HomeMy WebLinkAbout16-17773 / I �
' � CITY OF ZEPHYRHILLS `
, , 5335-8TH STREET �73
(813)780-0020
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Mumber: 17773 Address: 6012 17TH ST
• Perm�t Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class af Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: SINGLE FAMILY RESIDENTIAL Lot(s): Block: Section:
Squa�e Feet: Subdivision: CITY OF ZEPHYRHILLS
Esf�. Value: Parcel Number: 02-26-21-0180-00000-0490
Improv. Cost: 11,812.10 OWNER INFORMATION
Date�ssued: 9/26/2016 Name: RUMMAGE ASHLEY
Tot I Fees: 202.50 Address: 6012 17TH ST
Amo�nt Paid: 202.50 ZEPHYRHILLS, FL. 33542
D te Paid: 9/26/2016 Phone: 813-892-5519
Wo�k Desc: GARAGE ENCLOSURE 12 X 25
CONTRACTOR S APPLICATION FEES
CUNNINGHAM CONSTRUCTION BUILDING FEE 142.50
ROGER ELECTRIC ELECTRICAL FEE 60.00
<
���
� U �
Ins ections Re uired
FOOTER 2ND ROUGH PLUMB MISC INSULATION CEILING
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH E�ECTRIC LINTEL MISC MISC
1ST ROUGH PLUMB , PRE-METER INSULATION WALL MISC.
DUCTS IN TALLED WATER MISC DRIVEWAY
PRE-SLA � SHEATHING MISC. ,MISC.
CONSTR CTION POLE FRAME MISC. MISC
REINS ECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
local overnment shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
NOTIC : In addition to the requirements of this permit, there maybe additional restrictions applicable to this property that
may b 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.
"Wa ning to owner: Your failure to record a notice of commencement may result in your paying twice for
impr�vements to your property. If you intend to obtain financing,consult with your lender or an attorney
before recording your notice of commencement."
�Comp ete Plans,Specifications Must Accompany Application. All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUP NCY BEFORE C.O.
I • �
� ��
�CONTRACTOR SIGNAT RE PERMIT OFFI R
PERMIT EXPIRES IN MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
�
a
� �f����;. ..�,.�.-
�,.�:
�:�����' - _
. -.,, � ���- !I
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: ` ���� ` �
S
Date eceived: �
�'-lG-- ti
Site: , �v�l Z ��� CS'-r—
Pernut Type: L�v Z�C Z�'
Appro ed w/no comments:❑ Approved w/the below comments: � Denied w/the below comments: ❑
.. ��i �
�
�
I � `
� ��r1�� � ��Q � °
� � P � � �
\ `_'' / �
���� �'� � ��� V•�� �� �
' � � �
� I
This co ent sheet shall be kept with the permit and/o
,
, , ��
� �
�'? / � -�li�
Kalvin Sw' �l aminer Date Contr r and/or Homeown r L�
e
(R ired when comments axe present)
;
� �9°8°�? 8°0�Ri
Q�ES��3�P�°I'��� �7SE ��L�� .
�t44bC.629.a �o N jJti �� Lh f ���� tY'£/��,.��� .r���i� &}�b��$ �t ��'� ^f'ce.Y
�
e7��t.t 11 u1 FC fi'lE�� J Y783A/ &161�J'��b'� fl.eyd A _.
�g]1 cflsam� �� �h�ll tre d��e�a�u �o sc�l� ag gu�.ly c9iin�a�s�oe��� �or �1� p�ec���o
�
� r.-� e
{ l��
� � � _...--..__..__..__._._____.....__._._�.__._.._...___.___.--___ _._._`._____
i � � , � �
i � .�; �
i � � � E
I � �
� s ,�,: � tp �
6 ( ,�' � 9 �
I o-j 1 �': � � �
�
; , � .:�; � �
� �• � �Y+� y . � !
