HomeMy WebLinkAbout16-17205 CITY OF ZEPHYRHILLS
5335-8TH STREET
. .
(sis)�so-oozo 17205
MOBILE HOME SET-UP
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17205 Address: 37639 COREY LEWIS AVE
Permit Type: MOBILE HOME ZEPHYRHILLS, FL.
Class of Work: MOBILE HOME SET-UP Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: GRAND HORIZONS
Est. Value: Parcel Number: 34-25-21-0180-00000-3220
Improv. Cost: 9,000.00 OWNER INFORMATION
Date Issued: 4/26/2016 Name: WILLIAMS ROBERT L & BARBARA LIVI
Total Fees: 7,387.14 Address: 38402 CALLAWAY BLVD
Amount Paed: 7,387.14 DADE CITY FL 33525-0844
Date Paid: 4/18/2016 Phone: 352-206-7499
Work Desc: INSTALLATION MANUFACTURE HOME MH NEW 1,775 SQ FT
CONTRACTOR S APPLICATION FEES
HI TECH CONSTRUCTION S VICES IN MOBILE HOME SET-UP 60.00 MOBILE HOME ELECTRICAL 40.00
HI TECH CONSTRUCTION SERVICES IN MOBILE HOME PLUMBING 40.00 MOBILE HOME MECHANICAL 40.00
C&C ELECTRICAL CONTRACTORS WATER CONNECTION MOBILE HC 320.50 SEWER CONNECTION MOBILE 1,005.00
DOLPHIN AIR SYSTEMS INC WATER METER RES 3/4" 473.78 IRRIGATION METER 473.78
IRRIGATION CONNECTION 175.00 POLICE IMPACT FEE 254.00
FIRE IMPACT FEE 273.00 PUBLIC SAFETY 5% 26.35
PARK FEES MH 573.73 TRAFFIC IMPACT FEE 99% 3,595.68
TRAFFIC IMPACT FEE 1% 36 32
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Ins ections Re uired
M BILE HOME ET-UP
MOBILE HOME ELECTRIC
MOBILE HOME A/C
MOBILE HOME PLUMBING
FINAL
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,vuhichever is greater,for each such subsequent reinspection.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances
NO OCCUPANCY BEFORE C.O. � i
� ---
CONT CTORS SIGNATURE PERMfT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO �
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
� Print Form �
: :
CITY OF ZEPHYRHILLS
UTILITIES WORK ORDER
WATER ACCOUNT NO.: DATE: Mar 28,2016
OWNER/RENTER/BUSINESS:Robert&Barbara Williams LIV TRST CONT'ACT PERSON:
MAILING ADDRESS: 37639 Corey Lewis Ave PHONE NUMBER:
Zephyrhills,FL 33542 EMAIL ADDRESS:
SERVICE ADDRESS: 37639 Corey Lewis Ave
SHUT OFF SERVICE ❑X ❑X WATER
TURN ON,SERVICE ❑ ❑ SEWER
INSTALL METER ❑X ❑ GARBAGE
READ MEfER ❑ ❑X IN CITY
CHECK MEfER ❑ ❑ OUT CITY
� OTHER ❑
DESCRIBE OTHER: 3/4 water
• NUMBER OF UNITS
DEPOSIT AMOUNT
AMOUNT LAST BILL
DATE
MISC. CHARGE
METER: FULL 3/4
IIRRIGATION I
WORK COMPLETED BY&DATE ORDER TAKEN BY: Jackie Boges
COMPLEfED
ORDER GIVEN BY: �a�yL���
Revised 9/2010
� Print Form �
I , �
, CITY OF ZEPHYRHILLS I
UTILITIES WORK ORDER _ I
WATER ACCOUNT NO.: DATE: Mar 28,2016 �� I
OWNER/RENTER/BUSINESS:Robert&Barbara Williams LIV TRST CONTACT PERSON:
MAILING ADDRESS: 37639 Corey Lewis Ave PHONE NUMBER: II
Zephyrhills,FL 33542 EMAIL ADDRESS: �
SERVICE ADDRESS: 37639 Corey Lewis Ave
