HomeMy WebLinkAbout37219 GEIGER RD A • .
_ _ ; � � l
- �;TY C!F ZEPHYRHII.LS Permit �'" _ 4Qt,��Q �
(813) 788-6611 ��a,� �� ` �
� Date `�
�=` � 9'/p4-S• /�''.S
��Bt3l�.DING ELECTRiCAL Pl.UM8lNG MECHAN1CAl Sewer Conn
Water Conn:
Property Qwner: , Water Meter:___���`�
Job Address: T.f F.'s: "'�^
Parcel I.D. # �� ����M u��
Zar�ing: Energy Code. Radon Gas. ��'
Description of Work
� �/
NO OCCUPANCY BEFORE C.C3. �7� ���A�` DATE ,,, �
` +C.o. �--'a-� -�1`�'
Cornplete Ptans, Specifications and Fee Musz Accampany Application.
DATE
All work shall be performed in accardarce with �:ity Codes and Ordi�ances.
. inspector
Valuaiian orr ,� Permit Fee ~
Contract Price �s�-s',c d��- �7 Signature � �
Company
City License Registration � <� �/� Address
State Certified t�icense# ;��eP�Q�$#
. � � �
BUI�OING ELECTRICAL P�UMBING MECHANECAl.
• � �o�('�!Y �cL 4 `'�S '
Ftt. —�x'�' Tp. Serv. S .'��.'_�� Bt'ealcers-�-�^�r�
Pr e S L B '�j I5`,�`� �t� Ro u gh In����T b Se - r '" D u cts In�l 7�3"�'7? �
.
i.�ntel '�-'� Meter Can Water Cotnpressar
FRM. �^����f D��"- Canst. Pale�"�'���� � Sewer ����'� �r^ Finai
lnsul.CL. Poot_. Fir�a!
WL Pre•Met+�r �„�„�`�O�r
WA�'' ,Z$.�St�t�- Final
Dr��y V r+t�.�i'tc�h►1�.
f��G � �"1 r��� �f,3� Vt C ��c��i���`�;�'•..
�,,,�',rv��-
���''�'Lv�-io•'Z�-�I4 �
REINSPECTiQiU FEES:Wher�extFa R�►spection trips are necessary due ta any ane o#the follawing reasons, a
cherge of Fifteen and 00/100 Dollars iS 15.001 shaU be made for each trip for each trade:
a. Wrong Address � ������ ����"Q�4��..-X
b. Condemned work resulting from faulty construction.��n����'' i ����'g� ��
c, Repairs or aar�ections c�ot made when inspection catled.
d. Work not reedy for inspection when aalled.
e. Permit not pasted on job site.
f, RI8�13�tOt 8L j4�3 Sit@.
g. Work not accessible.
The paytttent ot i�spection fees shail be made before ar�y further permits will be issued#o the person owning
same.
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Pasco County Parcel: 03-26-21-0010-10200-0010 001 Page 1 of 2
�ata Current as of: Weekly Archive - Saturday, ]une 02, 2012
Parcel ID 03-26-21-0010-10200-0010 (Card: 001 of 001)
Classification 89 - Other Municipal
Mailing Address Property Value
CITY OF ZEPHYRHILLS Ag Land $0
5335 8TH ST Land $89,570
ZEPHYRHILLS FL 33542-4312 Building � $1,312,903
PhysiCal Addres5 Extra Features $77,034
37301 CHAPEL HILL LP
ZEPHYRHILLS FL 33542-1812 ]ust Value $1,479,507
Lectal DesCriDtlon (First 4 Lines) Assessed (Non-School Amendment 1) $1,479,507
ZEPHYRHILLS COLONY COMPANY SUB Taxable Value $0
PB 1 PG 55 THE E1/2 OF TRACTS
�
102 AND 107 TOGETHER WITH THE
EAST 50.00 Ff OF W1/2 OF SAID
Land Detail (Card: 001 of 001)
Line Use Description Zoning Units Type Price Condition Value
� 0110 SFR RURAL OPUD 5.00 AC $16,250.00 1.00 $81,250
� 0110 SFR RURAL OPUD 0.64 AC $16,250.00 0.80 $8,320
Additional Land Information Show Mineral RiAhts- 1
Acres 5.64 Tax Area 30ZH FEMA Code �Residential Code 2ZHN.U2
Buildina Information - Use 89 - Municipal Buildings (Card: 001 of 001)
Year Built 1995 � Stories 1.0
Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 None
Roof Structure Gable or Hip Roof Cover Min Roof(Corr. or Sh M)
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Sheet Vinyl Flooring 2 Hardwood
Fuel Electric Heat Forced Air- Ducted
A/C Central Baths 4.0
Line Description Sq. Feet Repl. Cost New
1 BAS 22,001 $1,709,478
2 CAN 774 $18,026
Extra Features (Card: 001 of 001)
Line Description Year Units Value
1 POOLCON 1995 3,375 $40,500
2 COOL DK 1995 2,240 $4,894
3 PAV ASP 1995 30,720 $7,258
4 SWC 1995 240 $285
5 CLFENCE 1995 1,488 $525
6 BSKTCRT 1995 4,500 $1,969
7 LIGHTSM 1995 16 $13,770
8 LIGHTDM 1995 4 $3,888
9 UDU-M 1997 2 $375
10 U DU-M 2006 1 $3,570
Sales History
Previous Owner N/A
Year Month Book/Page Type Amount
1993 08 3194/0420 WD $0
http://www.appraiser.pascogov.com/search/parcel.aspx?sec=03&twn=26&rng=21&sbb=00... 6/8/2012
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' � � ITY OF ZEPHYRHILLS
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UILDING DEPARTMENT !