���' ,'� i '( �..�,.. g � �q
� i ` � ' l
� ;f� ; ��: �; . � :�- =-�� ' ,�
; f • ; � �7 '�
�:�
i ±� i i � � t'T'� �� �
I `y� i � � �� � t � +
�� = ~ i
�`� ; 5 :��'f,�E,��G � �',kt�7'jf�J�'...� � f..-� ��Q. �
, � ; -' -t' , `, ,. � �,,"'��...f� �..,�. f
� j t ...Y-----:;;�-:_a ;�"`�kr,.1;��"�'<"�'" ..,.�, ''-�,�,.,s> `�:c�,,.�'"
� i �� — � �`�=-,''s,r �C� •
� i f �����
{ � . ', `��'s
rf ' a""'�...>"' ,
����._�----________.----------� --------
� �
t
�
�
�
,
SHObd ��,LL EXISTIP�G A.tdD PROPOSED STRUGTURES GIVING DIMF�dSIOP�S �AlD SETBACRS. r4i,50, IPdDICA'�
�.PdY BOD ES OF b�ATER, TREES ( IRICLUDIAIG SIZE, DIAMETERg TYPE) , �D ROAI3��YS �I�CLUD�FdG
NATqES) JACF.A�'I' TO THE PROPERTX. It�iDIG�,TE 'I'I�E SIZE, Y�AR, ,�.PdI� A1,� OF �90BII.�n SUC� �
12° X 60' . 19�I .. FLEE`�dCkOD.
�r rtt �f ,t „ �� n ac
ALL EA II^'tEAiTS , PROPERTY LItdES . RIG��'i'-OF-k4AY , and JURISDICTIONAI. LII�S r�ust �+�
� sho�m on all site plans.
' Dt? P�flT CR4AGH IRI1'0 �RlY EASEMEPd'T bdITH A STRUCTURE.
HOU9E CDAi�TRt}CTl4Fi PStOPa9E0 Ab01T�OW Pd09tL� HOA@� �ET-UP �
v�ar (d0'? vooa (�0') rsar (180'? ��
�t IS' "" �4'a 10' !6' ,,. �y Bb' 40' .-.
& O ~(� p� �
a8 (� O 9�.8� 06 � � .. ���
� — Om
p T.g' 76' � y Ettiaz�ng �-�� � b �8` �� o �
� Mauso � � HOJ9� ^o �o tre� �IIi841R� C7 I
a+ �a � m '�, — �P!bt� m
a i e _ , �,
Licensed, nded Praposal / Contract StateCeftified I
� &lnsured 8uilding Gontractor
Lic#CBC�43683
Cunnir�gham Construction
12152 Fort King Road, Dade City,FI 33525 ���������
(352j 521-0955*(813)?80-454Q*�AX(352)521-0596
Date 08-01-16
PROPOSAL SUBMITfED TQ:
Neme As ley Saukhasmar
Street 60 2 17'"Street
City Zephyrhills State FI. Zip 33542
Home Ph ne Gell Phone 813-892-5519
Email Ad ress
e here y submit specifications and estimate for.Garage Renavatians
1. D al all exteriar walls and remove ceiling and drywall spray orange peel texture on walls and knock down on ceiling.
.lnsulat ceiling in garage area R-30. Paint ceiling white and walls owners choice of color.
.Buiid a c(oset approximatei 3'x6'w'tth bifald doar. insfall bifotd door on(aundry room.
.Remov garage doar and fill in wi#h b(ock and stucco exferior with gray stucco mix.
. Instal! -windows 1-in garage door area and 2-to replace existin ones. �
.lnstall �wners supplied laminate flooring in main area and tils in bathroom and laundry area.
. Remov side exteriar door and Fill in with block.
. Insta(I ew 110 outlets to meet code and light fixture supplied by owners
.No plu bing included or AtC Bid.
0. tnstall new attic stairway. In same lacation.
