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<br />'J n,28, 2003 10:46AM CITY OF ZEPHYRH!~L~i~IW!QNa or fERMIT AFFIDAVIT
<br />. a ~. NU~Icm or D~mD RES~~tCT~ON~
<br />Th. .ad"'<.n6O .nd...t..d. tbl. th<. P'~t 4ay b. anb'.tt ta "d'.d ......at.a... kb1
<br />moy b. ~r. "'triot,v. 'ha. ei.y r'..lat<oaa. Tb. .ad.'oion.d "'WO.. ....on.<b.l<t,
<br />.CIQJUp11il1flPlI w.(th lUll' af.plicable deed J:e8triotion.::s,
<br />B. U.NLICEN~2D. hONTRAC1'ORS ~D CONTRAcTOR RESPONSIBILITIES
<br />If tbo Dwnar h.. hind · DD.tuotOt a. ca.traotou to .adortoko ko.k, th.y >lay b. '.qa
<br />to ~. 1, c....d 1 a ,ocor...o. ~Hh >ht. aa. looal ....l.tioa.. If 'h. aontraato. '0 n
<br />l.a....d .. ".u<... by l.k, botb tb. Own or 'ad aaatr.ctor moy D' c'to. fa. . m<'.nm.,
<br />v<ol.t<o. Und.. .t.t. lak. If tb. own.. a. <."odo. CDat'.cta. ... .ao..t... a. Po kh,
<br />11 c'.oing uqui....... ..ay .pply fo. tho <......d wo.k, they... .dvbod to an.to.t ~h,
<br />City Qf ZephyrhUle aldldillg D~PllrtJ1lent, 813-711$-6611.
<br />"'<th..,..<o, if tho -.. h.. bi... · cantmeto. o.eon<<.eto<o, h. 10 ,.v<"4 to hava
<br />ca"t"ctn.,., d.n .o.tioa'af tho "CD.t..ctn. a'DUnn.- af this .p.l...t... f.. ""uh
<br />"Ul b. '.apoaO<blo. l( YD." .a tho ...... .<... .. tho CD."Octn., Yo. 'r. <o....t...
<br />ya., ..th.. than tho cD.tracto., 'U r",,0.db1. for th. kork. If tho caotuntnr w1oh.
<br />yo. .., .<'0 .. oaah.cto. th.t ...y b. 'a <.d<caUD. <hat h. to not ,,'oPedy H.oe"... .,
<br />aot .htitled to P'<!Ditt!o. privil.... i. tbe C<ty of '."hyrhill., '
<br />C. T~~PORTA~IDN IMP~T 'E.ES JU~D UTILITY OONN~CTIOW FBES
<br />o , C""STRDcrUI"" LI"" L!\w I CJU\l>rEll 113, PLORlDA ar,,'I'UT.S, JIB IIH"'DBD J
<br />I C.rtify tb.t I, the 'PPli.aht. h.v. b..~ prov<... "itb a qOpy of 'P10r<.a'. Coa.t..ct
<br />1<.. Lak - H""awn.r'. P.ot.ctio. Goid.' pr.p.... by tho 'la.i.. D'''.rt....t of ".,io.1<
<br />'04 cooau.e. "ft.i... If the oppl<..ot 1a '~'Q" Dtb., that the 'o...or', I c.rity tb.
<br />have ohtai... · DDpy of the 'hov. '....ra.. dODUma.t 'a. "r_.. " goo. 'oHh to d.li.
<br />it to th~ ~ownarP prior to a~e"ce~ent.
<br />Iii~ COl1TIlACTOll'S/OJiHER'lJ Ar~IDA"IT
<br />I c..tity th.t .11 tb. iOfo~.t<a' <. th<. .""li.ati.o i. ,.cor.t. .nd th.t all >or. Wi,
<br />h. da.. <a OOOpli.oc. vith All ."p1<oab1. 1... r...1atio. c..at'.ctioo, '.oi.., nod 1a..
<br />claV,lgplIl",nt. ,
<br />>Ip"li..tia. i. h.roby _.d. t. obtoi. . P'noit to do wark .a. i..t.l1atio. a. i.......d.
<br />C..t<fy th.t .0 ~ork o. <"ata11.t.o. h.. c......c.. p.ia. to i....... of . P".'t ... th,
<br />,11 wo,. vi11 b. P"f.~d to mo.t .tAn..r.. af .11 1.w. "..lat<.. cD."..oti.o, City
<br />.odoo, ...... ....bUoa., ... laa. ..va10....ot ....laU.n. <. tho j...."'otio.. I als.
<br />c.rtify tb.t '1 und...t.hd tb.t tbo r...l,ti... of athp. ,ov.rnmeat.1 .....i.. may .PP1y
<br />the i.t.ad.. WO'k, .od th.t <t i. >w '.'P."<bi1it, td i.o.tify Wh.t ..tio.. I muot t.k.
<br />h. i. ..."l..ac.. S.oh .....i.. i.o1ud. b.t or. .Dt l<m1t.d t.. 'D,pa.t4BDt of
<br />&nv<'..~atai aOQUl.tl~-C"ra.a aaYb.'d., ~otl.n. Ar... 'h. S.viro....t.lly B.h~tlv.
