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HomeMy WebLinkAbout16-18014 CI'i'Y OF ZEPHYRHILLS 5335-8th Street ($13)780-0020 1$014 E�ECTRICAI. PERMIT ' PERMIT INFORMATION LOCATION INFORMATION Permit,�:18014 tssued: '[2I19/2016 Address: 57�0 & 5742 APP{�L�O ST Permit�ype: ELECTRICAL MISC ZEPHYRHILLS, FL. ` Ciass of Work: ELECTRICAL MISC Township: Range: Propos�d Use: NOT APPLICABLE Lot(s): Block: Section; Sq. Feet: Est,Yalue: Book: Page: Cost: � 1,sao.oa Totat Fees: 45.00 Subdivision: TREE LANE VILLAGE Amoun,t Paid: 45.00 Date Paid: 12/19/2016 Parcel Number: 10-26-21-0000-00100-0000 i CUNTRACTCIR INFORMATIQN QWNER INFORMATION Name: I JIM'S ELECTRICAL SERVICES INC Name: TREE LANE LTD C/O TEMPLE TERRACE Addr: 18302 EASTWYCK DR Address: '10912 N 56TH ST TAMPA FL 33647 TEMPLE TERRACE FL 33617-3004 Phone:�(813 810-4079 Lic: Phone: 1Ncark Desc: REPLACE POLE METER AND PANEL � APPLIGATI4N FEES E�ECTRIGiA�FEE 45.00 I � � INSPECTIONS REQUERED RQUGH E�ECTRIC CONSTR CTION POLE PRE-MET R ���%r� FINAL i � ,� C.'-�'` ; a1� _ i � � E � REIN PEC7'ION FEES:(c)With respect ta Reinspection fees will comply with Flarida Statufie 553.80 (2)(c)#he locai government shall impose a fee of four times tlte amount of the fee impased for the initial inspection or first reinspection,whichever is greater,for each such subsequent reinspection. lVOTIC�: In additian to the requirements of this permit, there may be additional restrictions appiicabfe to this property that may be found in the public recards af this caunty, and there may be additional permits required from other governmental � entities such as water management, state agencies or federal agencies. "Wa;ning ta awner: Your failare ta recard a notice af cornmencement may resnit in your paying twice for impr' vements to your property. If you intend to obtain financing,consult with yaur lender ar an attorney ; before recording your natice of commencement." Compl' te Plans, Specificafiions and Fee Must Accampany Application. All wark shall be per�ormed in accordance with City �� Codes and Ordinances. � i I � i i � CONTRACTOR PER OFFI PERMIT EXPIRE5 IN 6 M4NTHS 1NITHUUT APPR4VED INSPECTiO CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PRCITECT CARD FRBM {NEATHER � a7�-�aaoo�o City of Zephyrhills Permit Application Fax 813-78p-0021 Buflding Qepactment I . . Data Recetve f�r., ! � �,.� � - ,G7�� •.� � . � : Rhone�Gontaet.for-=Pert»ittin �'. � �j�"' ... ;.. _ ,. . Owner's Narn , f 2-� �`"� ���� tlwnar Phane Nlumber . Own�r'sAddr�ss 1•�/l�' �� S''�" �'�"`�f� ��"�a� ` �Ow�erPhone,Number � � Fee Sim le Ti ^ , —•i ' � ; , . p leNolder.Name •� � ` Owner Phane Number ` , _ :,.,•� . � - . � v • Fee Simple T�eholderAddre�a � - - J08 AdD{tESS �� �"" � / � .�V a ' � S L01'# C�� SUBDIVEStO lT re°e. ��. ' .� • PARCEI:iD# .` - _ . , , (OBTAINEDF.RqM.PROPERTY,TAXNOTIC@) . WORK PROP SED Y:NEw CONSi'R' ADDlAI:T Q� SIGN' 'Q [� �DEMOLISH , >er INSTALL �t ,.,,�.REPAIR . . PR{?POSED: S� _ ~' :Q • 3�R. � COMM . C� -QTHER TYPE OF CC1�3TRUCTIOPI'� [�� �r":BLOCK r Q FRAME " C�' 'STEEL "[� - ,: ' �/� t� DESCRiP110 OF WORK' �e¢`"�, ��I-�y l''1 e.�+e.�-- � bc� ay�-f BU1t�DIt+IG'S! E'' � , . . , . �] . �'�` 1`SC4 FOQTAGE�: , . HEIGHT,: � 08tlI !NG �_�''`� , _ . � _ � �. {" � VAl.UATtON�t}F'TO`fAl-Gt)NSTRi:#G'CtON L... . �J Ei. CTRICAC $ ��� AIUIP SERVICE ..: ;Q " Pf20GRESS ENERGY [� W.R.E.C. QRL I MBIt�G � :$ ,. ' l� ,. , � '' ' ' ' - � 'bV QME HANICAL $ " � VALUAI'lONOF;MECHAiViCALlt+tSTALLEtTit?I+i. � [�GA{ � , ROOFING t[�. ;, SFEGI/#1,7Y,.�:�.-..OTl1ER, „- ^ FiNI$HED Fi.�OR ELEVAYiONS � FLOOD ZONE AREA ,QY�S. ,NO II .. . .,.. • , .. �,;:,.; .;, _ . � , I �,,. ,.