. ;
' s��s s� s��t �
I Zephy�hilts, Florida 33540 �
; 1-813-788-66i'!
� oate rnAy 1��.�99,y _�___
: �
� '
C Name UG - .�v�C �"�?� . y/� �
� Address t E
I
l.egal Descripdon � .
Buliding Petm. � �� �J Fee .t'/ //JE/� �
Plumbing Perm. N �/C7�/ `� Fee�e�l�'���F-� �
� E�eot��aa1 Pe�m. r 1/D Y,,� Fee �-+' J`7JIJF/) �
Mecrint. Perm. � ���,� Fee 1G��1�'�
No. at Sewer Cann. �� f�s' ?`�
No. of water Cont►. '$`�, �'tCQ3. )y—
` / � '� '� c�5�0, 40
No. of YVa#er Meters
Transportation Impact Fee ����
. �
. Zone„`A +196 � .
Misc. �,�'7� f�f}� �o. �v J
" Toza !�, �.2�. jl
.
Memo: � �G��
L����'� �I�C�. .LI/�,,5' ����t..
' ��c�- �-�5���,
Si�nature .
WHITE Bldp.Oep�
_ YE�IOFAt;ltti4ities Oep�.
PINK Customer
�. ._ _ . . . .. _ - .. -
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; �
• � • � ' APPLICATION FOR PBRlLLT
CIT3[ OP 2EP8YRHILIS
BUILDING DSYART!lBNT
o�sR�s �•� Gr� c�� Ze�tw�t.��,�.�s eaoNs ???L— l s9`�
o�ett�s �►n�sgss
.1oB ADDRBss �1 �1�1 C-�P.le+elL � ZP�PH`(1�►�\l.Ll � (� 335�-�\
LBGl1L DSSCRIPTION: LOT(S) BLOC�_„StIBDIVISION
PARCEL I.D.# O 3 �� � ���C lC ZQ� O0 1 v (OBTAIN FROM PROPEICPY TAX NOTICE)
fiORK PROPOS�:�New Constructioa �lddition �Alteration ��tepair Install
Sign _,_,�love Deaolish
PROPOSBD llSS: _�ingle Fa�i�y !!/P • of Units _,,,�l�H
�Corercial Indust. Sria. Pool OtLer
�esrn��*A�t � Health Depattsent Approval
DESCRIPTIOP OF fiORiC: 1�M C/'1
BUILDING SIZS: X , Square Feet� Height
RESIDENTIAL: •ATfACH (2) PLOT PLANS 8 (2) SBTS OF BIRLDING PLANS & (1) SEP BNSRGY FORMS.
COMHERCIAL : ATTACH (3) SB?S OF BQILDIBG PLANS � (1) SBT ENSRGY FORlLS.
PROPBRT1f SURVHY HB�QUIRBD FOR ALL HBiT CONSTRUCTION.
PERHITS R6QUSSTSD
BUIIAII�IG S Valnation of iotaZ Construction
BLE4TRICAI. AlIP Service _Florida Power Corp. W.R.B.C.
____,�lBCHAIiIC6L = Velvation of ltechenical Installation
PLUHBING GlIS �OOPING SPBCIALTY
TYPH OF OOIiSTRUCTIOli: _�lock Pra�e Stee1 Other
FIAISBBD PIDOR ffi.BNATIOBS: [tl'. IS YROJEC[ Il� FfAOA ZOPB ARBA?
YBS BO
•**s*�t*����ta*ts::t�tt**�tt�tftt�*�*aa���
, CORTRACl'OR SBCfION
� ooe�e� ���aE �+��-►�c-�..1 CcMs,�v�„o.u
�1 State Cert. or Regist. # �(1�0 4 6 3
Signature �o.---Q. (� �l__ �,� Citq Licease xegistration � 3Z
if�tft�ff**#��f�t#*t#f!4!�latA���ltfR+f4tft
� CO�A�
State Cert. or Begist. #
Sianature City Lic�se Registratlon �
�**s�:*:f*�it:=t*:****�:�*ii�f�:�fa:t:t***
Pldill��B 002II�AlIIf
Sta.te Cert. or Regist. #
Sigaature City License Regist=ation i
:��**t�s��s::�**�t*�**�rR*::****�itia*f*+►�
d6S�d�6L. (�lIPANY �d iY'��(5 A��CO v1�C 7� �,dw�-7�� r
State Cert. or Regist. #
Signature City License Begistration � �-
• * e****�**�,►*���i**��!**ta�r*�**i*ir�t�
9TT�B CQMPAHY
. Stste Cert. or Regist. 1�
Sigaature City License Regiatration #
f*�tt*itttftfflf#!!�*1lf4tf�t**RR!*l�t�f*t
APPLICATION APFROVED BY PERlQT OFFICER.
f `
� COAti?IR`IQHS'4F F8R24IT AFFZDAYiT - �
� ° A. NOTICS OF DEED R$STRICTIONS , .
Tbe andeniqat�naderstao�s thak thie penit rap be eub�ect to'deed cestrictimie'rhicb�be�pra�trlcti�e tLan City
reg�ttatiaos. !be mide�igaed aBSEaea zeagonaibilitl for�plf�aca dtb emI applicable deed zeatt'ictfaaa.