11..A!I ca struetion debri to be removed by Contrac#or.
ropasal ost$11,812.10 AI(Payments to be Made to Cunningham Construction
'I Draw pan Acceptan $6,812.10 Notes: �',� _ " gr -��._
2 Draw ,alance C!n Com letion 5,oao.00 Notes:
Any alteratio ar deviatian from abave specifiCat'sons involving e�ctra -'
costs will be ecuted only upon written orders,and will be paid in fuN _ '�} - �'��.
by the owner All agreements contingent upon strikes,accidents or • �
� ��.-
detays beyon our control.Qwner to carry,fire,tomado and otner necessary � ffic /Agent Cunningham Canstruction
insurance v n abave work.Worker's Compensatian and Public Liabitity /N e:This proposat may be withdrawn by us if not
� insurance on above work to 6e taken out by fhe Contractor /aCCep#ed withi�l d3yS
✓
ACCEPTANCE QF PR(?PQSAL
The above prices,specifications and conditians are sa#isfactary and are hereby accepted.Yau are authorized to do the work as specified.
i have rea the back of this Proposal I Contract,which contains Florida Statues 713.001 —713.37. Payment will be made as outlined above.
I ccepted: � Signature: ���.����'j_(}-� � ��}�1��.�„�'}
�
Date: Signature:
�
!!lllll Illll lllll I!!!l lllll I llll Il!!I llll!lllll Illll III!llll
" 2016146880
' D��?��l-�/�D-����l�p'
perrnit No. Parcet ID No
, N4TICE 4F GOMMEHGEMEfiiT
SlB�e ot ����1� Counly o( ����
SHE UNDER5tGN60 hereby giucs notica that improvemersf xiti be maGe to certain reai property,and in aGcorCance x+th Chapt��-e///r 713.Florida Statutes,
the foitowing informaGan is provided in ihis Nottte af Commen/ce��y nc� 9 ' 7 ��/JO
1, pescription of Property: parcel Identiticatlon No.I�G► dG+���������0���+ �
SitCtt Address: �� � ✓�' �� � �
;r 2, General Description ot Improvemern [�i'9�i9 a�rE E/�/�L?(�.�1��0�
/ .2./f
;�, r Infarmatian or Lessee in(orrna6on if the Le see contraaetl for Ihe improvement.
-,.�S�Y� /�A K.-�'
O o'� � � �i,(,•L1i�flGLS ��,.�3S�Z
Address /,,�/ Cily 1 Stale
tnterest in Property: �f/�//'+��
Name of Fae Slmple TtUenolder
QI diHerrnt from OwnBr I'isted 860ve)
Atldress Ciiy State
� 4. C/ontracto �.. • .j�.7�!
/ �� �e � 4 '
Address /ry City State
CoNreaor's Telephone No,:��'"�'�-�z�� Q,„!�S� '
5. 5ucaty: '
• Name
Address ' Ciry Stale
AmounR af 8orsd:f Telephune No:
8. Lender:
Name
Address City Stale .
Lendefs Telephone No.. �
7 Persans with)n She State of Flonda de9lgnated by the ovmer upon vMom nolkes or olher documenls may be served as provided by �
' Section 7t3.t3{t)(a}{?},flodda Statutes:
�i,`
;' Name
ACdtess City State
Telephone Number at Designaled Pareon;
g, in add8ton ta himseit,!he ownEt designafes °f�
to receive e capy o}the LienoYs NaUce es proWtled in SeGion 713.13(t)(b},Florida Statntes.