�:. .,i. �¢a� BU(4�ER CGlVIPANY`` � . `'::� -_ . - � � SIGNATURE - REGISTERED Y/ N . '{`'FEE CURREk"' ` "�Y/>N `"' : ., : ,qv �`=K ' -.�::i,k".. `i';+ '..� Address' . - - s.: �°: �.,� . . ..�; � .,, r�Et nse� �' � �; �e #? ��� ;�ti�" � . ',5.,: Jj „- i I-.;. .�; .,, �. . , v.:` ..: f . �..� '- .. ,.1 �� ELECTRIC; ...St,-�: =� , -?GdliAPANY Y ;.>;x�`�'`�=-��:�f'�`-;�"�-�.� � - ., _ -= SIGNATURE � � RECaI$TERED Y/ N FEE�eURRe��-� " ;k'Y/'N-- . ` � , . � , _ _ _ . _ :. �� � � . -�,.� - Rddress� t -�"" ���'t�'.���cl�._�7'�.1� �: '•C - °�`� _ � Es-�;J r,;G;;.�;,l.tcense,#� ��t�� _ �"� . :�,.. .r� 4'.. � v -' v. - , ,.: - ` . � c . PLUMBER � ' - - 4�� � . SIGNATUREz � ., , ., -., ,. - . C.OlI�P;ANY , � ��._._,,:�-; , .x . r,�._�,. :�- ::,� r... �� ; 'REC,yI^aTERED ,.Y/„N>• i;,: „NF�:cu�n:•, , Y.�/.N,. Address, - , ,y ` ` ' ,`ClcBnse�#r N: 4,.+ - �: ,r,� � _ ��. - . ...:.. , . ..... . . .. .. ; •: ,. _ - a''.'` :pr:�.. MECHAMIG ` . ,� • . , �.. ., . ' COMPANjI„ � - , . �; / - . StGNATURE� .., ;*", , � - , � REGISTEBED Y%,N .`FE� .CURRE�.. . ,. . . . . ,_ � �y./"N: r T , _ �,, . _..sr .,,.., . _ _ta - _�a> 1: .. � — � •. _ ' >r._-. ,. . _, .,� , . At�d[888�� _ ' . 4., � . � � . 11GeflS$#,� `I � � .. .. . _ .. � . �. . , , "4. ,. _ Y�'»:�W..� .� ` OTHER f`" ,,�>c ,��� _ - � ,_ • , _ �;;;.: ;.. , ,_ r._•., ''_ . ' '. '- � .G0,1jtIFANY. .�,..�. . StGNATURE.' ., -;; :4, . .. -� . , � . ,�.: . , ,. ,... "�' �°' 'REGISTEREDp.;,' Y/"fV;.. ;�e Cuttit��' Y/N. ;;;:,,,.. .. ,.._.� .. ....._.. . . - _ ...., . _ , . .. " -� � �. `� . . _. ,: :;, . . . , : Address) ax,:,.,.,.E.,,,..,.,.r, .rn„�a,:.. _ - . ' , ,, + _ - - - .. . . .�., . , :.. . � ..,. . ...;.� _ .. , _ u ._ �,. ,. . •,;s.�<„._, , .,,: r:t�,�_ -�r. _- #<{� , .. - -= a ``'� '+�ic8nse � RESiDEN'il� ;;�Attaati 2 PC_of�Plans � , �., . . �4�-�v.<,..;,- . ,u��:.��..: . ,:.�, .. _ ,.�.t .-.f� . .:. :.:. - , ,r� r. , ,_ ;{_); :�(2)seis_of'Bu�tding�.Pfaiis;('1)set'of<Ener�#y=Farms;'�RA=W�Rer'i'ia!' r-ne�nr co � ,,. ., �{'fa'�. nsttucHori, :> -#;,;:��;�i�lttnimum�.t�en�(1,0)�,wort�tn�;d�ys�;after;'subii�iNel:d'ate:.;Rpquired onsife;'.Construc8on'Pians;'Stdmiwater=Pians w%�S11t Fence�ynstalled, Sanita"FacillUes&�1=dwm ster•=SIte�Work;.Permlt;#orsGtidivlslonsAerge.pro]e "� 'T f - .. _. ' :,; , ry ��..�.,,,4:�.�.rr,,�r:ut,. p. , :., ��.;;�;�:,���=s. . COMM�RC1 � At#ach(3j�cx�mplete'sets'of'Bultdiiig"Flari's„'plus a Ufe Safely Page;{1 j sef o#Energyr Fccros.R-0-{1V Perrnt#�f0��18W CBRStrUGF10tl.- . Mintmum ten(10}working days af#er submittal date.-Required onsite,Construcdan Plans,Stormwater Plans w/Sflt Fence installed, � � Sanitary Facilitles&1 dumpster.S(te Work Permit for all new;prpjects:;All commerGal.fequirements_must meet compliance '" � • .SfGNPERMlT Attac#i{2)setsoEEitgi�eer,edsi?taps:,;-:.=}z:°>'_,°... .. . .. ... . ... . ; ' . '•'"PROPERTY SURVEY regulre�fior all NEW.copstructlan._._. - - Dtr�cttons: .,:r��,�x}. .., . � , • '� Flii out ap Ocatlon oomptetely. Glwner 8 � nhacMr slgn back.of appl(catlon,nata�ized 1€aver�t 0,,�.Na�ce.cf Comr»encement ts rsquieed. (A!C upgrades ovar 57500) - M �� ..,..^:'j,,h;s`S,J�. Agent(farl the oonUacto�)"or`Power`of Atfainey(f�a�the ownerj`would�be someone with natarized letter from owner autho�izing same DVERTHE.0 lUi+11'ER�PERMITilNG_�._.�:_(Front�ofAppllc�tlan-Only} _,___. - - � Reroois If shin�les ,Sewers ^ Servics Upgrades A/G Fencas(PlodSurvey/Foatage) ..... . . ;�� Drivawa -iVot aver Counter if on publlc roadways..r�sat3s ROW i ! ( ., h_. e . - . .. •t) _ NO'n���F DEED.RES.T.RIGTIO S� The under�l ned;,under�tands�th�#,t#�s.} , If.m . -" " ' �`.<,,.��.'��::����-�"` � „9 ,,.�.,, :.4- ,;A�?, .aY;:b�,sub�e,�>�to,Fd„eed;�res�,�ctlons r �.