— SHUT OFF SERVICE ❑X ❑X WATER
TURN ON SERVICE ❑ ❑ SEWER
INSTALL MEfER XD ❑ GARBAGE
READ MEfER ❑ ❑X IN CITY
', CHECK MEfER ❑ ❑ OUT CITY ,
` OTHER ❑
DESCRIBE OTHER: 3/4 irrigation
NUMBER OF UNITS
DEPOSIT AMOUNT
AMOUNT LAST BILL I�
DATE
MISC. CHARGE
MEfER: FULL
IIRRIGATION 3/4
WORK COMPLETED BY&DATE ORDER TAKEN BY: Jackie Boges
COMPLEfED
ORDER GIVEN BY: �
Revised 9/2010
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City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: !^ d 11,'j� �r
Date Received: ,�-2�l�
Site: � � ��Y�' ��S �
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Permit Type: � /�-� � � 77-5` �
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Approved w/no comments:❑ Approved w/the below comments: � Denied w/the below comments: ❑
F� J _ 4r � r � �
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This comment sheet shall be kept with the pernut and/or plans.
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Ka1vi�Swi - lans Examiner Date ontracto and/or Homeowner �
� (Required when comments are resent
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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
�. Building Department
�
Date Received Phone Contact for Permitting �v
1 1 I 1 I 1 1 1 1 1 1 1 1
Owner's Name ��E; r L � �,cy''f^ W\r`��-"^t Owner Phone Num6er �L'� ��"ff` �
Owner's Address J�S�� Y'�e W C+�1 O(n��"�''�°1 Owner,Phone Number 4��' I C.��
Fee Simple Titleholder Name I1��`�� ,"' `�� �7c-� �����" Owner Phone Number
Fee Simple TiNeholder Address 3�S J M e�`0 S� ��'��"�� ' � S���,\� (_�' ��1��T7 1�
JOBADDRESS ��v� CC9� L�w\� �u� zt � �h��1S ('L LOT# �
SUBDIVISION �r�"r ''1�f�2'J1S PARCEL ID# 3�i-�s-21 -U►�a '—Q�4�Q•? '� 32 Z(,
(OBTAINE�FROM PROPERN TAX NOTICE)
WORK PROPOSED e NEW CONS7R 8 ADDlALT 0 SIGN � 0 DEMOLISH
INSTALL � REPAIR
PROPOSED USE 0 SFR Q COMM 0 OTHER \0 c t o.'�`C
TYPE OF CONSTRUCTION � BLOCK Q FRAME 0 STEEL Q
DESCRIPTIONOFWORK �e� fVIA,�V 1�l�T;� �I�%�CS
IBUILDING SIZE �,' X S7���� SQ FOOTAGE I�S HEIGHT I J
�BUILDING $ �O� VALUATION OF TOTAL CONSTRUCTION
DELECTRICAL $ la�o AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
�PLUMBING $ �,t91 I,
vv
OMECHANICAL $ D�D!v VALUATION OF MECHANICAL INSTALLATION 1 --v I���
I ��/ .��� ��
�GAS 0 ROOFING Q SPECIALTY 0 OTHER ( (/) � �� I
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA �YES NO `� ,� �'���
. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
BUILDER A COMPANY {'i\ \�C� CdnS Irv<)+a n�SV��eg �1�+
SIGNATURE �i REGISTERED Y/ N FEE CURREN Y/N
Address � �0 x 7�S W ir�'��"t�w�'�' 1=�-`3� y License# ,_1 1� /y D 2 5{3�
ELECTRICIAN COMPANY � Lt���C�`
SIGNATURE REGISTERED Y 1 N FEE CURREN Y/N
Address License# � QQL��
PLUMBER `/r/�/L /j� COMPANY 1�i �fCh Cu�15�:.lcti�n 52•^J��CS ^�K' .