Telephone Number of Person or Entiry Designeled by Ovmer.
g, Expitatlon data of Notice of Cotrsmentement{the BXPiJatton date may aot tse Getora the cffmpfetian of conswcsEa�arttl finaf payment to the
conlreUor,bul will be one year from lhe date af recarding unlea9 a tllftarent dale is specified):
WARNiNG TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE FJ(PIRATfON OF 7HE NOTICE QF COMMENCEMENT
ARE CONSSDEf2EO tMPROFER PRYMENTS UNOEft CtiAPSER 713, PART S SEGTiON 113.13. FIORtDA STATU3ES, AND GAN
RESUL7 IN YOUR PAYING"TWICE FOR tMRROVEMENT O YpUR PROP�R7Y. A NOTtC£ qF COMMENCEMENT MDS7 8E
V+ATH YOUR Np R R AN ATTOR EY BIEFORE COMME INO �N RK OR'RECORDING YOUR N07 CE OF GOMMENCEMENTSUIT
UnGer penaity at pe�jury,t dedare that I have read tAe forega3 no' t c encement a d t k the tacis stated thereln are true to the best
af my knovAedge and behet.
STATE OF FLOR4DA J
CdUN1Y 4F PASCO
ignat oi CMmer or Lessea'or p sts ot�essee's AuthadzeG
� OfficedD�'rectalPa+tnerlMana9et
Stcynetar}�s 7iQetO#tice
The foregotng ins4ument was acknovAedgeC hafore me thi��day o �� .2y�bY ��^" '`��
$g {type of auN�9•.Q��et,lrus(ee,aUomey in(aU)tor -
� ( a ot pa oo b tt oi whoRyjnsU� e !ed).
Perscnally Knavn Produced iaenuficauon p Natary SignsW _ �
' tlame Frint � ��
. Type of tdentificattOn Produce0 {
� ' - -- - . _ ��"`� •.�•� JACL�UELIIJE A VALDEZ
Rcpt:18025i3 Rec: 10.00 . * ' * �YG�l,i(SStOt�lA�Ft54606
DS: 0.00 I fi: 0.00 ` s, ..dr EXPIRES;AuguSt 13,2018
09/!6/2@16 E. M. , Dpty Cler�k °j�oortid"� BanQa4TtwBud�(NnbryServkes
wpdatalbeslnolicecommenCementycG53048 -• --'� �� ' `
.PRULR 5 0'NEIL,Ph D PASCO CLERK & COMPTROLLER ,
09116t2016 12:50 m 1 af 1
QR BK �4�� p� ��6� _ � '
��1�8��
�� � ' : �TAT��F FLORIDA,COUNTY OF PASCO
' �� THIS IS TO CERTIFY THAT THE FOREGOING IS A
� � nG TRUE AND CORRECT COPY OF THE DOCUMENT
. • ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
� � �'�"�he „�� � WI NE S MY HAND D 0 FICI SEAL THIS
y�. "".• ; * DAY 0 2�0
p88�.�� . � A S.O'NEIL, L RK&C M 7ROLLER
�3�► ° • � BY _ PUTY CLERK
��b�B.OR �`
r. __
_ _ T_ —..--._
x • s ,
�13-780-0020 City of Zephyrhi!!s Permit Application '` Fax-�B -0029
Buiiding Department \
Uate Rec fived r-- �--f� phane Contact for Permi in ��� .� � — ✓ �
Owner's ame ��� � � Owne �C " J �
Owner's kddress � � t7 Owner Phone Nnmber�� �
Fee Simple Tltleholder Name Qwner Phone Numlaer� �
i
Fee Stmp�e Titlehalder Address
JOB AbD ESS L��� ! � c�,i'���Z'�- I�� /L.f_.S �G.- .?�`�� � I.OT# �_`��L—1
� J / M VVM'��f/ �V
SUB�D{VISION �� ��.t'.,r, r�nc��.ir� /a? � 18'�-i .
{OBTAINED FROM PROPERTY TAX NOTICE)
WflRK P OPOSEq NEW CONSTR AD ALT Q SI�N � MOVE Q DEMOLISH
e lNSTALL � REPA
PROPOS d USE � SFR � COMM �J OTHER
i1tP�OF ONSTf�UCT14Pi �' BLQGK 0 FRAME C] STEEL Q 07HER '
_ '
DESGRlP !ON OF WORK �/�c..-/�SS� �7c./�� � ��
BUILDIN SIZE ��� SQ FOOTAGE�._._� HEIGHT ��
� B�«'Q��� � J f Q� �� VAI�UATION OF TOTAL CONSi'RUGTION
._L f.�!