�,.,, ,•-. .�,�.,._� �,a� .,..„.,:..',-..:-�.,..a�-,;,...o:r-' - .•°���.� w�t„ ,t'�:�� - - - .: ..°��.e �;..:?.+��- ..r , �. .. , �. . . � n`d ed���assum .:�..�� �. wrhich may;.:be�mare:r�s�tffctive��th��Coun,ty+��g�il�tfons:}='i'tiek` g ' ��,:.�'�`" ' . . u: er�l ri' es~:ce''sp�ns titllty=:fair coiinplian��:vuithsany` epp!lCable:deedrest�icttotls. �' ;.t�:>f::..•;�,;�- .t� ' -- ' - __. . ._ @_��--�� ,. � --:� ,. t_-: _.._ .. . .. . ___.� ,.,. .�,. , . r .,. � .... . . Y..... .,.�. ....., �7Ni.ICENSED�aG�NTRACTORS���tN�i:CON�RAC70R-RE�POFi�1�t��iTlt�S:��°if=ti�e~ouvne�r'�tias�µtitred�"a�`izi�ti�ac#t�r or contracfors to undertake work;:they:may�be.�rep,trie;ed:�to;,�b�s�ltce��ed�lrt�;aaaordance.wtth;sfat�.and�;lnr.ail�cei ulatla s't�<�If�the-=���'���-:°:�¢ � 9:.._.. tt con#ractoT��ls••not�l"tc:ensed�as-�req�l�itl;tiy law,=6io,tt`�the rown�r ainf�contracto��;may��6��:cfted��.for��='�hisi�errieanor.vtol�tion under sfate law. if the owner.or Intend�d?rc,o:ntr;a�tor��ar'e�:uncertain as:to.what Ilcensimga rsqulre�nen#s�xrin�ay�applj�.�for�'.'the�-:f��z==4��'� �; . ,��._a �3. .�... '. _F,.j._ .. «y...r-._.,.i.:�"°"` "H:f'�Fr:.0 intend�d workf�tFiey ar�i'ad�vlsed`to caritact ttieiP�isco:Co�nty,Buifi!liig;.InspeCtloti�QtYlstol,�la.tCettsltig Sectlon�t?27-847 ..„,�.._,. .:. _ _ � 8009. Furthermoire,if��the own�er'ii�'s�"hlr`eii a ca�iVac;to� or contractYors� he is advteed ta have ;the contractor(s)�,sjgnFKJ,r.:.,.::y;u , �r.� porllo�s•.of the:. cantrackor.:Black..,of,.,thie;.appllcettanafo�:�whlchu,they.:will.,�b��.r,eapon�lble.,�tf:you;�as�,lhe oviin�c ai�n es°the �ontractor;°that�may 6e an indica#ion�tfiet'Fie�=is"nait.�ro�ietiy"Ilcgrise�"�nd"Is—riot entftlsd"to permlt#Ir�g.�►rheileges In Pasca.,_, , hu,:. Counky. rv • _..., . . �_ ' . . ,. . _. .. . .,.__.�.�� �...;.:�:..��rv.,�:.�.� 7Ra1NSPARTATIl�N:IMPACTfUTiLIT1ES;CMl�l4�'���I�6�RE�t���tC�RE�QVEEtY�FEE3.�'T�e un�ersl��ie�ur�derstands thatTranspartation Impact fees,and,Recourse..Recovery_Fees,�mayxapply�to�ti�eY;lconsbvctton;of new butldings,vchange��bf=�Y`�"`��=����� � use in.exisNng buildings,.or��expansi��of-�e�cis�i�g'�bulli'tings. as sper.lfled.in Pasco County Or'dtt�anae number 89-07 �nd, 90-�7, as ame�de{d.,.�;,Th� undei�igned aiso:-understai�ds� ttaat�snch fees,:,as�may����due;;w11FKb�.ident�Eed at the�xtii���af=:�4=��=;;;'�.`;: .: 1r��.,.:, -. tR,_„�w„ permltt(ng. It Is furtfieP under�tood that T�sii�sp�orkatlon Impai�t"�Fee� anit"�i�esource'�Rec:o�ery�Fees�.mu'st be pald prla�to receWing.a�"c�rEi�fcate:af�occupaflcy"�af'fin�power;�etease:��°:If�the.pro�#_�d,oes�not ltavclve�`a�:ce�ti��ite of oc�cupat�ii'y.�?or�E.�';�����`_;' flnal power.�retease;�tF:ie-:fees�rnu�t��tie-paltl,�pci±�t to;permR lssuan'ce. ft��ther�more;°:1f:P�sco,.C.ouniyr�lNat�rr/Sewer:�lmpact��.���.�t:t '� t...;.i �-a�. , . . . . . Y,. fees are due;_they.mustAb�aapaltlnpiloc,to,.pemtlt:lss.uarice;:ln,aaaorclance wltt�:appllcable:Pasco'.=Countyt�arillxtances, - CON��UCTtON�C1EN LaHV(Chapt+a�T18�EIaN'da Statutes�as arn�nd�d): N`valuaaon of work is�2,500.80�ar r�ore;-1���s ����.k: certify that<J, #he..��appllc�ant,:-have�been:provlded �wlthr aL-c�py;.of_`thei�"Florida~Constructton� Llen�:Lav�w--Hom�owner's _. � Protecti�n GuEde"prepared by:ttie"Flo�da Oepsttmer�t�of Agricult�re and Consr�m�rf:/kfCalrs. If the �ppltcant l�.someone;�,...,,•_::.-z< other than the'owner"� I certltyf.th�t�l;have>oF�tainetl�ayaapy;of..#he�ab�ve�des:c�lbed��'ocui:i�enC��nd;p:ro�ilse�:ln�aooa�falth�to .. ., - :�r deliver!t`to:.t6e<',ciwner�'p"riot=ta�oin�riencearient�'.; • � � , . .� � - _,. _. _ : �ONTRI4CTAR'S/OIMNER'�AFFIDAVIT: I.c��#�"y�;tfi�#�ati:,th���lnformatti�na,l��thi��ppllcatlon i� accura#�.