<br />LanQ8, W.t~~/N4.tewater ~reGtment
<br />"..thk.ot 'lori.. W.t.. K....~nt D<.t..ot-W.ll.,.cy".... B.yh....} W.t1... ",....
<br />Altering ~.t8rpo~r.8a
<br />.......y CO"". of .........-...""11., Dock., Navi''''l. W.t..~.y.
<br />.v.P....,..t of Bo.1th , ....biUt.tb. ".v<o.., ~avi<O""'oCOl H..1th U.<t-H.U..
<br />W~.te~~tex Treat~ntl ~~ptia T~n~8
<br />~U.s. EnvicQ~en~41 Protection A~encY-A.b.stos ~b.t~~nt
<br />I .1.0 o.rti fy tho t, H f >11 m. tod el .. to b. U"4 <. '100. Z 0.. "A" or "'" .tc. ., <t i.
<br />un.o..t..d thot · 4r'in... pl.o '..r...i.. . "ODOp....t<.. vo1.......11 b. '.bodtt.. Whi,
<br /><. pr'par.d by · p.of...ioao1 oo.ino""..i.to,.. i. tll. Btat. Of 'lorid. P.iDr to P'~it
<br />"'..aoo., ,
<br />" pO'Mit i.~'4 .10.11 b. ca..t.... t. h. . l<c.... to P'.ooed with tb. .ork '.d 0.. ..
<br />..tl'Odty .. Vioht., C'.co1, ~1t.., or ..t 'dd. aoy pro."io.. of t/,. t'''.ioo! ODd."
<br />'.0' .h.11 i....no. of · p.tm>t "rovo.t tho B'<l~.. Offi.iol f'o_ th....ft.r r.~i..og .
<br />.."o.tioo af "'0'. io plo.., oO'.t'.otin~. or .io~~tio.o af ooy 0.... ~v.ry P..~t '
<br /><..... .h.ll boa... 'oV.1<. Dol... tb. ~.k a.tho.i..a hy .0010 P.rodt .. D~.o.d wLth..
<br />'h m..th. Of .....Oa., .. H ....k ..thorh.d hy tho ".rUltt i. '.'P....d Or .10'..0".. !IIX
<br />pO'1Dd of .1. Dooth. oft.. tb. tima tho Wa'k <. c."..o.d. 00..0 d.y ..t.noLD. of tlm.
<br />may bo .1lDve. fo. tho p.rmit with f.. en.... af $15.00. Th. ..t...i.o oha11 h. roqU..~.,
<br />'a ..it<ng to tho B.<ldiOg Of.io<.l. An approv04 1oOP.otio. mo.t h. io.... .o.<.g "ch 01
<br />....th P.dad, o. ,tll. P..j.ct vill b. Oa.ai.o... obond.o... ,
<br />""""IHO TO OlONR', YlllJ. 'AILV"" TO RRC!OIlD A HO'rICR O~ C.......HC..._ Kl\y ..BULT 1>/ YOtlll
<br />PAYING THICI IDR IMP.o~s TO YDUa p,O' aRTY. I, YOU INTEHD TO OBTAIH 'INAN~IHq, ~'UI
<br />WITH YOU. L!HD~ OB AN NtTOAN~Y ..m.. ABcORDlNG YOUR NOTICR O. C~C!K"T. JOB. UNo".
<br />f2,50 IN Do N H~Q" ..,CORD AND POST. "NOTle. O. CDNHBHC....T.. '
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<br />' , ~\ \l...- Ji " \1./ lM...-
<br />
<br />or \;h).HATU... coliTRACTOR ;
<br />
<br />
<br />aTATJ,I Qf i'LORUIA '
<br />COUNTY OF f-/r,(.<J...t".h-'
<br />The foregoing ins~r~Bnt w
<br />Dafoe. 8 bis ~da of
<br />by' .
<br />~ In.me of P~r8on .ckna~1Idg8dJ
<br />~ho 1s pe~.Qnally known to ma, or
<br />
<br />o WhQ hil~ prodUcaQ
<br />(type of idqntitica~1on)
<br />Odid nat take n OiJt:.h.
<br />
<br />3TAT./!l 01' FLORIDA
<br />COl1NTY 01' . Volusia
<br />Th~ fpcego1nq in.trume~~ W4a aOknDwl~WI~
<br />'.fo,. ... 'bie 28th..y 0;' T"~"a..,z"l'i"",-
<br />by ~illiam R. Greene - ~ .
<br />~~ (n~me Df per_on aaknowlB~9~dJ
<br />'~l? 1,l!1 P~!;'ltpnilly l!:nQtm tQ lnC!l, ,or
<br />
<br />o who haa ,P.t'OdI.JCfild
<br />ltype of identJ.f'\Qill:Jtln)
<br />and id npt ~ake an o.th
<br />
<br />
<br />1.1 &lne
<br />
<br />
<br />
<br />Georgia A. Boring
<br />N_me typed, printed Qr at.mp6d
<br />
<br />ilQJmow,hdfP1\ent
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