B. UNLICS2i88D COxi'PRACTORS AND CONTRAC'�OR RSSP02�1S�IBII.ITISS
If t6Q 41lLBt L8i h�LE9 8 CoaET8CtOL Oc t:ORttdCtOta ttt UR�EL�!M6Ikr �'Y�Y�3 Yeg�ft�d t0 b!1#t�ltpEd�II i�GIdBIlCB M�th
etate aaa la:al regalatia�. If the contractor is not liceneed ae nqaicW bp la,bot6 the a�mer amd cantractur r�be
dpe�1 for a i�led�eanar violatton cnder etate lar. If tde amer or inteaded ooatractor ara aacertato as to r5at]ia�ui�
requizraeata aap apglp f�tbs iatm�d rark, tbey are advi�]ta contsct#he City af�pbix3�21i Bni2�in9�t. {813)
786-6611.
Bnrtl�enore. 3f#he t�t has 6irea a c�traetox ar c�►trac�re,he ia adriaed to bare tt�canErac#or{a1 sfga P�xtiaoc fff Lbe
'�aatractor Seetioas'of thie appliwtiac for dii�tLep rIil be rpapoo�ibie. If toa, ae tbe amer dgn ee tbe antaractor,
�on ere i�catiug tbat�, rat6er than tbe contractor, aze respomible far t6e Mpri�. tf the wntractor rd�es qoa to aiqa
as Cnnisact�r tEat�ay be sn iaafcatfon il�t Le fa not pz�erlp 2iceased aa8 is�at�tftlEd to F��9 P���i�s in tbe
Citp oY EepL�Uille. �
C_ TRAIiSFQRTATIOId I1�JPACT �3 AND UTILITY CONHSCTIOIi FESlS
D. CON89.'RUCTION LIBN IaAW (CEAPTBR 713, FLQRIDA STIIT�ITS3, 11S AMEINDED)
I ce�tffi tbat I, tDe applicaat,hare been grctided rith a capp t►f'Plorida's Coosttaetf�t Lim La�t-Ha�aaer's Frotacti�a
GniBe•PnPare�hl t6e FloriBa D�part�at af Egriealtare and C�o�tec lffaiire. If t6e applicaat ir�a�eme otter t6mu tbe
'orner'. I certit'p thak I have obt�ined a�p of tbe aba�ve describea�t aml pradae in good faith to delira it to t6e
'CIIIt9T'ptltlX tA CO�ACElRIIt.
E. CONTRACTUR'S/OWNER"B AFF'�DAVZT
i s�rtify t6&t ai2 tba infotsatioa ia tbis agplicatfan ia accurate and that alI rark�ili be dona in capIiaas�rith�II
apgliCable 18�E regutat3n�j CaaettuCH.arl, s�inAr ana IeGd derelOprent.
1l�pglication is herebr�ade ta obtain a pauit to dn rork aad iastaliatioa as i�idicated. I certifY tha#ao rorY or
iaetaliatfeo L��priar to ietaaace ef a peait a�tbat all�oxk ri12 M perto�dl ta ieat rteadmtda of alI iare
r�alating c�anetroctia�.Citp crodes, :oning regalati�a, aed land deQelop�ent reqolatt�e in tha iuncLdicttoa. I aY�o
certift tLat I�derBtaail that fi6e segnla#ioo�of otber garetntmtal�eaCiea ial appiY to tbe 3ntmdPd�Y, as�t�at it i8
=p reagonei3rl�ity to ideati$t�t actitme I�asfi tate ta be ia catplianca. 55�c4 agancies iaclt�de bat ac'e not l�ited ta:
k Departaent af�uuviran�ental R ne�lati�-Cpprese Bapheade, Yetlend 1lreafs and Bn�llq Seoeiti�e k'sode,
i�tetjYas�rater lseat�ent
#Southreat�lorida Nater Baaa�eat Diatrict-1ie12s, Cpprt�e 8a�beade. iietland l�ceae. Eiterittg Itateit�oateat
*�r Co�ak 6�ineezs-Sea�alis, Uocke, Navigable Mat�enap�
�D�t oF fleslth i peliabilitetire SetsiceaR B�itocaental 8ealtb Uoit-Mall�, Yaste�ter lnqftxnt,Septic lants
;t�Bm3tnweataI PmtEction 1lgeac4-,�6be�tos abateaatt F
I also certifq that� if fill�aterial fe ta be ased in Flaod Sane'A'or "A�etc.', it ie unaeceboo�t6at a draiaage p2an
a�reasing e'cnpeasaLl�j toluNe'ri11 6e ea6rittea rbidt ig�by a profeeaicaal engfaeer regLteral ia tise 8tate of
Ftarida prior t�pentit issaanc�.
E pez�it iesaed a6a11 be�straed to be a 11t�aee to ptoceed ritA the+rot�k ar�d not aa�ttazity to Tfalate� cacce181terr dr
eet aeide aay provieftanu oF tha technical wdes� �r a6all,i�uance uf a penit prereat t�e�ildiag Of#iciat fro�t4r�eafter
reqnfiria�J a oaxrecl:ion of errars in plauama� cmatroction+ or.iolaki,�s of aap oode. Bierq penit itwed ahi11 b�a�e inralid
untese tDe t�tc'k aathuri�ed bp euch�nit!e cx�rraaced rithia afs aoetha of fsenan�, or if teacl aut6ori:ed bt 13�e pecait ia
s��speaded ar aba�e�9 far a�arioa of eu amthe aE�r tha tiie t6e rortt ia oo�. One 40 tla�utduian of ti��e,a�lns
alia�l for t6a P�t ritL fe�c6atge af 115.00. i6a esteaaim e4a11 6fl cequested in rritiag to t6e BuilAtng OEficial. !n
agpsoved iaspectfm sq8t be i#�gea d�iag each ait aouth pericd,cr the pxrDj'ect tdll be t�atidazd!abaa�ood].