�nd thak all work Y,R,.. will'be done in compliance with all.appllcable laws regulating constructlon� zontng and��land`�developm�nt. Appltcatlon,!s hereby made:to obt�ln�:a.permit�,,#i�:.�do�£�wo���and;t�iatal�ation as indt�a#�.d:��4`=1� +certify t�iat no work�or instaltation�fias�' - cammenced p�ior to Issuance of:a permlt��a�nd that�:all �vork wlll be pertormed�to meet-standards-of�>all laws �egula�ing- consbuation, Count� and Glty codes, zoning t�egulatlans� and tand development r.�gul��ons�'in-the�jiirlsdictlari;=��!�al'so� - certify that 1 u�derstand�that the regulatlons of ather�gavernment agencles may�apply:,#a,the:lntended.wark, and th�t tt Is my responslbl#lty#o lden#Ify•what.acttons l,must�take;:,tat be.=ln{corrlpl#�nce a,Suc.h}agetaicles-lncf�de�bu#��ai e:nat llmlted to:_:� - . - Depaztment af-ErnrironmentalF�l�tofection=Gyipress."Bayhead�; VV�lU�ilend Areaa_and Enylronmentally Sensitive . Lands,Wai�rM/astewat�r Treatment: ,,, � i " " ;� � � - Southw�st Flartda V11�ter Man�gement�`::�is#rict:Vldells; '=Cyptes.s.' Bay.#�eads��� 'Wefland� Areas, Attertng . Watercaurses. ,} .`>'-_ - - � ., � � - � , • , • - , ,. :�u - Army Corps vf Engfneers�Seawalls.�Docks,M�v#gatile Waterways. . � - .Departmentr�of;,Heal#h�.,B,;;Rel�abllitat)ve;.�S�rvtces/Ertvitanmen#al:t-F�ealth�Uhit_W�e11.s;=�Vlt�stevitatersTre�tment; Septic':.Tants�:.__ . " _ - � _ _ ,', -�_,. _ - .. � . - US Env�ronmgntal�Prote�tian Agencgr:Asbestas�bafemen�, � $ Federal Avlattun�Autl�o.�lty�;Runways:�. ' I undecstaitd.that:ths:fcltowing;rest�lctlons appiy tiit tFie use of fllt:� � - Use of fl111s�not atlowed in.iFtoo�o.Zone"V"untess expressly permitted. - If the-xflll�material��ls��to'be used�ln.:Flood�2one. "A", (t Is unde.r'sta�od that`a dralnage plan addressing � "a�mpe�sating votume"wi11 be sutiml�ted at#�me of�permitting wttleh Is prep�'ed 6y a professional engineer:. . - � Ilcensed.tiiy;�ltie;�tate of:floflda: � , � . .; .. . . - - tf.th� f111::�na#erfal=ls-to-'�e;us�d tn Flood Tone 'A" in�connec�ion�vitlth�$��termltted bt�lldlt�g using stern uttall., :_. conatruction,;I_cerHfy�th.at#ill:wlll.b:e�used only.to.f111 the area�wlthln�the�stem�wall: � � - If ftll matetla}�Is�`tm tie�u�ed !it any .a�ea; 1 �ae�t(fy that .use. af;such fltf w111 nai.adverseiy aFFect adjacent_ , ' properti�s.r iF�.use:of;fill is�#o�nc��to-adversety;.�ff�ct ai�jaiEent�,pcc�perties,.the owner may be ci#ad for vlotatln�.- - the condl#ion�i��of�the.bullillcig'perrrilt ts�ued.<u�der ttie':atEached,pecmlt�applicatlan'�for.:bt"s�le"s��:thar�:�one (1) acre w1ilcF��ire elevated°tiy fllt,.,��t,engtne�red dralna�e pian 1�reqaired. . If I�m the A�3ENT FOR;TH�01MNER',;I;.promise.ln_goodi_f.alth to Infarmfthe°�owner of�the permitting candftlons setforth In thls at#idavit prfor!a cominencing conshvctlon. �1't�nderstand that�a�s�aparate`peemit may be requ[red for etectrlcal work. . ,. plumbing,,signs, wells�.pooisi.,alt'.conditioning,.ga��; _or:o.,theT instali�ttons not�spec�ically included�in.the�applicatlon. .A,_ - , , �,,� . n . ... .,,_., permlt Issued shall be consfirued to'b"e�a�Ilcense`�to'�praceed wlth tt�e.�viirork�nd��not�as:,au�hoHqr:b:�.vtalate;��cancel,�altery ar set aslde etijr�provi�Eons of#lie:#eahnlcal.c�ade�;;nor shalt Issuance�of a.permit.pr.event ft�Hulldi►ig G#fldsl from theceafter . requlr(ng a correctton�af.�errors;ln,plan�s,.con�tiriictlon oc.vialatlons of�any�cod�is:��-.�very�p�arrr�it�-l�sued`stislF•tiecome�invalid unless the wcirk aiilho�(zec! by such permlt:�ls_co�menEed•uvlthln,si�c��►tor.tths �f�permlt lssuence, or tf vvartc aufhorized by the parmit fis suspended�:or�;sbandoned�for.a;periodhof<six:�B)�mantf�s=.aftei�the-ttme the�wo�k��is com�nenced,. An extenslon � � - . �. may be requested.