[� El�EGFRtGA! {$ � AMP SEF2VIGE 0 PRQGRESS ENERGY Q W.R.E.0
I �,��3 '
� [� PWMBING $ � /� i
, , �----_-___� �� � ��, t,,
: �� ✓
? MEGNANlCAL $ VALUATION OF MEGHANICAL tNSTALLATION
�� �, �----__ --� ���, �
�� � � �
;� Q GAS . �OOFWG � SPECIALTY Q 4THER
,� FINISNE FLOOR ELEVATlQ 8 � FLOOD ZONE AREA QYES QNO � (� �J�" � tJ''�""
��
:j � .S' . ,,,
,� SIGNATURE i'G � y COMPANY ����7I�f (�� `
EGISTEREO Y I N FE CURRENT , Y I N
r f ��
;! Add�ess �" � License# ����/,� �
i� • /
.�-- ..
�� ELECTRI IAN ��(�` � CQMPANY ���:X..� �fE=��l�
�� Sl�NA7!!i E REGISTEREp Y/ N FEE CURRENT Y/N ,
, j�
� S fj"!?rl /�
�� Add ess �� License# �/[����,,�,��, __1
�� �
;� PLUMBER COMPANY
j� ���''N'4�U � REGiSTERED Y/ N FEE CURRENT Y/N
?� Add ess �i �
I! !� �icense#
�' MECHAN CAL � (� „ CQMPANY
i ! SlGNATU E ftEGlS7EEiEp Y I N FEE GURRENT Y/'N
- Addr'ess Lfcense# �` - �
�TN�R � COMPANY
SIGNATUFZE � REGIS7EREQ Y/ N FEE GURRENT Y!N
Add�eSS LlcenSe#
RESlDENj IAL Attach{2)Plot Plans;(2)sets of Building Plans;{1)set of Energy Forms �
Minimum ten(14j working days after submiktal date. Required onsite,Const�uctfon Plans,Sanikary Facllities$�1 dumpster
' CQMMER,GlAL Attach(3j sets of Building Plans;(1)set of Energy Forms.
� Minimum ten{10)ryorking days after submitta!date. Requirgd nnslte,GonsWction P1ans,Sanitary Factli8es&1 dumpster
} Aif cammerciai requirements must rneet campltance.
SiGN PERM)T Attach(2)sets of Engineered Piarrs.
"*'PROPERTY SURVEY requlred Po�a(1 NEW constn�cfian.
direction ; - - 4
Fill o�t appiicatian compieteiy. , �
Own r 8 ContraEtor sign back of appiication,notarized � �
If o�r r$2540,a Nofice of Commencemenf Is required, (A1C upgrades over$588U) _ - �
""� Ager�t{for the contracfor)or Power,of Attomey(fo�ihe awner}would be someone with natarized letter from owner authorizing same�;:,;.;,,
� .. .. , , , ,._:.-:, �
OVER TF�E COUNTER PERM17?iNG��� '(Eront of ApplicaGon Onlyj;� ��- ="='�'��== :. -
,=�F�:�.<-�-.::-.. "i
Reraofs Sewers Service Upgrades A/C,� '_ Driveways Fences(PtotlSurvey/Footage��f:u��-,�y;,;w>;;��
.' � � .. - � � .. � _ �w" M � �m_
' ' � -_�"n�`�'i`;,,r;=n;_^`i--'`.
� °�:'�K���:;s:'`>'';::�_..,
' --- _ r.�`s_s'�.��.n; ';���`"?^: .
r ':.z`-„s :x=3.;.'.