�I!@IIu6 i0 0lt�: YDOB PAILOiliB T��E IOtItB OF��I�R!`�T t�LT I�t001t FaTi�G lftiCB YOit II�JP@�R8 t0 tOQE
P90P�. IF�II�ID!0 OSlIIN FU�CU6, CpM�!Illf'810�t Ll�t Od M A!i'OA1BY�6Y�➢pli6 IWA IO'fICE OF
CQ4�lfClQ�il. 30B$OIDffit�2r504 I6 Y6608 DQ M�T(I R�DR4 ENQ YDS!11"iDftC6 OF�!'.
t���-G/� �
--� .,�
SI£!(bttt�:iA�R OA 116�1{T SI6'ttal�tRS: Cp1f8bCl�R �
$t�tB Og Flf�llD� STATB OF F1�
f.OUAlT OP CqUA�¢OP S i',�\'�
The �oregoing inatzvsent ras acknarledged R�e fozeqoinq inatzur�ent was aclma�ledged
before ne this , 19_ by 3sefore �e tt�is t\lct . 19��t by
( _ / �
�CLC� �. l�ul(�P
who is perscmally kuc»m to ne ar �eho i�as xho is ersoaal2p��o`� or rho 2tae
produCed praduced .� N�A-..
as ideatificatian ana rho did/did not as tificatal��an r 'd/did not
taice an oa�th. ,c�t�.
� (Signatnre) (Siqnaturej�` ���_r�
(Na�e,Tpped. Pzinted or Staaped) (Naae fiyped, Priated or Sta�ped)
NOTB1tY PUHLIC NOTIlRY PUBLIC
�ottg.�+� v�unta.Forto
, y'...7G . My�n CC�B3392
. • �,at�..r�.r as.�wr
' tl+,dl.benyA..od.ca.rw
���OFF4���OT ��•1655
1 ` �� -
' ' . • ' .. v��1 C.'�. " ' APPLICATION POR P�tlil'f ' .
� CITY OF 2EPAYRHILIS
BUIId1ING DSPARTlIBNT
ORNBR'S NAl� PHOAE
OWN@t'S ADDRBSS
JOB ADDRESS
LBGAL DSSCRIPTION: LOT(S) BLt/Ci(_SUBDIVISION
PARCBL I.D.# (OBTAIB FROH PROPSRTY TAY NOTIG-)
fiORR PROPOSSD: Ne�+ Constcuction _�Iddition ____�flteration �epair Install
Sigu �iove _pe�olish
PROPOSED USB: Single Faaily _�lJP * of Units _H/H
Co�ercial Indust. Swi�. Pool Other
Itestaurant Sc Health Departwent Appmval
DBSCRIPTlON OF fi0R1C•
BUILDING SIZS: X , Square Feet, Height
RPSIDSBTIAL: AITACH (2) PLOT PLANS & (2) SETS OP BUILDING PI.ANS 8 (1) SET EH6RGY FORF15.
COlQlBRCIAL : AITACH (3) SBTS OF B[JILDIR6 PI.ANS � (1) SST EHERGY FORlLS.
PROPSEtTY SUR{ISY R6QUIRBD FOR ALL NBii COIiSTRUCfION.
PER!lITS R60UgST6D
UILDING s Valuacion of Total Constcuction
�
CLBCfRICAL �6� Ser�rice �_Florida Power Corp. W.R.B.C.
lIBCHANICAL = valuation of llechanical Installation
�LU!lBIAG GAS ROOFING SpBCIALTY
TYPS OF OONSTRUCTION: �lock Fraae Stee1 Other
PINISHSD FIAOR ELBYATIQAS: i�. IS PROJSC! IN FIAOD ZONB ARSAY
YBS NO
•tf:i:t�*:t;**t**�art*t►**�**R*t*«�*t«a��r•
(70NTRACfOR SB(:fIOH
Dl�I� OOlIPAHY
Sute Cert. or Begist. �
Signature Citq License Hegistration �
•�t*tt*�*str�Rt�t�t:f*s*�t*f�f!*tirt;�AAt*:
,� e - p coMrnaY Dt��_�ea ��iG-�r•c
� /J SC�ate Cert. or Regist. # � UUuOV'S_
Siana `�- � � !L.-.—City Licenae Registration � a?'7 3 ^
.
i lfs�t�ff!!tflt*ffflfR*f1f#tlfffttf*!lftRfi
�� ���
State Cert. or Begiet. �
Signature City License Registration #
fttfltlRfftt�*ltttflf**fR*f*tR#*!if*#fttff
�WYi.�.7iYaY COHPANY
State Cezt. or Regist. #
Signature City License Begistratioa f
•*f ite+et►*�***:::w�**r*��tss+*i*+3t+t*r��►sff•
Q1�EB CO!lPAIiY
• State Cert. or Regiat. i
Signature City License 8egietratiou #
•***t**t***t:tt��tt*a�*�tt*ftlr��****�***•
APPLICATIOH APPROVED BY PE[i2IIT OFFICER.