�In.,wrifing,�ir'om,tFie,'Bullding,Offlclal�for a peirlod•not.to-exaeed'�nine�t�r��(90)"days ai�dvwlllµdemonstrate �ust�iabi�=causs for.�the exte�tsion: if work ceases.far ninefy.{90}cans.�acutive:day.s...the Job�ts constdered aba�doneif. WARNfNG TO QINNERc YOUI�rE.AIUJRE�>TQa:R�CQEtDaA��lQTICE�;Q�,�C,+DMMENG6ME�7'�.#tAY°RESL�lLT IN�YOUR � PAYtNt'�TWIC��I�OR,:iMP!RO�EMEN'�'S•,�t�,,�f�°iUl'��PRC��!ERTY:�,I��YO.U�t��E�i1Ch�T��n8Tl�1N�FIN�pE1N�;'C13NSUL.T , WIT D I� O �1. �Y, OR�1 :a. .FaU _ � , ...-- - - - �toRtc►�..ru��•€:s:=,tt�.o� -, . .., .,., , .., ... .._ . . _,.,. ,u. . _..., � _ : : t �.,� --- ---. __ _.__ .--: � .. .. -. , , �� ' I OWNER C1R AO�NT ,. -. .. _. ., , , �ONTEtAGTOR � 1....%�� _ ..� : , Subscrlbed aad�wom M(or a�lrmed)befar�m�this Snbsaibed'and'svwm�ta{at aflfnnedrb�tOre me t6i� by _b�....'�S`i,,.� I�:�,lac.� , Wtio Islare personally known to;me.or:haalheve,produceesl Who.ls/are:p.ersonally.lcnnown:to;nte.;or.tta�ltesve,p�oduced • " sis t�eiiB�caBon. ` as klentl�c��on. No�ary Pub11c . � Motary Publlc, Gammisslart No: Coinn�laslon.Pto. , ' (Vame of(Vatary typed.Pdnted or atamped Neme of Notary typed,prtnt�d ar st�mped ,.;, a��=aaoozo City of Zephyrhills Permit Application Fex�$13-78Q-Q021 I �uftding Department Date Receive-i � —f���l � ,:;:phone�Contact for�P������ _ B�3_ �/� :� �Owner's Nam' �`e'� �'"""`� v�C�`�.�' Ownar Phone Number ' � � � � ..� ' � �, Owner's Addre�s ° � ���t•."`. S 7 -(�� Owaer Ph'ane:Number� Fee Simple TI le6older-Name � - � O�wner Phane Number '�� � I , - Fee Simple TI, eholder,Addresa � '� � JOB iiDDRE �� � / /`" � £'If� `S �" LOT# �� SU�D1VlSIO I ; ��. ��"`'`'� � pARCE1,iD# ' . WORK PRCPI SED , ._�NEW"CONSTR . ` "� AK'}DIAI:T ��] S1GN NED F�PROPERtY,r�TICE)DEMOGI$H : e: INSTALL B ....REPAIR � : _ PROPt�SED�,SE .. Q - SFR. � COMM .. � � �OTNER , • . TYPE OF COI STRUCTION�"� Q�� { 'BLOCK-." .Q' ' FF2AME � �;C�. 'STEEL' "�J` . ,°,. �. , DESCRIPTIQ OF WORK' � ' " � � � . _. �t11t,DING:S1� E"� � •� �°SQ'FOt31'AfiE L��; ,HEI,GHT;C- �� � ,• ,, - I �,...�. QBtJl�iNG • �� VAL.UATION�tOF:TOTE1l E:G?NS1`R!1{:TION^rv . � ' � _ , • , .. :, GTRiCAC $ ��� AMP SERVICE, Q '�PRO�FtESS EAtEEZGY Q W:R.E.C. [�]Pl:UMSING � . . � � �� - :.� � � `' � - C� z OME liANlGAL $ ` " � '- "\!ALlJATION QF;MIEChlAiViCAL![VSTAL"LATIt?N: , � �" � . a.. , t , . ;r�:, _ ,, � . [�GA Q ROOFIi4G ;Q_ ;, 3PEGIAI�TY,:,..Q_�,. OTHER�; �. � � .� � FIIVISMED FL�OR EI.EVATIONS PLOOD�ONE AREA � QY�S. LNO � .. , '.t ,��,. . .,,...,.�� F:�..- .•ri;�...: BtJF1.DER COMPANY=`= - . -- '`��.,� . , ,_ . � , . SIGNATUR�� REGISTERED Y/ N .° "�;�'F.eE CURtt�•- " Y/�N • Addres� s,: .�� .. ' '`;G: T3�-,, e:Etcsnse;#;,. j( '' f'.,-.,l� 1 a � , _... r�... :.y ,, f..�,. .., � r,";:: ' ' .. ;� .;;,.° , ;�---�:: "'_"'� `-,:,�. :;, :`` �' �i—�-��,. _ �. ELECTt2tClRfit, �;,_j,,,,;_ �2�'----��,.. ,}co�w�a��r��� =�.5.: .--s.,C�%���. �_��:s-�.�..-:�_ . � �.-...._'� �:. �.-.� _ . . SIGNATURE� � REGISTERED Y/ N �E:cu�n�-� '�r y�°.Y/.'N " - • . . , � .. �. (' 4- " =Yr� 1��2= � ,e►ctdre'"s'�� ,1� a;2 ��'�'�`')1�t2 3f?�'' j'�' '`�t- ..r✓ : � ;:�;F.ucense:#�.1:��J3.�. �'J.���� r y�b /� . PLUMBER `.i, • ... , ;� ' . _G�MPANY ,4Y_�,Y.x- ;� ,.:..�,.__,. �_= .,: _�.. SIGNATUREi, �': . . - � , �'`_�GIS.TEREp -. . 'A,:Y,/,:N:s , .,FEe:CUIRREn:; -�Y�/4N� - Address . ' , � . • �,Ctcer,tseY#'±�.�' ' .`: 1 _1�?wp MECM��cai.; . . . . . . + _. -. . coM�ar�r � . ,. . _ , -, ;�, ;� - , . , StGNA7URE� � - �'' �- ' '� ' ' � ' REGI$TERED Y.,;/,N. ' ���cutt�En... Y/�N � y � _ , . - .. . . ;:.:,t;,.;.<, -x .� :, Address: ..fi: ^� . . y �w ;'� . . _- ' - _ . -_ � �tCeiinse#t�'`,,., ,— � � .1 . .