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<br />1\. HOT:1CB Olt V,gBlJ JUis-rnlt1.tUH$,:'tf~l\r,~'4~1.~;'l~..~,.' '.... v'
<br />fhe under.Jgned ander.tend. t...t till. "djt".r''''''''''Jec'ilto~,'UllrJC:Uonl. wblch lar be lOre restrictive Lhan Cily
<br />If!gul.UOd'. tilt Uftc1ft.J...... dIlHfIJI"UUtfori.U tflU. an, applicable deed reltricl1on8.
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<br />Furlher~ri~ if the owner has hired. tonlraclot or conlracl6tl, he 18 advised Lo hi'S lhe contrBctor(l) 11gn portJonl of Lhe
<br />.conltftlor 8ettl..' of '~I' .ppHnUm f<<lf IfIIlc:h the, ,dll .. t'.pon.lble. If you, a. the owner .Ign al the cont.raclor,
<br />you ar@ Iddlc:alJng lhat fbU.t.thlr lh.. the tdnltatlot, itl r"~.lble.tor'lhe worl. If the contractot vllhP.o you'lo 81gn
<br />81 rontr.ttor thal II' be In In4ICIlIDd tbat b. J. not properJ,'lJeen.ea and i.nut entItled to perlltllng prl,llege. In the
<br />Cll, ~f lephythlll... .
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<br />c. T.RAHSPURTA'tlOH IMPACt FEES AND UT.lLITf CONNECTION' FEES I
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<br />u. CONSTRUCTION LIBN ~AW · (Cun~TSR 113~ VLonIbA.8TATUTES, AS AMENDED)
<br />I certjt, that I, lht eppJlcentt he,. been prOfI'" ,llh I eGpf uf '~lorJdl" tonllructlon Ll@ft tal - HOIeoIner..'P~tectJon
<br />Culdll" prt!p.rlM1 b, th. tautJd....tbflt~of:AtrJc:uU.r. ......t.-r Affalrl. If U...ppllcant I. .onone other than the
<br />.owner.. I eerUI, lhat I.... obt.lnH I I:Opt of lilt .bote ".etJbtc1 doc:uHnt and prOll.."Jn good faIth to dell,er It to the
<br />"olfJlltr' prior tit toIIIt~nt" i ,:. ... .
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<br />E. CONTnACTOntS/OWHBRtS AFFIDAVIT
<br />I certif, that all the intortlilon in t... .ppllcation I. ItcUt.t, and lhat all worl wIll be done in COIplJance wllh all
<br />BppHc8bhl Jilt. UguJ,UIIf c:onelntU.,' .anln't ana 1_ ,........t.
<br />Ilppllcallon I. "rib, IIdd td,.ttl.. per.l' t'tdo IOr.'I~:.III~UltJon a,' Indlcaled. I cerl~f, Ulat. nu "orl .01' ,
<br />lnlltaU.Uon till' t_II,*\'d6r."t,~_, .l;!,~ot~. PI, d, Ih., '~~" ~ ,~~.I~i.," r"i.Ul",:..r.fOdld~~", .".t, ,.tIdc1arc1lfOI all:1a..
<br />requlaUII9 tOII.trucUtJn; tilt ~,~~.:~I~U~..:,...'J. ....l~.t~l'ei1IJ.lI.,allii'~Ju~l.dlcUon~.l~tJa..o"
<br />certUrlltat I u.r.llnc1tti.l'tbt t",teUCil.'&t c.tfllr"OO1tfilAiaI1oo_1u' "".pplt'to 1th'''lntem1ec1lfOrt, and lhat It is
<br />If rl!lpottllblllt, lt) lc1dlU, .t'.tU_;lt_tt.tIh~t.o~,..~_l1.ntl. 8uch agencl.. lncluc1e but are,not U.Ued to:
<br />t DepartMt of Indr....tal _laU. .., tr.t'h IffWMI. Rtl., At... anc1lntlrorileJltallf Senlltty. Lands,
<br />, ;,. ','.,' !';I;: "'J:W.t.er/lftIlIl.lu.J'lItalnt
<br />t southwesl 'lodd. If.let t'lJlttdc~ .i "'U.,"'~,;ttH".,.....,.,. VIIU.nel Arl.l. Altering Watercourses
<br />t IIr Cor of ~ ' 't" tlled_bl.' 'atll1t.,. ,
<br />· Deparbenl ., '.' Dlt61 ,.~hri ciY,~,""Jt_W."'lU.' Oall - IIell.. lI.stnater Ireallent, 'SepUc lants
<br />t US ladr..-lIl"r. jl.". .lItIl-.t "'.' '
<br />J aho c:t!rt If. IIltr '''I.'ld'bt''b.tf~IIt'.I~''Ictft'''A' or 'A,tb:.., It II understood that a'dralMge plan
<br />8ddrellllnq It 't_n..U".to."~;~ttUlbe .abIIlU",~bl~\JI,rtpar" b, a prolelllanal engineer registered In the State of
<br />'Iorlela prior tet IN!t.lt....UMet... ' ' '. ".'.