SIGNATURE Lf REGISTERE� Y/ N FEE CURREN Y/N
Address �� �JX � `^�'^1''��-���`^� �-3�� License# —`�� �M V 2 S�3�
MECHANICAL �� ��� ROM EANY� O-N��'V uR���Ii`�6 S�S
SIGNATURE
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address License#
IIIIIIIIIIIIIIIIIIII11111111111111111111111111111111111111111111111
X RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of Energy Forms;R-O-W Permit for new construction,
, Minimum ten(10)working days after submittal date. Required onsite,Construction Pians,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster;Site Work Permit for subdivisions/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities 8 1 dumpster Site Work Permit for all new projects.AII commercial requiremenls must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
""PROPERTY SURVEY required for all NEW construction.
Directions:•
Fill out appiication completely
Owner&Contractor sign back of application,notarized
, If over$2500,a Notice of Commencement is required. (AIC upgrades over$7500)
" Agent(for the contractor)or Power of Attorney(for the owner)would be someone with nolarized letter from owner authorizing same
� OVER THE COUNTER PERMITTING (copy of contract required)
Reroofs if shingles Sewers Service Upgrades A/C Fences(PIoUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
:
+ � NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to"deed"restrictions"
, _which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work,they may be required to be licensed in accordance with state and local regulations. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work,they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the"contractor Block"of this application for which they will be responsible. If you, as the owner sign as the
contractor,that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings,change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07,as amended. The undersigned also understands,that such fees,as may be due,will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a"certificate of occupancy"or final power release. If the project does not involve a certificate of occupancy or
final power release,the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEM LAW(Chapter 713,Florida Statutes,as amended): If valuation of work is$2,500.00 or more,I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide"prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner",I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner'prior to commencement.
CONTRACTOR'SIOWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction,zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has
commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work,and that it is
my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,WateNWastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
- Department of Health & Rehabilitative Services/Environmental Health Unit-Weils, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties,the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one(1)
acre which are elevated by fill,an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER,I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other instailations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate,cancel,alter,or
set�aside any provisions of the technical codes,nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans,construction or violations of any codes. Every permit issued shall become invalid
unless the work authorized by such permit is commenced within six months of permit issuance,or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is commenced. An extension
may be requested, in writing,from the Building Official for a period not to exceed ninety(90)days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days,the job is considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S.117.0 ,
OWNER OR AGENT � � CONTRACTOR � �
Subscribed and sworn (or affirme be re me this Subscribed and sworn to or affirmed)befor lhis
by .�i4llrl.�/ /� �T�'JfJ�P'YL'1� by �hL iq. R-5/�17✓
Who is/are personal yTknown to me or has/have produced Who is/are personally known to me or haslhave produced
'dentification. identification.
G�/�� Notary Public • Notary Public
Commission No. Commission No.
Name of No rinted or stamped Name of Notary ty ed,printed or stamped
=,`in"''•e!%o'Lc PATRICIA S.REW 6101•SBE-OOB�eiircu�urajAalruylpepuog `�ao�i io'3�.,,
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Site Plan
- . Corey Lewis Ave
Zephyrhills, FL 33541
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Penetrometer and Torque Probe Test Results
(These sections below to be used when applicable. When either is used must be initialled)
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
, �ocket Penetrometer Test (required if declaring soil bearing pressure greater than 1,000 p.s.f.)
X �� X lS�� X /v�cJ?7
I
�Testing method
1. Test the perimeter of the proposed home site at 6 locations as shown.
2. Take the reading at the depth of the pier pad r�r footer.
� 3, iJsing 500 psf increments, use the lowest reading and round down to that increment.