` � CONDITIONS"OF PSRMIT AFFIDA�IT . - _
� ' A. HOTICS OF DESD RSSTRICTIONS '
ihe andereig�eE mder�Woda tbat tbie penit�af be eabiect to'deed r�trictiooe'r6i��af be�ore reatrictiQe than Citp
tegalatiaas. Shs umdereig¢ed aaam�es�pooai6ilitY far coepltence dth a�applicable dted iestcictima.
B. UNLICSNSSD CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the oimer bae hice8 8 caotractor ar cantractare tn tmdertate rort, tLep�ap be raqulred to be lice�sed in accordaaca rith
etate and local regolattaos. If the contractor is not lioenee�as reguirad E9 lar, both tbe amer and coa��ap be
cit�for a dsdeaeanor�folatioa oader etate lar. !f tde amer or iatended oontractor aze oncertain as to rLat llcenaing
sequire�te iap applp for tbe u►teaded rork, tbep are advised to ooat�ct tde Citp of Leph7cGille Bnfldin9 Gepact�t. (613)
788-66I1.
Furtbenon. if t�orner haa hire8 a contractac or contractora, 6e ie advieed to 6are the o�tractor(�) sign portioms of tha
'Cantractor Sectime'of t6ie applicatim for rhich tDep rill be reeponeiDie. If�oo, as the or�er ai�as tLe caattactar,
yoa are iadicatIng that pon, ratber than t�contracbor, are respaoeible for the aort. If the c�twctac rirhea yoa to aigo
as cantcactor tbat�ag be an iodiwtim that he fs not prnperly liansed and 38�t mtttIed to P��9 P�vileg�a in tLe
Citp of Laphirhille. �
C. TRAN3PORTATIOH IMPACT F$ES AND UTILITY CONNSCTION FSBS
D. CONSTRUCTION LIEN LAW (CHAPTSR 713, FLORIDA STATUTS3, A3 AM$NDSD)
I certifp tbat I, the applicant, hare been pro►ided ritb a cnQp of•Florida'a�anet�octian Lim bar-Bo�eamer'a Pmtecti�
6nide'prepared bp t�Florida Depart�t oE dgriwitace and Conaiaer lffaire. If t!�a�licant ia sa�one otDer tEan tbe
•amer', I ce�tify t6at I 6are obtained a c�pp of tde above deecribed do�eat aIId pca�iea in good faith to deliver it tn tha
•omer'prior ta co�enc�eat.
S. COHTRACTOR'S/OWNER'S BFFIDAVIT
I certiFq t6at all t6e infonation iu this appiicatian te accnrate and that all�rort rill be doae ia capliance rit6 all
applicable lare regnlatiag cm�struction, s�in9► and la�derelop�eat.
lpplidtien fe herebp�e to o4ta9a a penit W do rock am]inetaliati�ae iaaicatea. I certifq tEat�rort oi
installation Eaa ao�eacea prioi to iesnance of a penit and tEat all rork rill be perfonea to aeet etandarae of all lare
regalating canetracU�, City cades. caning cegulatione. and laod developrent regiiletiane in Me f ori�6iction. I also
certifp that I m�deretand tbat tLe regnlations of ot6er gorernrental age�i��al aPN9 to tbe 1AtmDed rark, an�that it ie
,�r reeponsibilitp to identifp rhat actione I�ust tate to be fa cxipliance. Sach�encies incluae�t are oot 1Litea to:
*Depart�at of eavirn�ental 9egulatian-Cypress Bep6eade� Yetlard Ilreas a�Bnvfra�ntal118eneiti�e Lands�
Yaterl�aeterater lreatamt
�Soatlorest Plarida Ynter!lana_gesent D'utrict-fTelle. L}ptesa BaYheade► Metland�e, eltering Yatercaoteea
*�Cotas of&�gineecs-Searalie, Docke, lavigable Yate�rale
•Deaartaent of Health i IIehaDilitati�e 6ecrices,Bnviran�ental Hwlt6 Onit-Yells, Yasterater lceatamt, SeptiC iente
�W�otirm�tal Protectian AyeneP-�ebestos abataent
I also certifq tLat, if fill iaterial ie to be osed in Fload L�e'e'ar's,etc.', it ie underetmd tEat a draiaage plan
addreesing a'co�peaeating vola�e'rfll be ea6aitted rhicL ie prepared bp a profeseiaaal e�ineer regiatered in the 8tate of
Flarida prior to penit iesoauce.
s peadt iseued ehall be const�to be a lfcenae to praceed dth t6e rork anD not as authoritY to dolate. canal alter. or
set aaide anp provieiooe of tbe tec5oical aodea, �r ehall iQseaace of a penit pree�t tbe Hatlding OfEicial fm th�fter
requiriag a correctioa of ercore in plane, caoet�ncti�, oi.iulatioos of anj�e. 8�peait ieooe0�hnll bec�e imalid
amleea tha rork authori:ed bp eac6 penft io ca�enced�itLin��ont6e aE ieeuaaw, ar if rort aathori�d bp tEe pendt ia
auepende�or absadm�l foc a perioa of eu�after tLa ti�e tLe r�rt ie ca�ena�. One 90 daq�steoeion of tLe.,iaY b�
allarea far t6e penit rith fce c�acga of�15.00. !6e erteoiion eLall be requeated in rtit3mj to tEe Buildinq OEficial. M
eppimea inepectfon iuet 6e lagged duting eatfi su routh period.or t6e pzoj�ect uII be consideled a6an8aned. '
tlAA�A6 i0 Of�: Y008 PAI60�t0�!�!!t�OF NI�[!�i➢iSQL!IN t00Y PA[IN6!Y[l8 P�Il�IfB!0 YOOB
P80P�f➢. IP YOp INl�!0 OSi1IN FA�CII6, �{SQL!YIlB YO!!R 6�iA�llf bli�Y DBP�B R�II6100H ll0lICB OF
CQ4�t. J�S 1��1►500 I119AIAE DO�i�iIl�IUID POSi 1"AO'[IC6 OF�'.