<br />. "perIUb.aed ..II11 hi t'dItittWc1.tirtit::~ .lle:etiie to prljtltd'ttUh thllfOrt Bnd nol a. authorltr to,lolate,cancel aller, or
<br />let aslelt an, profl.l..,l t.M~~etIduf",;IIO~"'U:~' of . perllt prlfenlU.t'BuJldlng Olf~clallrOl thereafter
<br />requiting. totttc!U.. 01 'ttot.".. ~p"'_ltIHl.~tJt 91DllUone 01' an1 toc1t. ,1'lrt~lIfrtllt' JI.IIIl1~...U"" ,lllfalld
<br />unl".1 the ttorl Ittt....t1~bt....,lptt..~j~.~~, ,. ..~lW....J, ~~ ~f .1~.uance, orlf worl lathor"" bJ Lhe perllt Js
<br />IUlIp@flC1l!t1 or .~<.M.fl.Jod of;.Ia,..(,.~tbrlfitUII.U.. tfOfl'Jd'~ntM. One 90 ela, elten.lon of UH, lal be
<br />allOlle~ r<<lr l...,....~, ,rei .,tve:Ctf...al....~'M*'l~~l1 te requ'ltec11n rdUn9 to lIJs Building Offlclal. An
<br />Brpro,ec1ltllpttU...._~c1dtlngitaEftltWtPIIQIIPttt.lht project will be tonoldered i1banc1oned. .
<br />""RIUIIG to ! 'ltIf'I.... toiRItURD.lA!lOtltl. 'IIA' ItllUr,r I , R PAf.IIG "'lei FOR J"PROVBllIiIlTS YO YOUR
<br />PROPlm. It' .. ", ;I~~.'fot'" >:-.:srA~ v. RI~~"li IOOR lIorl~\O' ~.
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<br />srAfl OF FLORIDA ~.iL 0 ' ' ~ .. :. MAt' U, MIDA ~.d (' C CJ
<br />count OF -f/ t!!'( \ tuIm 0' r// 'J
<br />Tho torl!9oin9 in.ttuJldnt",1I11~~JulOWl!,dg!.~:.~;'rh. foregoing instrUllent was 8cknowledg~~
<br />before 1d8 t:hili 1J"w.5'f",5 ,!;)f~ .hi ,. . ~ Jt.lorA ..e thin /I~/A I 3 , ~CJO by'
<br />(11) &1" ,I- J/~ Y' '. ~.. ., .' ~..JYr/ J:,~J . " ','
<br />who s d-ernonR1l1 known to, lie or MhfJ ha.ii t'c~.~.tMho s ~erBOnaUY known to me or who has
<br />produce "' , 'lItoduce . . .
<br />dB IdenHflcatiun and "he cUd/dId taut , f, ~.'! at" Id@hUficaUon and who ot .
<br />td~ a' ~.., , :..:t.kll OlItb
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<br />(Slgnature) p .!..It..l~lgnature).
<br />~RB eAtjKLli_
<br />TName Ty e t.. 1" t.8.I~D 9l"~d ,.. ". (thlJlle Tlpe~ ,.P1N\nr\rwelic~atttFMlD )
<br />lUOTARY p" '\,; Notary ~ubllc, StateOf.t'kll'lda .... · . .. . !tOTAHI . .PUnLl~ My Comm. Exp. Aug 31. 2002
<br />'1 ~. I. My Comm. Exp. Aug 31, .2002. ,.. , · .' ^ . " ,~\- ",/ Comm. No. 771791
<br />";';"Oi';'~~~~ Comm. No. 771791
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