X l�� � :X ,�� y X �S�
The result of the penetrometer test is �� p s.f.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Toraue Probe Test (required if using anchors less than 5 feet)
The result of the torque probe test is �� inch pounds. If the test results show 275 incr
pounds or less, 5 foot anchors must be used.
C� (initial) r1 state-approved lateral arm system is being used and 4 ft anchors are allowed at thE
sidewall locations. I understand that 5 ft anchors are required at all centerline tie points where the torquE
test result is 275 inch pounds or less and where the mobile home manufacturer requires anchors with �
minimum 4,000 Ib holding capacity. ,
, xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
� declare that I have personally performed the test(s) contained herein and that the reported results
are true and accurate. Date tested 3-17/� (initial) �'�
�
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i i 7 3/16" X 25 3/76" P � FOOTEi SPP-�CINGSA
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FOR TYPICAL PIERS SEE PAGE SU-41-Q021
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. ._ '.'ThER R:iriitBE)A��'i5 ARE TO EE ti?�:?�D TO �`S SPEC'FIED IN iH� „ACGBSE�J �'• �1�'`� `"'• ��", �
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{P�` NOTICE. C;�ri�t fiY� �1 �DA7£.'r,{n,,• - REV. lE;icn:
�i�O� J A C O B S E N H O��11�tJ Tr'�� S?ELIfICA i10�'S AND DnA'A7M1GS AP.; D Iv!.I O9'Z2—O� II
}� � . ` ORtCu7f.l.PROPRIEI�F�, A,tip C6:�.C�'HhAI QP,n14h1G TlilC.
��„_�i_.J uA�%RfA�S QF YCGBSi.H StxMU��CTJRtNC --- I
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{FOR SidE'�rALL OPE�v�NGS SEE tdOiE �3 ) ,
LOAD SPANS �
SQIL BEARING
CA?'ACITY pSF 8'-12' 12'-16' �.6`-20' 20�-2�f' 24'-2E3� 28'—�2'
� � 1GOQ J90 sq. in. 494 s4 in. $97 sG. in. 701 sr. ir 805 sq. in 90� se. in
~" 1�4Q 260 sq. in. 329 sq in, �48 sq, in 467 sG. in. 536 sq in. 606 sq. in
•s ?040 195 sq. in. 247 sq in. 299 sq. in. 351 sq. ir, 402 sq in. 454 sa in
n,r 25C�4 ]56 sq. in. 197 sq. in. 239 sq. in 2B0 sq. in. 322 sq. in. 363 sq in
?�-1IN F'!ER CP.P �r'On ibs. 3G"Lc", ibs. 5143 Ibs. u3uA !Fs. 5583 fbs. 6uG8 Ibs
L _I.—._�_
--N LO�D SPANS �
( SOIL �iEARING 8'-12' 1�'-16' 1�'-20' 20'-24' 24'-28' 2E3'-32'
� CP.PACI1'Y PSF
� � 7G00 409 sq, in. Si9 sq in. 62"o sq. in 737 sq. in. &47 sq itr. 95& sq in
1500 273 sq. in. 346 sq in. 4S9 sq in. 492 sq. ir,. 565 sq. in. 63$ sq. in
� � 2000 205 sG. in. 259 sq. in. 314 sq. in 369 sq. in. �'23 sq. in. 478 sq, in
i �� 25G0 16�; sq, in. 207 sq in. 25i sq. in. ?95 sq. in. 3J4 sq. in. 383 sq. in
�
i ?vji� pI��? LA?� 284i Ibs. ,i&Oi lbs. 4�bi Ibs. 5i2i )bs 588i fbs. b641 fhs.
z,o�n s��Ns �
;' �� SOiL BE.ARII�zG �'--12� 1�'-16' 16'-20' 20'-24' 24'-28' 28'-32' �
i � � Cr.r".C;TY PSF f I
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I� i:,OG 2�6 sq. in. 362 sq. in 439 sq in. 5i6 sq. in. 593 sq in. 670 sq. in. �
I � 2000 2!4 sq. in 272 sq in. 329 sq in 337 sa. in. 445 sq. in. 502 sq. in
� 25G.r1 17i sq. in 217 sq. fn. 2b4 sq. i� 31Q sq. in. 35o sa. in. 402 sq. in.