SI61�fUHB:OIIABR OB b�li SI�: CUAlRACI'6H
SfeT6 OF F(AAIDI SiAiB�FL�IDI
(70011![OF OOONli OF
The foregoing instrnsent rae acknowl�qed The foregeing instrusent xas aclmorledged
before ie thia , 19_ bq before � t61s , 19 bp
rho ie pereonallp lmrnm to ae or r6o has �ho is personally lmo�w to � or rho has
produced prodnced
ae identificatiom and rho did/did not as identification and rho did/did not
take an oath. take aa o�th.
(Signatnre) (Siqnature)
(Naae.Tgped. Printed or Stamped) - (Naae Tpped. Printed or Sta�pedl
NUTIIRY PIJBLIC NOTAAY PUALIC
,' .. _ .' ' , " ' � APPLICATION FOR P�iMIT
� CITY OF ZBPHYRHILIS
BUILDING DBPARTMBNT
OidNSR'S NA[�IB PAONB
OWNER'S ADURSSS
JOB ADDRESS
LBGAL DBSCRIFPION: IAT(S) BLOCit,_SUBDZVISION
PARCSL I.D.# (OBTAIN FR�! PROPERTY TAX NOTICE)
WORK PROPOSBD: New Construction _�ddition �lteration �tepair Install
' Sign �iove _,Detolish
PROPOSBD USE: Single Fa�ily _�i/F � of Units M/H
C.o�ercial Indust. Swia. Pool Other
^�tesCaurant & Health DepartRent Approval
DESCRIPTIOP OP iiOR[t:��, C_A
BUILDIHG SIZB: R , Square Feet, Height ,
RESIDENTIAL: ATTACB (2) PI�OiT PLANS & (2) SSTS OP BUILDING PLANS & (1) SET ENSRGY FORMS.
COMMERCIAL : ATTACH (3) SSTS OF BUIId1IN6 PIANS � (1) SBT ENERGY FORMS.
� P80PBRTY SURVBY RBQUIRBD FOR ALL NEW CONSTRUCTION.
. PERMITS RFAUSS�gD
BUILDING s Valuation of Total Construction
BLBCTRICAL A!!P S¢rvice Florida Power Corp. W.R.E.C.
,�iBCHANIGAL ; Valuation of Mechanical Installation
PLUlBING GAS ROOFING SPECIALTY
Tvnp nv mnc�rvrtr�rrnv. n�..,.t V�n�e etmt nr1.e..
�I7gtld 1�IfiJAN �I'IS[ld 1I�i1ti0H
(Pe��S =� Pe�II��d 'Fa�L S�N) �Pe��S =o Pa��=d 'Pa�L��N�
(a��iS) ' (a=n�erd�ES)
't{�$O t[e � E
�o� PiP/PiP �� PIIe IIO�a.P�L�i�Q'dpFxBP �oa PiP/PEP oH� P� ���3���pix�
paanpoid pa�nposd
aeq oqN so � o� v�ou� diteaoe�ad si oqK seq oqK so a� o� uewtq dtieuoa=ad si oqK
� b4 fit � StQ1 � @�OIBQ dQ GT � arm am aTnTan
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� � CONDITIO�S� OF PSRMIT AFFIDA�i'�T •' � •
A. NOTICB t)F DSRD RTSTRICTIONS ' � �` �
fl�e nnaereigae� umderekaade tbat t6ie penit�ap be sab�ect to 'deed reetrictf+u�' �bic6 say be�are restrfctive than Cfty
regWatiamEs. !he umdersigned asem�es sespaneibility for r,�pli�mce rit]► any applicable dee+d reetrictions.
B. UNLICBNS$D CONTRACTORS AND CONTRACTOR RSSPON3ZBILITIES
If #he o�uer has bired a�antractor or t�tractors fia m�dertal�e xor�, �t►eg�ay be reqnitefl ta be lice�se�1 �ia a�oarilaace rit�
stsrte and local t�eguldtiaaus. If tbe t�ntract�r is not lit�:naea as reqa,ired by lar, b�ath the oim�et' and ta�o►kracto�c'iay be
C��d E4L 8 �I�1ROL 9�4��OIl tid�@L 8t8� 1dM. If #.�t@ 01tAEI 4I �[ttEGdL� !?O�ttLdC�OI el'!@ UIICBtkd'lA dS �Q Nhdt 13C@II8�
regttizPJPa1t8 aag applg f0r tb8 ititeAded �otic� thep ue adp� t0 t�ltaCt the {�ty of $eghy1�I18 B�tfltl�tiq Depol[tien#� (813)
786-6611.