�.,-, , , ... , , , , ,� i _.. . �.. . _ ... ,.. . .. - � ,. ., , ._i'� i'FY.�r...�.,1 t�TN�lt :�. .r: � ,_ . ... . _. , ., ... ': � ' �tC0111lPANY " °`�' ' ,"' ;' ^ ,. � ,�::..�. SiGP1ATURE�, ., � r� . _; ,'` - °`� , 'd `REGISTE►�`"; , 'Y/ N:'; ;�E"CURit��• : -Y%N . �i�'!s�< ,F,' :4: ..... .. .... . . � .. . .. .. __ .. . �.l.y.. .� . _ .-. . ,_�. .. .j 1. ' �lddress '�'?�:�i;.:•s`. '.n,:7:7.° ' _ .a � �rt ;.`., S , � �L�C8t18�#"�. ..- - „a.t, a•.,�..'.�,:aa':•,« f,;t�,,t ;;3r;. ' . ,;.�2.. -«,t-y..,,-�,�.,..Fy,-;:T:,.. ;3?s:,.•; ^44�'''air.. R!� /�E '��- `..i•' .�.. RESIQEN71.��sA�;�Attaciii'(2)jP.,lot�Plahs;,(2}sefs;of'�u�ld3ng�Plans;'(1�)set of�Energy=Farms,_R-aW�Pertriif for new�co�stnicNort, „ � _ �-,,:Minimumsten,(>70)�working;dqy,s„after�sabinittal:daf"e.��;R'eiquired Qnslte;:Coiistiuctlon:Plans';Stormwater'Rlans w/Sttt Fence insialled, �Sanitary'Facllltle,s �1;dw�pster-1Slte•Wor4c;Pertnit.fqr;sutidivlslo s/lerge�projec#s;wts��"�,:�i;- ''' ." ' � , � . {. �,.: s&:,�..„,., : .. .., _.. . � .�;F�: �. ; -:�.>:' ' ,, : -. . ,.,;,., � . COfVlM�RCI, y Attecfy{3)Ycisii�t�pfefe�seis'of'8iiltiliiig Plaits"plas'a't:ife Safety'Page;(1}set of Energy Farins.R-O-tIY Pennit�far ne�+.constructtQn.�� .• Minimum ten(10)woridng days after submlttal date. Required onslte,Construction Plans,Stotmwater Plans w/Sllt Fence lnstalled, Sanitary Facllltles 81 dumpster.Stte Work Pertnit,for all new<prajlscts::All commercial tequlrements_must meet compllance :" � .SI�N AERMI Attadi(2)°'sets cf`Eng[neaiedsPla�n.s.t,-:==:':xa�'»-:.- . ,... -_ .. r= I "'•PROPERTY SURVEY require�i f�r aIl NEW canstructlan._._. • � � �Dtiectlon�: .-;sg������,..- ._. - . � - - Fill out a'pllcatlan completely. Qwnar 8i GcntracMr slgn bacic.of applfcaflan.aobarizad !f over �50D�a Notie�of:Cammencement la required. {NC npgrades cver ST500) :. '• ent f� tFie contrd�ctorr'or'Power of Attame 'fur the owner would be�someone wtth notarized letter trom owner autha�zln same � ( � ) Y��.._ _.... . ) � , . OVER THE_G Ut�tTER:.PEl2MITFIt�lG�-.._�_(Front-of-APPIlcatEon-Only)-._-- Reroofs If shi gles Sewers Service Upgrades A/C Fances(Plot/Survey/Footage) _ ,,� __ .V.. ._. _ . ._. ,- , � •,� , .. � �=r.;�' . �,�,�, ,,.. ,.: _..; ,: . ,. Orivswa -Not over Countes tf an publla taadwrays::need`s RO�W' I , } .. . ....� � � , �,�..u-'�.%3 m>`,:,s�:o' NOT1 E 1�►��DEED R�S.T.RICTIO�IS.. Th.e.ti%i�d8r�lgned;under�tands;�:�h�t�thlg;p�tn�lf::��f,a�,subjec�,to�"deed*hrestrfcti�ti's" C ,,.i "'t'i 'rt�. ,:,�:�:;;s>_v ; ,..k ,y ,,r;.�:.r •r>�r�.x :.r�; � w �a:�: ��:�.::.:,wt:.��:,::�a���: whlch may-:#ie,�r"iiore,�r�s�ctl�ie��t#�ai�ti''Coci%ity;:.�g�le�fons:�:�The�uad�rsi�ne.d�assume"s�respons�b!llty�fo�-comp!lance'wlth�ny • a Ilcable�deedrest�ictto�s. �-:�t.y,:::;,;.;�;�:.r::�s;:�'•.,., �� ' - - -- _.�,:�. ., � , � ..,:.,. :.� .. �. _ .:-. PP ...,n ..�.._.,.; . . +, ._ � �� ��;_....t�.__„u... _.,... ,. .�.�,. �,;...r_..r.,.,...._�z �., ?i u.�M.+!�:'::r' IUM�.i�ENSED��COM'1'RAGTARS°ANb CON�ICT�R�dtESPAN�II�ICiT1E�:��If-��e��owner�has�°�lilretl"'�`°i�r�t�aCtor or � contractors#o undertake worii,:they ni.ey,bs,�requiredsta,���v,l,icens',e.�d;inlraccardance:with�state��andX�toc�l:regulat[on.s.���if�the�U:�=��.�=a,=' , ,,.,_.�, , a.... c�ntractor=1��•nat�IEcenseil-as}>reqiafFed'6y lai�r,'tiath�the�oumer�ri`il�co�a�ctor°may``beY ciCed for'�k�rnfi�c!`,ermesnor vlolatbn under state l�v�r. !f'the ovuner ar intend�dfhc�n��tor,�er,e,;tunceirtein�as`tci what,licensln�wr.equlrexnents FinaY'�PP�Yf��fiar�4lie?�,�r=�;#=� intend�d�work,,tHey are;advl"s`eii`to aantact the�=Pasco County Bullding�.inspectt�n Qhiislon,-Llcensing SecNon et.727-847- 80�9. Furthermore, I� the oiivner��'has�'hlrec!'