� �riIN. PIER CAP. 2975Ibs 3175Ibs 4575Ibs 5375Ibs 6175Ibs 6975Ibs
LOAD SPANS �
SOI.L BEAPING 8'-12' —i 16'-20' 20'-24' 2�'-28' 28'-32'
� CAPAGITY PSF
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r" 1000 486 sq. in. 618 s 751 sq in. 883 sq. in. i616 sq. in 114$ sq. in.
i500 324 sq, in 412 s .� Ol sq. in. SS9 sq. in. b7� sq. in. 7b6 sq. in
� 2000 243 sq. in. 3d9 sq. in, 375 sq. in. �42 sq. in. Sd8 sq. in. 574 sq. in
� 2500 194 s in. 2d� s in. 3C0 s in 353 s in. 406 s in. 459 s in
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20 PSF ROOF
10 PSF q.l.
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NOTICE. �« t t}St�Ht1 . DAT£. REY. �TR �
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NOTTC6: ORAYt}I BY: DATE: REV.IETTr.R:
,�ACDH5EtV HQht'!E5 n��+c��s uo c�uw++cs� O.A, 4-12-00
��.s�u�� °�"'"�c�n.�" ADDIiIONAL BLOCKING �
P,O, BOX 358 nG�J�1 YA7EFl45 Nt�F"fiOWED i0 TIiE
SAFETY HARBOFt, FLQRIDA 34695 A�1fXi KA s"J�Pu�'S No�u51 6E pRAYMG NUM�R: D3,19-14
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,- ^ ...:iiC�� � ,...,�ic'��':'y' �E cI �"'r:,� iGil� �._;il.:. 01'Iicrli�Vvi;.c cI1C:i��USI L'F_. 2 Iii�f'!II"�.�f� ��i,� :iG
HI TECH CONSTRUCTION SERVICE, INC.
P.O. BOX 878
WIIVTER HAVEN, FL. 33882
PHOR�E: 863-968-0731
FAX: 863-968-9462
Carl A. Bryan License#IH/7.025337
� To: CITY OF ZEPHYRHILLS
I,Carl A. Bryan, President of Ni Tech Construction Service, Inc., authorize Larrv Stewart
to submit,sign, and pick up permits on my behalf.
� � �
' Carl A. Bryan
Contractor/President
Sworn to and subscribed before me by�vrCX--' - � �'_V�-��:€,�-' ,who is personally
, known to me this / �� day of_ �,7_�.�G, ,�016.
, � -
r,� ���,.�,�"� '� �
, .�
f�otary Public =aysY A�e4 Notary Public State oi Florida
; Paula L Elliott
State of Florida {seal) �`�R��� ExPCe 10/06l20199180�8
1
� I IIIIII ilill IIIII IIIII IIIII IIIII IIIII IIIII IIIII IIIII Illl III
2016056431
� -----— Z
1�7��T[t__i!• Oi+ �'.O?.V.[I1'1LI'�TCl:I�/ri;`d"1' Rcpt:1762858 Rec: 10.00 �
' '� � — DS: 0.00 IT: 0.00
• � 04/13/2016 L. K. , Dpty Clerk
Permit t:o. • - - — ---- --- — —
Tax Folio I�io.__.���=z1- G1\S!0– t�JJJ•) �Z1J
THF U1VL�ER_�IGi�D herehy gives notic�tl;at irn�.ru�r•emcnts will'oc mad�.tu certain real property,and in accordance with Section
7.3.13 ot'thc rlorida Siatuies,LI1C fO1101Y1P�';niormatien:s pro�,�i;lcd in this NO'TICL UI+COIVIM�l�'C�MI.NT.
