.8~ATUTES, AS AMENDED)
<br />I certif, that I, the .ppllcent, ha,. been prOflaea ,Ilh . eopr ul '~lorJdl" Conltructlon tlen Law - RoIeoMner'.Protectlon
<br />Culde" prl!p.rt!C1 b, lhe tlbtld....ttIMbof,Agtlcaltar. "'\CoIIdItr Iffllu. If Ute .pp1JclIIl 18 .000000e other than the
<br />-owner', I certl', that 1 .... Obt.lned I top; bt'lhe lbote ...ttlbtd dotuIent Ind prOl...,$ln good faIth to dell,er It to the
<br />-owntr' prior let eo.entlMnt. ' , . ".,:; ;,,"
<br />
<br />E. CONTJlACTOn'S/OWHER'S AFFIDAVIT
<br />I cerll" thAt .11 lhe J.Corllllon tn l.J. .ppllc.llon t. IccUrlte Ina lhat all vorl will be done in cOIpllance wiLh atl
<br />8ppJJceble Ii... teguJIUIIf LUlllncU.,'lanlng, .nc1J.t....Japlent.
<br />Application I. "'rwh, .lIdd ldf.tll., I per.ll l'Jc1o IOr.l~i Jnlt~U,Uon II JncUcated. . I cerUC, that DO ~or~ .or .
<br />InltaUaUon .1' ~."dbt ~lo.~".ot~ IPlr.Ud;t~~.I~ ,-.r1: i11t bI'~pir~odld.l~' ....,t .tIIi1ai:!1i:of all: law8
<br />rl!gul,UIl9 conlbucUan; tU, .,~"..:{~latl.~lJ" ...u_( r.1iU.l1Rt~ JlitlldlcUOlt:.'~t"atIG"
<br />rertU, thlt t untlr.l.lhat' the' itgileUOi* '&t' ..~..e_fMi1ii",fo<.l"" ,-".pplf"lo 1lb'''lnletsclec1 worl, and that It 18
<br />If telpottllbllUr lb tdtftUt, tthal'ltU_JtMt.tl,.,\O .~,..~_lIlntt. 8uch I19l11cl"l Include but Ire.not U.Ued Lo:
<br />. De,4d_l of In,ir....l8J llgulaUoa ..t,.t'ht.rt..... wtlMt At.., llIII1lntltOl1ilent.allr SenlUhe Land.,
<br />. ,," . ,', ,,', ";~ ' . '.' :.:..~"'.t~.t~.,tJpattenl
<br />. Southwelt 'lorld. Italtt t J.Utlt~ .; ..tl.~ ~,;tMi ..,....,.,. WeUana Areae, Altering Watercourles .
<br />: :'lr:O: : It ;.~'" nn.tt;.;..Jl:r~"~~;t:. ...1U.' Uall - Velle. Valtewater freatledt, 'SepUc flllll
<br />. US ladr..tI r"'O . j1~'~, "." ....t....~..ti.'.' ~ "
<br />J allo tertiI, t, ..tet at II (et be ........ 'IMit.. 'I. br 'A,tlc.., It II anc1eutood tbat'a'dralMge plan
<br />8ddrellln9 . 'c_nl.UI9."J,,~;,ttUIIIt .abl1lIUtc1j ~hl~\Jlprtplrtd b, a prolesllonl1 inglneer registered In the State of
<br />Florida prior lo petltl.l"UMtt.~" . " " " ~"'"
<br />. A per.1t fllued .ball hi t'dItit~l!c1.tirbt..~ .l{terii. to ~ttM:.ec1'ttUh the tIOrlanc1 not a8 authority to 'folate, 'cancel aUer, or
<br />let .Rlall In, protl.I....'l tIIt..~~,~.~...Ui!Jhant. of I perin pr'fentthl'Bul1dlng Olf~clll (rOl tberea, (ter
<br />relJdldng . t.Ort~tI.. .., 'ttoti"t. ;f~_tt1E[I~~l:tW httllUon. of' In, tcx1e. ,1'"rf~lIfrtllt"I.._~...U"" .1l1faJld
<br />unl"I' the ttorllttlhctrll.. bt"';:...~~J*~~~~I~. ..,11 ~~ of ,1~.Uanc:e, or If lIOr. luUlorllect bJ the per.1t 18
<br />lIuRpenc1ed or eblndontc1lot'. ",rJoc1 ofi,"~_{Ii~tbt lfi....Uii~U.t tfOrl" t~~ ~ncM. One 90 da, ellullon of Ute, 111 be
<br />alJ01It!d fetr till ttertU.ttJt lit .,t..:Ctr'.IS._~'MU.!!L"'U ~ requlltec11d wdUng to the 8uUc1ing Official. An
<br />8rprOYtlt1lnlpeeUOIt IUIt' bt t_ddtl'*9,.."JMtI'IIIII1P~f'lht project .111 be ton.lderec1.banc1oned. ,
<br />""RIIIIIC to OllIIa! .. 'AU.. lOi....IA'lOtltl. IlAY IIIM.r .11 YOUR PAWl' nllCI FOR IMPROYIHIiJn'S YO YOUR
<br />pROrlm. ~f ~l~'ICJ, ~~Il,,:"!m,'. '. , '_I 01 ~ AnoRllt 81FORI RI~lIlG YOUR JlOTIc;B, OF ,;..
<br />ttMltllllIf. M "'Jt..'l.;f~:.~ ~"."'"it '.", ,:.\~)n POSt A lIOtlCl OF CdIRIICIIIIIII .
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<br />~ '. . ,". t.,. '. '. .
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<br />SiGII"'URI: OIfIfIR OR AGIO
<br />
<br />t!' ,A.
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<br />--
<br />SICiIlAtURR: COIIJRACtOR
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<br />I'
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<br />STATI OF FLORIDA ' ~ ., :. WAr' U, PI.ORIDA
<br />counf OF \ coom OF
<br />Tht! tort!golnu In.t~t.,,1I~1 ,~~knOW1!.dg!~::~~'rhl foregoing instI'Ulll8nt was acknowledg~~
<br />before 118 thUi .,. ' ,.!.,1'........... ,bi" ., o,It,fore 118 this , 19 by
<br />
<br />, ." fIIl..",."f .'
<br />
<br />" ~ i '
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<br />who Is personally known to ..e or who ha,ii t',..""who Is personally known to me or who has
<br />produced ',;;,' ~lJtuduced : '--.
<br />ItS Ident:lflcat:iun end tfhd did/dId tn,t t".'aeil idenUficaUon am] who did/didnot '
<br />take an oaUt. ".,', ',':' \,'.~ '.\J" I I '.like ma olJth.
<br />, . -, .. .,.-,,,." to. " ,
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<br />(Signature) !.,.J~lgnature)
<br />
<br />..... (NdJltft Typed, Printed or stamped)
<br />, ' .~ 'ROTARY. PUBLIC
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<br />(Hame Typed, Prlttted"or stlbft1?~d) ,_ .
<br />NOTARY rUBble , .' .' ,...
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<br />." -.\ 11II", 1'1' ,
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