_ '�, . :f';:r".'-aAfFS
,. _ F;��:ri.j�.';;:�;',c:�,r. �P _ _ -
,�'^`�.. �t:a zr
__.... ..._ c m-f.�'_�yE.�-e�'dxiY.d�,E. _ �
,-. -.5........,x<IGrv:ru,t.fl.'Rm..,�`:��' �-�. ._..
r---- _ __ _ __
- 4�' F. . � � 'i 4
s �'°`
a a} , � y';�;,
�'r�: ._ . • . '
, �
:�, NOTICE OF DEED RESTRtCTIONS: The undersigned undersfands thaf this permit may 6e subject to"deed"resfrictivns° ;:-
� which`may be more restrictive than County regulations. The undersigned assurries responsibility for compiiance with any �`
, applicable;c#eed resfrictions. . - - �
UNLICENSED,'CONTRACTORS AND CONTRACTOR RESPONSIBILITIE.S: If the owner has hired a contractor or
contra:ctors to-undertak�work, they may be requ�red to be licensed in accordance wlth state and tocal regutations. If the
contractor is.not,licensed as required by (aw, both the owner and contracto� may be cited for a misdemeanor viafafion
under state law.� If the own�r or intended con�-actor are uncertain as ta what licensing requirements may apply for the
, intend'ed worR, they,are advised fo contacf the Pasco County Building Inspection Division—Licensing Secfion at 727-847-
� 8009::. Furthe,rmore, if the owner .has .hired a contractor or contractors, he is advised #o have the contractor(s) sign
porfions of fhe "conEractor [ilock" of�this applicatian for which they will 6e responsible, 1#you, as the owner sign as the
contractor, that may be an indicatian that he is not praperly licensed and is not entitled to permitting privileges in Pasca
Goun�}r. ` �
TRANSPORTATION IMPACT/UTILI7IES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands ',
that Transportation Impact Fees and Recourse Recovery Fees may apply to the conskruction of new bUildings, change of
use in existing buildings, or expansiori of existfng buiidings, as specified in Pasca Cour�fy �rdinance 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
��permitfing. It is furfher uniiersfood fhat Transportafion Impacf Fees and Resource Recovety Fees musf be paid prior to
receiving a "certificate.of occupancy" or final power release. If the project does not involve a certificate of occupancy or i
� final power release, the fees musf be pald priar to permi# fssuance. Furkhermore, if Pasco County VltateriSewer Impac� ;
;fees are due, they must be paid priar to permit issuance in accordance with applicable Pasco County ordinances. ; ,
, F CONSTRUCTtON LIEN LAW�Chapter 7'13, Flar�da Statutes, as amended); !f valuation of work is$2,544.00 or inore, ! ;
I cerfify that i, fhe applicant, have been provided with a copy of the "�lorida Consfrucfion lien Law—Homeowner's `
Protection Guide° p�epared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone :
' otf�er than fhe"owner", I certify fhat I have obtained a capy of fhe above described document and promise in govd faEth ta
u n
deliver it to the owner prior to commencement. �
� CONTRACTQR'SIQWNER'S AFFtDAVIT: 1 cert#fy fhat all the infortnafion fn fhis app}icatlon fs accurate and fhat all work ;
�will.be done in campliance with all applicable laws regulating construction, zoning and land development. Applicakian is "
hereby made #o obtain a perm4# to do work and installation as Indicated. ! certify that no work or instailatian has `�
commenced prior to,issuance of a permit and fhat all work wiil be perfarmed fo meet standards of�'all laws regu}ating �� �
construck#on, County, and City codes, zonfng regulatfons, and land development regulations in the jurfsdictian. I also �I
certify fhat 1 undersfand that.the ceguiations of other government agencies may apply ta the intended work, and �hat 4t is ��
my responsibility fo identify what actlons I must take to be in compliance. Such agencies include but are not limited to: �,
� ` , Department of Environmentai Pratection-Cypress 8ayheads, Wetland Areas and Environmentally Sensitive ;
, Lands, Water/Wastewater Treatment. j;
� - Southwest� Florida Water EUlanagement Dfstcfct-Welis, Cypress Bayheads, Wetfand Areas, Altering $;
, • Watercoutses. '`
; - Army Cotps of Engineers-Seawalls, Docks, Navfgable Waterways. � �
� - �Deparfinerit of Health. & Rehabilifafive Services/Environmenta# Nealfh Unit-We(Is, Wasfevirafer Treafinent, €
' - Septic`Tanks.