�a cohVacto�'o� coritractors� he is advlsed #o have;the con,rtractqr(s)�rislgnf,j,�r.� e�.,., �;..,5 portions�of fher°cantractor..8tock".af:this�appiic�tian_for;wtttch tliey,_:wllt�,beu�re�ponsible:-.�•>ff:you,,as��,lhe�oameT,si�qn as#he"" „ '. contractvr; that�iay be an lndicatl�n�tfiat�`tie'-1s"not�r'oper�y�llc�nsed antl Is not ei►tltie��o permltfing:priulteges in Pas�a , C�anly. . " � � � � ' � "' � x.ti��:4. ... �_..�� . : ;...�<..-:::... ��:• ..... .... ...... .... . ... . .�..-.-,_-..s::.�.._.,..._.._.. ���:>.�., TRd4NSPt�RTl4T10N�IMPACT/UTlLFTIES�sI�l�+l4��'�Al�b:RE�C1UaCE RECOYERY��FEES:`�The�uritlersl�ri��understands that Transpartatlon Impact Fee�:and:Recc.urs.e.Recovery�Fees�may.app1y:ato:t(�e,�:constructi.an,of new�buildings,:achange�'of c°=A'`��"w=��`� use in eiiisting buitdtngs;�or=bexp�r�sler�r=of�ekie`ti�;g�E�utldings� as'specified.in P�scc�County Otdtnance number 89-07 and 90-07, as amende,d:;-:,�;he under�figned �Iso;�r�nderstands; th�fi'su�h fees,,�s��mayF::;��_d.ue;.�vuitl.abe.identi�ed at the��iine�of`���:�=`:�`Y�' perr�!lting. It 1�hirttier understood that Tta�ispoFtat#on Impacf�Fees•and'��Resouraat�Rec�tii�ry�Fees:,mus#be paid prior to � ,..�r 4 ....�,�.�-�:_.c�:-� rece�ving.a cerf4Rcate-o#°occupat�cy" or,flnal�.pawer.,�ele�se: :I!'°ths.pro�8��.does�rto#�involve�<a�csrti��te of accupartiiy or�,==::;;° flnal pawer.release;�tliie��.fees��inu�t,'be patd_�p�lor to�permlt i��ui�rice. F�kth+�rmorei;:I�:Pas�.,�ounty=;11VaterlS�we��:l�npa�t�-. •ti{h°��:�7 fees are.due;�they:,m.,ust:be�p�idap�.tpr.#o.,permit'�issuance=ln,a`ccordanae:witk:appOcatile�Pasco��County�ardtnances. • CON3'fitUCTtON�i:IEN`t:.AV11�Cfiepter T13�Fior�`da Sta�tutes,as amended): if valuadon of work 1s�2,500.00�,oct mor�,,�l�••��: >:£s;�. certity that:.1� #he„:appllcant,:-tt�ve:;�.�ae�.pr�vldetl:.wi#ti:;a`-coPy°.of==t�e=."Eiori�a=:�onstrr�c#ion-�Lien��,;law--Homeownea�'s Protecttort Gutde" prepared by;tlie'Flo�ida Dep�..rEmet�t�:ot'�Agr{�u{tt�r� and ConsHr�m�r�ktfairs. If tlie �ppltcant is sameo�e�:::....::.::.-:, ther qan th "rnmer" !certl�y_th�+!�.lt�ve;okit$1netl;a�copy.of..#he°��bQve:°d�s�cr1 ed; t ` " p. '.` �{�y,� � til � ! r �t� . .� d�}��ht�i�r{�� ����:,l�'a���:;��lii�`V _ . :�r�� deliver It to:.the�'i'o'wne�:`pi�io�sto�i�inmencem�nl;'`; ` ".� .. - „ - ..._ -� - " ,� � _ , . .. -. +�AIN7'Rd4CT�R"310WNER'S AFFIDAVIT: i.cer�1ly,;tti�t�;�ll�#h��lnf.onnatlen,i��thia appltcatlon is aacurat�.and that all wnark ' will'be done in comptiar�ce with.all.appticabie larws regulating construction� zoning and:�land developm�nt. Applica#lon ls hereby made=#a, obtairi=:a.perm#t,�#a��do�w�ttcr�and�:iitstetl�tlart as inclt�ated:�=-=1� ce�tiry t�at no work�or tnstatlation tias`: - commenced prio� to Issuancc+� of.�a:permtf`aa� tha#�:all work wili be perFormed-�to me�t=st�ndaTds;af:ati I�ws�regutating�. construation, Gounty and Clty codes, zoning regulatians, artd.land deuelopment regiil��ans�tn;tlie:jurtsdictlori:-��'=1-�alsa; - certify th�t I unde�st�nd that the�regulations of ottier�goverriinent agena4es may�apply.:�to.the ointended.work, and that!t is ' my responsibillty to identify�whak'�.actlons I.must�take_,;to be<rin.corrlpliance�.,,Such�agen{cles°include°bt�t�are::not llmtted#a. � ��� - �ep�rtmenf of Er�vir.onmentai>`+hPiafitectlon-�`Gypress:`�3ayhead''s�;`1Netland Areae.and Enytranmentally Sensiti�e L�nds�WateriWastewa#er Treatment. . ,_ - ,. .. __ . - . Southwest Ftortda �Water Managementn:C�ls#rlct-Wefls;`.,Cyptess���Bay.#ieaif�,-,�Wefiand Areas� Attering Watercaurses. , ;:,,.. _�..;� .,:�� ,;.:;.�...� ,:��.. .. . ,. _. - . _ ,., .. . , • Army Corps of Engineei'�'s'=Seawalis�`Dcicks�tVavlga5la 1Naterway�, �. : � - Deparfroent,;of..;�,Heaitha:;,B,.