1.Descri tiun of ro er [e=rcl descri tio�i :__ S - �l - d��� - ������
P P P h'( S P ) � �I- � - �'j 22�7
a)Street(job)Address: 3763`I ��rew L��,,,T��vt _Ze�,�,�r������ F=� S`� _ ���
2.General descriptiou of impravements:
� .�,r��� �1\ J�c..l �M�n�{`�,c' _v r Z���v.c �in ���1 � �v. ('Trv (���f i i�n S
' 3.Owner Information � . —
a)Narne arid address: �tir�i�r� �, w��1•",�.c .��� C��.1�2t`/ ��cS/��/, �{y/��l�S �Z
b)Name and address of fee simple titleholde;(ii'other?nan owner)__� ---�$�77YP
c)Intcrest i�i pi•operty ____ O�,vn<< '}1.r,,vh�. ��v� — ----- ,
4.Contractor Informa�ion - -- —
a)N�imeandaddress: �`�� � P��` '�J�S� fvcfl,,, S�rv�crc .�rc � �� ��X �7� i,,��n',,r t,wc„ f=-L ��k2
b)'Celephone I�ro.: �_t6(�3= �16�-c�7�,� ---------F�;No. (Opt.)�- �y� �
�`--------�----
5.Surety lnformation ,
a)Name and address: N 1�
b)Amount o±';iond: ��� � � --- ---------
-4-------- - ---•
c)1'cle;:hone No.: r1 1!�= _ _I'ax No.(Gpt.j ,U �---- -- --
6.Lcndcr --_------- ----- .
a)Namc and address: 1V� /�
— N�-- -•--- Phone Na. ��----- -
7.Identity of persc,n w�ihin the 5'tate of rloriaa.dcsignatcd by owner upon whom noiices or other documents ma,y be scrved. �
a}7�';Lne�td address: � � I
b)Tclephonc I�o.: .,:ax No. (Opt.) --- '
B.Ir.addi.tion to himsclf,otivner designatcs the followinr;person to rcceivc a copy of thc Lie�tor's Tdotice as provided in Scction
713.13(1)(U),F!orida Statates: ,
a)Narneandadd:ess: Mc.e'lc S`�t���� � 1�1�� �� N��r�sk. �rc I�w��,� I^� 33G�1
b)Telephone No.:_�__�13 �?7-7�,,�� Fax No. (Opt.)��, q77-sy�s,s .
9.F.x,�iration date ofNotice of Corrii;.:,;�.cernent(tlie cxpiration datc is onc ycar firom thc date of recordiu;unless a diffcrent datc
is sp�cificd): i
WARnTINC TO nR'1�'�R: AN1'PAYiVI�N`1 S MAll�BY TIIL OWNER Al�['l;It THE�XPIl'.a.7'IO!\ OF'1'II�:l'O'1•icL or� �
f� COM�11��`C:I;IY,CLNT AR� CONSIDLR�D TMPROP�R PAI'117L�'1 S UNDLR CI-IAPT�R 713,Pr1R1'].;S�C 1'IOi�'713.13,
1�LORIDA S'!'�i7'U1'LS,.Al!'ll CAN RI',SULT IN XOUR PAYING'1'�VICI' FOR T,vIl'ROV�,l�1E\'T�'I'U 1'OL'R PROP�P�TY.
A 1\'OT.CC:1�or• conrn-c��'C;L•'�1:ii,1�'T P,�U51'L'T:;P,1�COrliT�:l)�1ivl�PO�TLI� Q�;TIl�JOIi SITr IiLI?OR�TIIL I'1RS'f
TF+`�;YL(::i'ICi�. 1I�'YOii fN11';I\'.l'� 1'C C)1.�'.l':!I;V l�I��AR'(:?id%, C171'iIl.T_•"i'].'U-Uf? I,i;i�°r,?�_I? qi� ��?�: :aT'(lI:';�''�_1��:l,i:(liiT: 1
C�V�vicllLiV�..ir�., �'t•''il;.[Ci.)l:-�._I+.(_'U1�{)�!`;�, �� 1 ^" ll -`I� "t � "— i, , _ ,' _ . ._
_ i c;i:_C� ,� ,_. . C.:r G;riil�i�� , ��.