- US Ertvironmenta#Pcatectian Agency-Asbesfos abafement. �
• - .� � Federal Aviation Authority-Runways. ,;
1 understand that the followfng restrictions apply to#h�use af fill:
- Use of�II is riat allowed in Fload Zone"V"unfess expressly permitted. � �;
- !f #he fiii materia! 4s to be used in Flood Zone "A", it is understood that a drainage plan addressing a ��
"compensating volume" wiii be submitted af fime of permitfing which is prepared by a professianal eng�neer
• � licensed by_the State of Florida. �s:�
� �� - 1f the fill rria#erial is to be used�in Fload Zone "A° �n cannection with a pe�mitted building �sing stem waEl ` (
• � � const�uction, i certify that fill.will be u�ed only to fill the area within the stem wall. ° I
� - � 1f fill material fs fo be�'used In any area, 1 cerfify that use of such fill wil! not adversely affeck adjacent �
prop,er#ies. >If use af fill is found to adversely affec# adjacent properkies, the owner may be cifed for 'violafing �;
the conditions aF the building permit issued under the attached permit application, for (ots less than one (1)
, acre which are elevated by fiil�, an engineered drainage plan is required.
if I am the AGENT FOR TNE OWNE12, I pramise in good faith to inform the owner of the permitting cohditions set fvrth in
khis affidavi# prior fo commencing consfrucfion. t undersfand fhaf a separafe pert�if may be required far electr�cal u+ork, ;
plumbing, signs, wells, paols, air conditioning, g�s, or ather�installations not specifically included in the applicatian. A '
,permit issued shall be cons#rued to be a license to proceed with fhe work anci not as aufhority to violate; cancel, alter, or $
set asfde any provisions of the technical cades, nar shall issuance af a permif prevent fhe Building�fficial frQm fhereaffer ;
requiring a correctlon of etrors in plans, construct3on ot violations of any codes. Every permit issued shall.become invalid �
unless #he wark aufhorized by such permit is commenced within six monEhs of permit issuance; ar if work aufhorized bY k
the permik is suspended or abandQned for a period of six(6) months after the time the work is commenced. An extension
rtiay be requesfed, in wrifing, from fhe Building,C?f�#cial for a period no# fa exceed ninefy (90} days and w�ll demonstrafe `
Justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned. ;
WARNING TO OWNER: Y FAILUR � RECORD A NOTICE OF COMMENC MENT RESU�T iN UR
— PAYiNG-TWICE FUR-iMP V __ENTS t7_ OUR PROP RTY. !F YOU lNTEND OBTAI INANCING, C SULT `
WITH YOUR LENDE A A O E EFt?�RE CORDtNG YOUR NOTI QF"C ENCEMENT�- ----� �—` —
�lOR1DA JURAT �.S.1
OWNER�OR AGiEN CONTRACTp �
Su d and�swo r a e, � f�1thi,s ` ed an swo r a d e me th '
Y �y �Y �
are ersanally known m has/have prodUced � are personaliy known k or has/have produced
/ as lden8flcatlon. �I� as fdentlfication.
' � � �_��� Notary Pubtta !
, Nofary Publfc
` om ion N�'�"�::pu�
m ion No.K g * � * MY COM�!lSS10N�FF t506o6
_-.. � ,�o�,.•..��, JACQUEUNEIIVACDEZ
� L 18
�t Name ot tJotar� ����?A�1�13,209$ Name af Notar�'► f �`�r���d ru u abryServlces
.�;::�:f; �r�aFF��g.�°! �BondedThruBudgetNo�ryServices
�`�:"{� _ - , �
�:�.�,,. . _ I