�ReYaab111taflv�z,;Services/Enviironmentalµl��alth=Unit:Wel[s;}�V1lasteviraater��Treafinent; Septic Tanks:.... ' � , _ . ... a . . , - - . ... _ - US Environment�t�Pratec#nn Agency Asbeatas�bateme.n#: , : � .- federel�AvlattoiiAuthoclt�y=,�Rtint�tays:`� ` � � � � I understand.that the=.following:�ceatrl�ctlons apply`fo t�ie use of flll:• ���.� . - �Use of'fili ls not aliowed In;Ffoods�Zqne"V"unless expresely permttted: ' � �• • If the�fiil m�te�ial�is��fo;�b.e vsed;`�ir� :flood Zone. �A*, it 1s under�tcod ihat' a.dralnage plan addres$ing � , . "compe�sating volume"w111 be submtttisd at#ime cf�p.ermifting which is preparad by a professiona) engineer ' - - Iicensed.tiy'#he;.State�of:Flot��: �. � � . . -;. . - - !f 1h� AIF;�material�la#o.bar,used In Flood ?one "A" in�conn�c�ior��wlth�a�permitted bi�ilding using stem wati„ „ ' _ conatcugtlon�ul�certify:that�:fiil:iAr�U:b�-used oniy.to,tll!the ar�a wlthin�the�stem wall: � . � • If flll 'materlal��Is�to �be used�in,any area;. I �ce�tlfy,that .use�. of�:such flll wlll r�ot adversely=affect adjacent x ` properties.....if use of f)Il:is;;found:_to adve"rs�ly;,�ff�ct adjacent�jper�perttes�.the awner may be clted far viol'attng; , the�condt�ons:af-the biaiiiding��jierrril#-Issiied=u�de�tFie�'attaofied,.�ermit`�ppticatian, for°�lots��.less�th�n_one (1) acre viilif+cti.ers elev�t+scl��5y t!!t;a�t engineer�ed dralnag�ptan fs required.. .. � If!�m the AGENT.FOR TH�:;AIAfNER�;:l�:pro�i7itse,ln,_goodafalth#o Infortr��#tie.owner.af-the perniftting condltlar�s sef-forth ir� thls atfidavit�p�lor to commericfng.constructlon. �r;u�;a��e��a m�t��a�iper�te:permlt may be requlred tor eleotilcaF work,.� , . „ plumbing,,.signs, weiis,.poolsi.air=.conditioning,:g�s,�_,or:other lnstall�`�l+�ns nal�speciflcally lncluded•tn.the applicatton. �A . . permtt issuei!shal! be cot�sfirtied to`'be�a`i ii:ense��to�pt�cee d w i t t t"�e�war k an i l::n o t,as:au#h o c ity;t o:v io lete;,c�nce t, alter, ar , seE asfde'ar�y�provlslons of ttie.tecl�i�lcal:c:�d�i�;;nor�hatl lssa�rroce°of a,permtt.pr.ev���--�=�uEldtrig t?#ficialfrom thereafter requlrl�g�coereollon:af:;ecrors;ln=plans;�consti�ilctlon..or v!olatlar�of-any�codes:�:�very�p�mtif�lssued sliailFtiecome�lnvatid unless the work�uthorlxei� by such permlt>�s.commenced�wlthtn,$[�t,,Rnonths of�permlt lssuence, or If work authorized by � the penntt is.suspended�oc�.ebandoned;for:a;perlod,nf�slx•:{�)�inonti�si:.ef#et`the tlrne the�wor�k��ls commenaed. An extenstarr may be requested� in.,w�tirig;..fcom.tFie;Bulldtng,l�ffici�l�for a peridd�nat�.to exce�tl`�ninetjr.�(SO)"days-e�idyw111~demonstrate )ustlflabte ca�se for.�#he ex#ensfo�:� If work ceases;for ntnepr.{90}cons.ecutive:day.e...#he Job�is,considered aba�donei3.� . WARNING TO O1NN�R: YOUR.,FAIUJRE�TQ.,.:RE�:O�tQ:A��G�;IGE:+QF;�GC�MM�MGEMEfi�'F'..NfAY�RESU�T IN�°YCtUR `� PAYINQ TW10E.:FOR.1lIA_�tOVEMEN��•.Ti�:�YOURi�PRC�lREIi�TY:���l�°:YOUxIN�`�EKID'�Tt�r�6H�•''I�IN"�F1NiI�I�1�1N6;�CONSULT _ f ,, },. , �� .r .-�� . - - . ..,.: .. : ...,,, . . .;,., ..::: ;:::.:-,:�.. .,,..,.., .... F�.oR��A,�ta����4�.�-��:4r..��}_ = - : ._�_.LL.. -.. ,_._.., . . OWN�ER OR AtiENT . ' CC�M'RAt�TOR � .Ir�- �` " � 5uhsal�ad and awom to(or�f�n»ed)befor�tt�e thls Stabsdibed�nd'awam•�{+ri�'afllrm b " `ma�@it� , . by .:•by....����- `I��_ef�. :. , •: W#io tslare perscnattyr knovm.to•me.or:hssthave.pr!�dur.ed Who:islere p.ergon811y.�Cnoam�h�.m.e.:or t�aaThav,e:prodiaced• .. . � " as!d"entlfl`s�8+pn. ' as identtfrcaUon. , r Not�ry Publlc , . Natary Publla Commisaton No;t Gomr�lealon�tda, Name ot Notary typed,pdnted ar aGamped Nams ot Nctary typed,pdMed ar�mped ,