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<br />A.' NOfl~ or liDO IlqrRJduOYI
<br />'rtua IIIIcleuiqa.d under.tlAM ta.'C thb pezwJ.t _y b. 'llIl,ect tg "d~.d nat:riatiorl." ....ic:h
<br />'.IY a. ..... .anr1Cltl~ thin' C.lty ngulatj,cme, 'I'll. Ilnes.rU,9I\Ies ..iQIHI I'I.,o"...,U1ty tOJ:
<br />e,.p~~.nce witH any appl10&bl1 d..a ~11'trictianl:
<br />8. UltI.:tCDSlll COftIaC1'OIl8 AN\) CO)JfRAcToa RUl'OM8%8t:'I'l'J:EI ,
<br />% e t,he ClWI'IU lur.. "'~r" . cantrlotar r>>: aent.:aotarl to llneslrt.akl 1101'1;," I"'Y ...y b. .lqu1ncs
<br />to b. UClIibllcl 1n 'OClOl'daJlal ..i~ nat. Uld loc:al rl,IIl,Un.. If ih. contraator h n~
<br />l.I.el".1d 18 l:;'qlLf.1'H br lair, lloth the OWftlr .nd IIClntrac:tol' 11I1' be o1tld tar I .Ud....nor
<br />910hU.ft 11ft_II nUl 11.. U the '._1': ar ~tlQded oontrlotllli an un~ttl.\." al ta whit
<br />lie.naing requ1r.1.nt. ..y apply for the in~endod work, th.y arl Id?iled to cantact tn.
<br />City at CIP~yrh111. luildlnv DDp~~entl 813-780-0020,
<br />PwrtMrROre" U the 0~1lI1' Iku 1U.r.d a aol\tr.otor or oOllu&Ctorl, hI Jo. .dYlIld eo IIavI th,
<br />contr.ct~rl'l li9l\ po~tlana' IIf th., -Coatractor S8Gtlone' gf tll1. appl101t10n fo~ whiCh thlY
<br />will b. r..pttndl:l.1... U )'012, ,II the OWMI' dqna aa the ooA1;1'I.U1'. )'clII nl lncu.olu"9 t:lMt
<br />you, r.ther than the contra=t.1', al'a rllpOl\slbl. to~ the work. .n: thl aOll~~.C1tOl: wbhe.
<br />you to .19ft .. Oop~aata~ th.t --r b."I" in4101~LOft th.c' ho 1. nllt prop.~~y li.en.o. lAd i.
<br />not eatltled to Plraittin; p~tvill,aa 1ft ~. Clty ot Z.Phy~hill..
<br />C.. rwSPO"!M'ION IIfl1ACT rut AalD un:'t'tY CORNCct%())I Ril '
<br />Q, COI8f1lOC'rUIOH LIQI f.M (CIlAJn:a 71,', n.oalDA lITATonl. M MENDED I
<br />I olctlty that :, tb. applia.nt, ~~. b.en prov1~'a with, aopy'ot arlozlcl1'. ConlCr~~~on
<br />11.D r:.w - Itauowner'.. Prot.ct1011 QlU.de" pr.pI~ed l:Iy the FloriCSll DepllRllllnt ot Aqr10\11t\ll"
<br />..ad C4n....~ Affdr.. ff the applicant 11 I"'" ..hu that till -OWNII", %, c:::ecUy tht I
<br />~ve obtain.o a OOPY of the aI:l~ deloribld ~ou.lnt Ind pr~I' 1n good faith to d.livl~
<br />it to the -oWnor" p~lar to QQII&8no..-nt.
<br />E. COal!aactoRI'/OlIlIla'. Ari'ZDAYf'f
<br />% c;;art.Lft that ill the 1nfonaUon .1n tll1l1 appUcaUlln'l8 acc\U'lte Ind'thu all wo~k Iflll
<br />b. doni 1n o~ll.noa with III appl10abla law. l:'fUlat!n, co~t~GCion, loftin" ana 1.no
<br />devclQplDnl;.
<br />App.1.1C;IUon 18 Mrlby 1lA1S8 t.o chtaa . peC'lll1t to do "orlt and J.nataJ.iat!on II .l.Ad.t.OItod. I
<br />O.Ztlfy that no ~t or In.tall.t.lon ha. .....nolO prloz to 1..uaho. ot a pomit and tl\at
<br />all work will bo ,.rto~d to "It .ta~~. IIf all 11.. ~at!n9 oon.eruct.lon, City
<br />.00.a, zOALnq rlgul.t.ion., and lan~ dev.l~nt rl9ulltlon. iA the ~uril~ot10n. % al..
<br />certify thae t ,undlrlttdd that the r'~elonl ot other 'O"~ftt.l lqeneL.. ..y Ipply to
<br />the 1ntendld worle, and that it i. .y r'lpoft.~i1ity ~o ldent1ty ~t &Ot101\' I lIut tllee to
<br />ba 1ft G~l.l..no.. luah 1,.noL., Lnol\ldl but Ire not lia1tad tOI -o.,.re..nt of'
<br />Environment.l Rl9Ulation-CrPro.& Bay.....da, .atland Ar..1 &~d Environaentally S.nsi~lv.
