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HomeMy WebLinkAbout18-19997 CITY OF ZEPHYRHILLS i 5335-8TH STREET (813)780-0020 19997 BUILDING PERMIT PERMIT INFORMATION LOCATION INFORMATION Permit Number: 19997 Address: 39418 KENNEDY AVE Permit Type: RE-ROOF ZEPHYRHILLS, FL. Class of Work: ROOF REPLACEMENT Township: Range: Book: Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: Subdivision: LINCOLN HEIGHTS Est. Value: Parcel Number: 12-26-21-0280-00000-0470 Improv. Cost: 7,500.00 OWNER INFORMATION Date Issued: 7/20/2018 Name: DAFFRON ELIZABETH Total Fees: 80.00 Address: 12222 KELLY LN Amount Paid: 80.00 THONOTOSASSA, FL. 3592-2752 Date Paid: 7/20/2018 Phone: (813)369-1285 Work Desc: REROOF SHINGLE CONTRACTORS APPLICATION FEES SOLUTION SOURCE ROOFING REROOF RESIDENTIAL 80.00 � G i eke DRY IN ROOF INSP Ins ections Required F PE JOINTS ROO, IN�P�a�l� 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,whichever is greater,for each such subsequent reinspection. NOTICE: In addition to the requirements of this permit, there maybe 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. "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." Complete Plans,Specifications Must Accompany Application.All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE C.O. dNTRACTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Receivgd i / Phone Contact for Permitting — rr-r Owners Name Elizabeth Daffron Owner Phone Number 813-369-1285 Owner's Address 1 12222 Kelly Lane Thonotosassa FL 33542 Owner Phone Number Fee Simple Titleholder Name I Owner Phone Number Fee Simple Titleholder Address JOB ADDRESS LOT# 47 SUBDIVISION Lincoln e' is PARCEL to# 12-26-21-0280-00000-0470 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED a NEW CONSTR eX ADD/ALT = SIGN = = DEMOLISH INSTALL REPAIR PROPOSED USE ® SFR = COMM = OTHER TYPE OF CONSTRUCTION ® BLOCK = FRAME = STEEL = DESCRIPTION OF WORK Re-roof with 18SQ of GAF shingles and undeda ment on a 1 story,3/12 pitch roof BUILDING SIZE SQ FOOTAGE 1352 HEIGHT 11' =BUILDING $ 7500 VALUATION OF TOTAL CONSTRUCTION =ELECTRICAL $ AMP SERVICE = PROGRESS ENERGY = W.R.E.C. =PLUMBING $ / =MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION '�r qGAS X ROOFING SPECIALTY OTHER = 0 0 0 FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA YES NO I1 1 lJ� BUILDER rE brl 5vur� SIGNATURE FEE CURRE< Y/N r Address QLicense# CCC ELECTRICIAN SIGNATURE FEE CURREA Y/N Address License# PLUMBER SIGNATURE REGISTERED I Y/ N FEE CURREN Address License# MECHANICAL COMPANY SIGNATURE REGISTERED Y/ N FEE CURREN Address I License# OTHER COMPANY SIGNATURE REGISTERED Y/ N FEE CURREA Y/N Address License# 1111111111111111111111111111111111111111111111111111111111111111111 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 Plans,Stonnwater Plans w/Silt Fence installed, Sanitary Facilities&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,Stonnwater Plans w/Silt Fence installed, Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance SIGN PERMIT Attach(2)sets of Engineered Plans. PROPERTY SURVEY required for all NEW construction. .�1 I. l 1 1�1 ! I I I J I I r r Directionis: Fill out application completely. Owner&Contractor sign back of application,notarized If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500) Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/Footage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OFDEED S: The undersigned understands that this permit may be subject to"deed" restrictions" which may be mpre restrictive than County The p�sjL1mes__responsibilityfor compliance with any i ipp�o������n is-trn�mna. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner ha's hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state arid local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for o 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—LicensingSection at 727'847- 8009. Furthermore, if the owner has hired a contractor mrcontractors, he is advised to have thm-um o\ sign portions of the "contractor B|ooW' of this application for which they will be responsible. If you, as ttle nvvnar 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. CONSTRUCTION LIEN LAW(Chapter 713, FUorida Statutes, as amended): If valuation of work km$2.5O0.0Omr more, | certify that |, the appUoent, have been provided with a copy of the "Florida Construction Lien Law—Homeowner's Protection Guide" prepared bvtheF|ohdaQopartmentofAuMcultun* andConaumer/Nfoina. If the applicant iasomeone other than the^owner". | certify that lhave obtained a copy ofthe above described document and promise |n good faith bo deliver itbm the^cmvner"prior tocommencement. - CONTRACTOR"SIOWNER"S AFFIDAVIT: | certify that all the information in this application is accurate and that all vmod« will be done in compliance with all applicable |axma regulating oonatruction, zoning and land development. Application is hereby made to obtain a permit to.do work and installation as indicated. | cmrtKy 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 |axvo regulating 'construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also modifv that | 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 bobe|ncompliance. |flam the AGENT FOR THE OWNER, l promise in good faith tm inform the owner of the permitting conditions set forth |n this affidavit prior commencing construction. | understand that separate permit may be required for electrical xwork, plumbing, miQna' xmaUa, pools, air conditioning, 8oe' or other installations not sped,ifically included in.the application. /\ permit issued shall be construed tobem license bm proceed with the work and not asauthority to violate, | alter, 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 vvod« authorized by such permit is commenced within six months of permit issuance, or if work authohzed by the permit im suspended or abandoned for o period mf six AO\months after the time the work iocommenced, Aneudanoion may be noqueobed, in xmding, from the Building Official for o period not to exceed nineb/(9O) 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. OWNER OR AGENT CONTRACTO ' Subscribed and swomm(or affirmed)before methis SubscribedJsw Who is/are personally known to me or has/have produced Who isf e personally known to me or has/have produced 4 C\0_4_4� as identification. as identification. Notary Public IAU� §yr� Notary Public * Commission No 12] Name of Notary typed,printed stamped, —me of.N � F�udaEil3Ka ^ Z,6-2 D— OT70 ma7cto ova •`off Dom tea: _ FtoC;c�o. 4rof_ �r� ao •cF�ut+tDfcB�Ue►�y�eresrgta�tii>�mopn�wuae�ana�d�tesoratpmp�y.�tTncm�ofc�''�� - '.• �« coo.• � �9 - iePJaFdC4§tU�JAla�af�C �m µ �� !. oi�O�P•YCettdto�lfoeSd�l3+k� '' �` N t9 tD gyp. StRslAdd CD ? . co 2 G`estifdiittttfet:et c•. M N 3. aVR�erhriannoi'Le�e�usr.�f�me'1�oia�Arg - -{� _ CW t:�cadiisPteps n • t4�mmib58flr�pteltt,�zdder: (lidm�mE&c[tsOMCier �• � — 4. ON-dw-�t +fir aorel�onePmr - .. Is, seer. , - rat • . - Ad4ta�s - Ar�a:al4cYBmut v Gto: lbift • ASdtts't . . - - � trc��eiiTePio: T. 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O ARE 3e0 E,o WepF u»I -t Z'OIG? �ANA LL LT Pt 9 NYWAZORNpA 9=29 Izl _UI Q Q Z coum NATASHA A.R.ANSBURB50B G —crlas�t•AUHutti�d v- O U a � MY COMMISSION#GG04 E7tPIi;ES:JAN 3D,2021 tU <n <L u.t b*ist shft Imutm Q i—''y a is�Btat�aecdwsta� abetmesnetf -+t�so��� �+1 > rn�z ~ a fh , m ffi -One dstsfhatty,eg.4N-* PA Pwtai�hv�+etL�98picdix�dld � t�v �. � Type dl aftedwPrsivatd ,— — NaMe(PdnS► . dO PRULP S.0'NEIL,Ph.D.PR6C0 CLERK & comPTROLLER _ t 07/17/2018 10:45am 1 of 1 OR BK 9757 PO 3349 CO l 'd 49E0 ION - . •' • • � Wb'!1 �/ ?l�iZ •1° •�ey� 1 CONTRACT# 00941471 MAN LOWE'S AUTHORIZED REPRESENTgTIVE NUMBER. CUSTOMER L01 IT to 15.�/-Z 6u. EI,Zabf STORE NO. STREET ADDRESS STREET ADDRESS I13.1s,1I3 -79zr b 43kd 394IS kr_k1 c!4. f4VC CITY STATE ZIP CnY� 1�5 STATE ZIP I1 , �, lls �L 335y/ TELEPHONE l O G U TELEPHONE p DATE - LOWE'S CONTRACTOR LtOENSE NUMBER CASH BANK LCC REG 6 Z Zvr 1 CGC15OB417 CARD CHARGE INSTALLATION STREET ADDRESS CITY STATE ZIP S Q ME 45 A 606t t L°L­�S will w.OvC hr^ti( �'w r X,✓i uvfj^' o ,!f ,✓iT1Qlr (4F jl✓` ba/l ,n C Loy,, to {1 - gdAx3,v-t �h Ircita NOTICE TO CUSTOMER—'PRICE CALCULATIONS: In-order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the measured square footage of the Project Area.As a result,the parties agree that the lump-sum Price stated in this Contract is calculated upon both the.value of estimated Goods required to fulfill the Contract(including waste),which may exceed the actual square footage of the Project Area,and the labor which maybe estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not be refunded once the Installation Services are performed. NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet Renovate Right.By signing this Contract,Customer acknowledges Contract Total having received a copy of this pamphlet before work began informing Customer * 7i 579 of the potential risk of the lead hazard exposure from renovation activity to be applicable taxes included performed in Customer's dwelling unit. NOTE: If rotted wood-is discovered during installation additional charges will apply. You will b#:given a quote and a change order must be completed and signed by-the customer for any additional charges. Customer must initial. 