,`:Cis 1L:4 .
�/ STA'fL'OrCLOR1LA ` �
I
1�. /�, �,_- � i
. �'��N/ j
� Signature of Owner or Owncr uthorizcd OFticer/Uirector/Partned:�:�iager I
�bf�xr� _J. W ��� ��vrC I
� Pnnt Namc --
, I
i 1 ne fore�,;oing instr,ument wa;acicno��ledged hefr�re me this �,1;_ day of �'1�.�c. h �20`� b�;� , �
n ` � ---
� _1"°'1!'�c��, S_ �e.',� — a; fV;i�`'r`7 " (type of authority,'r..g,offtcer,irustec,
attorney in fact) for f�e.f Jh�-. � , w����w^4 _(tlamc of party oii..bqhalf of�vhom in ru t�vas exccutcd). I
� �' � �
-� Pcrsonally ICiiown OIZ Produced Identification� Notary Signature � � �LL•GGc-G,�
TypeofIdentificatioriProduced W�ISZ-�7��`1� -�'��� Name(print) Q '� � � � �e�.J ,
0. (`\C�� �
Df�Vl� �\C'CnSC �R —
Verification pui•suaiit to Section 92.525,rlorida Statutes. Under penalties of perjury,I declai•e that I have read th�fore�oing and that
the.facts stated in it are true to the best of my knowledge and belief. .
r•oxn�smoc,ry,�oio , � �',��� /, ] .
w.( �.� �
Signaturc otNatural Person Si n g(in linc{I 10.)Aborc -
,��������� PpULA S 0'NEIL,Ph D PqSCO CLERK & COf1PTROLLEf�
•�nYev,�., PATRICIAS.REW 04/13/2016 10:llam 1 of 1
� ;�' ;;__ Commisslon#FF 145307 OR BK n G
- :'�•���: Expires September 5,2018 .7��J� P� 2445 I
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� �fj�,�t'"` B�d�d Thm iroy Fdn Ineurenoe 800385•7019 ' --` ---- �-- --—— -- —
��������
S�Al"E Os �LOFI�k', CCfU�T`(�� PA aC0 ,�� ° e ��°�
THIS ISTO CER I IFY THAT TfiE FOREGOI�IG IS A �
o �
TRUE P,IVD CORR�.CT COPY OF TNE DOCUMENT � '
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE • • ' �. �
WITNES,S MY FiA�IU AND OFFICIAL SEAL i HIS/ � ' IrtiGod"We�"rusr � '
,�-O
�_QAY 2 �G f� � � �,� . � �
PAULA S. O'N�IL, ERK&COiVIPTROLLER �
/� � . IS&7
BY �dll=��i---B�-�LLTY CLERK Es�'��������1,��
:y
\
CITY OF / / � � BUILDIN�
ZEPHYRHILLS DEPARTMENT
OF ADDITION OR CORRECTION '
� • • - •
ADDRESS DATE PERMIT f
�7(�� � C.����. , ' S-� -c�
THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before the job
will be accepted.
�� lf�'. ,��'7`C� S ,� .S ��G✓J
�t is unlawtul tor any carpenter,contractor,Builder,or other persons,to AFTER CORRECTIONS ARE MADE CALL
cover or cause to be covered,any part of the work with flooring,lath,earth 780-0020 FOR R -I ECTION
or other material,until the proper inspector has had ample time to approve
the installation.
OFFICE HOURS 7:30 AM-5 PM MON.-FRI. INSPECTOR