<br />~fta.. W.tor/Wa.t.w.t.~ Trl.t..nt
<br />-So~~w..t r1or1AI Watlr Nana,...nt Di,tr1ct-Well', Cypra., 8ayholdl, ".tl~ ~o...
<br />Alter1nq Wltercou~"1 ,
<br />9An1y COI'pI l>f ErI'J..ne.r.-S....aJ.lI, Doolel, "1..1gll),1. -.IenlY' ,
<br />-Dep.rt.lDt ot B.llt~ , Rlb&b1J~t.ti... '.r.-ic:::.., IDviro~l~t.l H..lth Oftlt-Wel1e,
<br />IIleta..'C.~ Tr.at.lli.nt, !I'p~ic::: 'l'IInD '
<br />-U.S. Env1ro~nt,1 Prot'.tion Av.noy-Aabo.t01' ,blteunt
<br />1 al~o eertily that. if fill ~terial i.'eo b. u..d in Flood ~OD' -A- or -A,.t~:*, 1~ 1.
<br />undlr.toad th8t a draJona,. plan adar..11D, a -oocplnl.tln, volu.l. will bl ,aD.itt'A whJ.ch
<br />1. preplred ~y a profl,.ional 0,,;1nl.1' re;l.tlr.d in thl St&~a of florid. pl'1or to permit
<br />111U&DCI .
<br />A pa~t i..ued Ih.ll,bI COnltrUld to,be . lic.nl. to prgc:.cd ~lth tnl work Ind,not I.
<br />Illtbodty 1;0 violatel cane.l, ,ltar, or 'at a,ide. ""y pzo?hl0M at tM t:eahniClll eodlll,
<br />n.r ahan 1.uUllfOe of I peftli.1t pr....nt thl 8\IU41D; lJUioial troll then..uez rllq.arin9 ,
<br />eorreOUOh ot euorl 1n P1MI, oouU'Iltn:1ori, 01' 'l/101llI;io"l of lAY 0". Ivo&,r' PllM.l.t
<br />1"UGes Iball Deco.. in"alid ~nle.. the wack luthorlzld by ,uoh p.~t: 1. COIm8nced within
<br />.~a monthl or i..uanol, 01' 1t work .uCho~i&ed br \h. pe~it i. .~,p.na.d.e abandoAld for'.
<br />puilld lit ab. .Dnth. .ftu tIla t1ftle"the writ 1. oo.enced. One 90 'daY ,.tendon 01 ti"l
<br />..y be .ll_ed l!cr th.'pandt with fn ohll'9' oJ: US.QO. "h. utalu,ion Ihlll b. raqu.ete4
<br />1n w.~t2.n9 to 'tile lw.ld1n,i OUi.ial. An .,pr...cl lnlDelRion '..t be lowld clu~A.n, ..a'" aill:
<br />Mllth pedocl, or the pi'o~ect w..t.U be ClOft,Lo~.o abandonld. ,
<br />lnWIDfd ra 011II&.: 1'001' riutau TO JEC01D A ~O'J'ICIl or CCMIEIICtMINf tall USUl.T IN YOUR '
<br />PAYn. TWICS roR tNPROVIMIWI TO' YClOR _PI";,,, IF lIOU IIUNll 1'0 OI1'I\J:N nIMC%WG, c:oIl.ux.l'
<br />11TH Y'ooa LEIIDe" OR All AftOMllY _&'ORB uaJRDING YODIl lJOI'fICJ: or CO*DlC Joe.. tJIIDD.
<br />12,500 %N VALoa DO NO'l' MelD TO aIcOllD 'IIND POIr A -llIOuet or ~
<br />
<br />
<br />SICMAfUUI OWEA 0& AGIH7
<br />
<br />Sf AT! OF N:lMDl
<br />coatlTY or
<br />The eorevein, inlC~nt wa. lekn6wled,..
<br />~to~. .. thu _ dlY ot '2Cl-.
<br />by
<br />In...' of plrlon ICknawl'09.41
<br />o who i, per.onaUy II:nOWft to ",,' or
<br />
<br />C "'h~ h.s prodllced
<br />(type of ldentl1101tlon)
<br />and WIloCl2J.es Ca14 not Uk. an oath.
<br />
<br />
<br />MM" ~ORlDA
<br />,"" SdrLS'
<br />l~-~' an a . OZZJ
<br />~ . jCornnUsSiol1 # DD61S374
<br />-"",""",. Expires: NOY. 16, 2010
<br />BONDED nlllU AllANnC BONDJNG m,lNe.
<br />
<br />819netura 01 per.on takinq .eknowladq..."t
<br />
<br />w... t~04. printed. or nutpod
<br />
<br />2:00/2:00 reJ
<br />
<br />sn-~-SlIl'HI3d
<br />
<br />98~892:68L8 XV3 LP:PL LOO2:/6L/LO
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