Purthenare, ff the omec has direa a ooatractor or contractare, he ia adviaed to have t6e aontractor(e) siga�drtiona of the
'Gmtractor 8�t�ioas' of t6is applicati� for �fcb t6ey�i�l be reapo�aible. if pon, as tl�e orner aign as tLe cantcactor,
you are in�dicat�ng that pou, rafi�er tban the r�n#ractor, aze responsi6le far tic�e rork. If the ccntractor riehes pou �o sign
as t�tractoar that�ay be an indicafi.itm t6at be is tat ptoperly license+� and is aot �a►titled to pertittiag grivileges in t6e
City af Sepbyrr�atlis. t .
C. TRAN3PORTATIQN IMPACT FSES AND UTZLiTY C4NHECTZ4N FSES
D. CONSTRlTCTIQN LIEN LAW (CRAPTBR 713, FLORIDA $TATUTE3, AS AM$I�DBD)
I certify tbat I, t6e applfcaut, bave beea pmvided r�th a cogp of *Flari�a's Co�stcucE�ion Lfea Lar - Ha�amer'a Prct�ction
Guf�e' prepaze8 by the Florida Dapart.�at o� Agriculture ana Coniau�er ,I�'fairs. If ths applfcaot i� eo�te otl�ac t6an t�e
•o�ner•, I certifp t�at I bave olrt�i�aed a cogp of t6e above deacribed docweat aud prt�ise in good fa3�d to deliver it to t6e
"o�er' prior to corenc�ent. '
E. CQNTRACTOR'81UWNT�IEt'S AFFIDAVIT
I certify t6at all t� iafonatian in tbis applicatiian ie accurate a�l t6at all Moxk �ilt be daoe in co�pZiaace Nit6 all
applfcable lars reg�lating can�stracti�. ��ain9, and lam�de�elo�eat.
�pglication is l�ce.b�r�ade to obt�ia a pe�ut to da tiort ansl i�stallat�iau as 3ndicated. I cartifp tltat no Morlc or
inetallat�an bas +oo�ens�l priar to fesaance af a penit and t6at aIT rork rill be perfoaeti to�# sfian�ards of all lars
tegul8tinq oon8l�CUCtioIIr C3ty CodeBr ��iuq C�gulBtioAs� and laad develaAent regulatione in t�e 3uris�tctim�. I a180
certif�tbat I urade3rsta�td t�at #� regolatimos a# ot6er qavecaseo�ntel a9����Y �Y to t6e int��at�, aod tl�at it is
■y resp�sfbilitq to identifp Mhat actfoas I snst tate ta be in co�rliaace. Sach ageacies include bnt are not li�ited to:
� Delt�tt�t of $rlvattoAleIlt83 Reguldt�� - Cypte88 Be►pbEadSr N�t28std llt�8 �tid BtivfXOti�ttt811y S�ABitf9B L�r .
ilaterJM�steyater ireatient
* Sonthrest Blorida Mater ltana�e�ent Dfetrict - Mells, CYAresa HaYhea�e, ltetland Areae, llteri.ng Matercourees
' *1lrni Carps o#�ineere - SearalIs, Docts, �avigable Natentays
* De�arbent of Healt6 �C Hehabilitatfve Services, Bnriramu�ntal 8ealtri IhOit - T�lls, Mask�rater lreataatt, Sept�ic tanke
* QS �iroo�ental Prot.�imt�qea�.9 - be6eat� �ba#�eut �
i also ce�tify t�►at, �# fill wterial is ta be used io Flaod Sane 's• or 'd,etc.", it is wnd�ataad t6at a draiaage plan
addressing � 't�easat.�r�9 volwe' �fill be sabtittetl rh3cb is gregared by a pmfeasional engine�r tegisteare� ia the State of
Florida pri,or t4 petsft issaance.
A penit ivasned sball be t�nstta�l to be a Iicense to grocEed�itb the xork and aot ae aat6oritp ta viola:�te� c��nt�l alEezt ar
set aside �ty parovisians of tbe tecdnical coaes� aor shall issuemce oE a penutt preve�at the �ilding Of�icial fra� t�exeafte�t
r�guiriag a cozrecfi�� of errors iQ plans, ct�atcuctfan,.ar violakioas of anp code. �re�y pewlt issaed mhall be�■e fnval�d
unless the rarl� antLori�ed bq such penit is ca�anced Nithin siac �antbs o€ issnan�, or if rork anthorf:ed bg tbe pe�it is
snspende8 or abandanea £or a period of si�c �onths after the ti�e tbe xaark is +c�eat�:d. O�ne 90 8ay exteasion of tiae� �ap be
allor� for the penit�rith fee charge uf #15,00. !1►e ezteasioo sbal! be r�uested in�rritfng to the Buil�nq Off�cial. l�t
apprnv� iunapect3� w8t be loqged during ea+ch sis�tb period, or the groject rill be con�i8ered abaac�o�.
it�R�IltG!0 Qi�tBR: Y40R F�LDR�SQ RBCOBD lt lttlllCB OF t�C@�t1!!�X A8S{iL! IN YOOk pAY1�6 '[IiICB i�OS D(t�R4IVS!!ltlllS !0 Y0�
pROPBHlY. IP YpU IlflBND i0 OB?IIli FININCIlt6� t�Stn? i�IlB YOQR L611DBit OH �A]I'ROEABY BBFDRB A�Iii6 lIQOA 1i0�lIC8 OF
t30�NC�R. Jtl� U1�1BA �2�500 I8 Y11L11B DO !t0'[ N86Q ip �MD Y�'! 11 'NOlICB OP �".
$I6IIBTIf�6: OYi16H�,h�tli S16'NAlQAB: CENilEt1{.TOH
Sx'IITB OF FLORIDb Sist6 pB FL�iIDA
CtlUt�iY OP CtAililY OF
T2Re faregoing inotruo�at xas aclmotirledgec� The foreqaiag iaetrwe�nt wae ackarnrleclge8
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ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name • • Classification '�1 :��, - •-�:� f•
Address ' '�c. I `! 2/<.�=��>.�-' OwnedManager :% ,'� . l,
Business Phone � � ' � ' Emergency Contact Phone— ��'�':/` ;`<��„r
Occupancy Load Alarm Monitoring Co. Phone #
TYPE OF INSPECTION CONDUCTED
� QUARTERLY Q FINAL Q ANNUAL Q BI-ANNUAL
Q RE-INSPECTION ,� OTHER � - '
� APPROVED Q NOT APPROVED
Q COMMERCIAL CHECK
Listed below are items which must be complied with before this occupancy can be approved by the Fire
Department.
1
. � CODE VIOLATlONS
This inspection report specifies code violation(s) which if not corrected coutd cause a �ire, contr�bute to the
spread of fire, or prevent safe egress during a fire. Your immediate attention to the correction of these
• violations shall be required, as failure to do so is a violation of the city of Zephyrhills Fire Prevention Code.
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tnspect. Date ' " - 'nspect.Time �'� Fire Dept.ID# •
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Re-Inspect.Date -''�� s me `
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Owner/Manager Signature r "� � Tdle �r� �"fr C f�, �
This building has been checked by the Zephyrhills Fre Dept. under the codes & regulations of the NFPA minimum
standards, the State Fire Marshall's Un'rform Fire Safety n�les and other local fire safety codes.
Whlle Copy - Flla Yelbw Capy - Bld. DepL Pfnk Copy• Buslness
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, � - � �ZEI'HYRHILLS FIRE DEPT
Zephyrhills Flonda 3354iJ {813} 782-$1$4
FIRE GQQE lNSPECTI�?N
Business Name �'.�r �.. �"` Gtassification t�i `�'�- r- .•... t�. � � J
�
� � `�" �,��- Owner/Manager
Add�ess � � C-.�a• %
Business Phone Emergency Corrtact Phone
(?ccupancy t�oad Alarm Monitodng Ca. phone #
TYPE C'>F INSPECTIQN Gt.1NDUCTED
Q QUARTER�Y Q FINA� Q ANMUAL Q BI-AMNUAL
Q RE-lN�PECTfON d OTHER
!,�APPR4VED Q NC3T APPRt3VED
Q Ct�MMERCIA� CHEGK
Listed below are items which must be camplied with befare ihis occupancy can be approved by the �re
Department.
O GODE VIOLATiQNS
� This inspection report specifies code violation(s) which if no# carrected could cause a �re, contribute to the
� spread of fire, or prevent,safe egress during a fire. Your immediate attention to the cornec#ion of these
� . viotations shal( be required, as failure to do so is a viatation af the city ofi Zephy�fiills Fire Preventian Gode.
�
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Re-tnspect.Date ,,� �ci'cs `
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4wner/Manager Signature L:� �`�f � �L�' S '("d�e f/,�'rr' - ,���.�l�r-( `
This building has been checked by Ehe Zephyrhilis Fre Dept.�under the codes & �egulations of the NFPA minimum
standattis, the State Fire MarshalPs Unifarm Fire Safety rules and oiher local fire safety codes.
white Copy -Fib Yeibw Copy•Bk1. Dept. Pink Gopy - Business "
,
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� � � `ZEPHYRHILL5 FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
�� �
Business Name lll;._' � Classification /��=��•'f���•�
Address ` �>�/`i C�,,f��:�f��.' !, OwnedManager .°�{'=' �� � � �is%:���1 r,/f
�itTl�%:�;f�,�,t-
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Business Phone � -� � �- � Emer�ency Contact Phone � - �:• : - :
. .. '�- �1' �'I�l�� C��/�
, � /
Occupancy Load Alarm Monitoring Co. �"�'%'''j � ' ' Phone # �' ` � '� r
I'�_� ' � f�_-: J
� TYPE OF INSPECTION CONDUCTED
� QUARTERLY ��FINAL Q ANNUAL Q 81-ANNUAL
Q RE-INSPECTION O OTHER
� APPROVED Q NOT APPROVED
Q COMMERCIAL CHECK
Listed below are items which must be complied with before this occupancy can be approved by the Fire
Department.
O CODE VIOLATIONS
This inspection report specifies code violation{s) which if not corrected could cause a fire, contribute to the
spread of fire, or prevent safe egress during a fire. Your immediate attention to the correction of these
violalions shatl be required, as failure to do so is a violation of the city of Zephyrhills Fire Prevention Code.
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Inspect. Date j.�.3/���`?� Inspect.Time ��'�`� Fire Dept. ID# % �• '�
Re-Inspect.Date InspectorsName ���`-���-��"�`
6 , � ,
Owner/Manager Signature `J�-���#, i!��ft;c, r:'`�t,�t�__. Title /.%f;�! '=C_,a�; .! , _.�i.�,t. c.
This building has been checked by th�'�Zephyrhills Fire Dept. under the codes & regulations of the NFPA minimum
standards, the State Fire Marshall's Unifo�m Fire Safety rules and other local fire safety codes.
Whlte Copy- File Yelbw Capy - Bld, Dept. Plnk Copy- Buslness
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