'Any work or material not specified is not included in this contract.Any changes or additionsmill be at an additional charge for the material and labor. NOTICE TO OWNER: — ACCORDING TO FLORIDA'S CONSTRUCTION LIEN LAW ((SECTIONS 713.001-713.37, FLORIDA AND STATUTES),THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS SERVICES AND ARE NOT PAID IN FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY:THIS'CLAIM IS KNOWN AS A CONSTRUCTION LIEN. IF YOUR CONTRACTOR -OR A SUBCONTRACTOR FAILS TO PAY SUBCONTRACTORS, SUB-SUBCONTRACTORS, OR MATERIAL-SUPPLIERS, THOSE.PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FOR PAYMENT, EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN'FULL.IF YOU FAIL TO PAY YOUR CONTRACTOR,YOUR CONTRACTOR MAY ALSO HAVE A LIEN ON YOUR PROPERTY.THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR, MATERIALS,OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR MAY HAVE FAILED TO PAY.TO PROTECT YOURSELF,YOU SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE,YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN-RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS PROVIDED TO'YOU A"NOTICE TO OWNER." FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX;AND IT IS RECOMMENDED THAT YOU CONSULT AN ATTORNEY'. PHOTO RELEASE:Customer grants to Lowe's and.Low e%employees and independent contractors the right to take photographs of the Premises where Installation Services will.be performed and all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's to copyright,use and publish the photographs in print and/or electronically,and agrees that Lowe's may use such photographs for any lawful purpose;including,but not-limited.to,marketing, advertising,publicity,illustration,training and Web content.By initialing,here,Customer agrees to the foregoing. [Customer to initial to the left]. .Work I to cammg�ce upon reasonable availability of Contractor-andior any special ord or cu tomer made Good(s)which is anticipated tube L✓ V'''' .3� (n4q S ' {fill in date]. Estimated completion date is- -l.i, f�•^ 1 1'"'or+42 [fill in date]. Said estimated substantial completion date is aot of the essence.A statement of any contingencies that would materially change said estimated substantial completion date is as follows: .r2§k StatPl$QFlt'QfcEr�O gencieS).- This`Contract provides that all claims by Customer or Lowe's will be resolved by.BINDING AR131TRATION.Customer.and Lowe's GIVE UP THE RIGHT TO GO TO COURT to enforce this Contract(EXCEPT for matters that may be taken to SMALL CLAIMS COURT).towe's and Customer's rights will-be determined by a'NEUTRAL ARBITRATOR and NOT a judge or jury. towe's and Customer.are entitled to.a FAIR-SHEARING.-But the arbitration procedures are SIMPLER AND MORE LIMITED THAN RULES APPLICABLE IN'COURT.Arbitrator decisions are as-einforceabie as any court:order and are.subject to VERY LIMITED REVIEW BY A COURT.FOR MORE DETAILS:Review the section.titled ARBITRATION AGREEMENT,WAIVER OF JURY L o L-iv; willjc o^o vc ha w,q oil ey)S�grij r4w f,019 L 01—re 5 W, NOTICE TO CUSTOMER—PRICE CALCULATIONS:In'order to properly perform the installation of certain Goods,the Contract Price may include more Goods than actually will be installed based on the.measured.square footage of the Project Area.As a result,the patties agree that the lump-sum Price stated in this Contract is Calculated.upon both the.value of estimated Goods required to fulfill the Contract(including waste),which mayexceed the actual square footage of the Project Area,and the labor which may.be estimated based on the amount of Goods required to fulfill the Contract(including waste). By signing this Contract below,Customer acknowledges receipt of this notice and agrees and understands that the Price includes these costs which may not*be refunded once the Installation Services are performed. .NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamphlet Renovate Rlgft By signing this Contract,Customer acknowledges •having received a copy of this pamphlet before work began informing Customer Contract Total of the potential risk of the lead hazard exposure from renovation activity to be *applicable taxes included ,performed In Customer's dwelling unit. • NOTE: If rotted wood is discovered during installation additional charges will apply.You will be,given a quote and a change order must be completed and signed by the customer for any additional charges. � . Customer must initial. *Any work or material not specified Is not included In this contract.Any changes or additions will be—anaddiflonal charge for the material and labor. NOTICE TO OWNER: -ACCORDING TO FLORIDA'S-- CONSTRUCTION LIEN.- LAW (SECTIONS 713.001-713.37, FLORIDA STATUTES),THOSE WHO WORK ON YOUR PROPERTY OR PROVIDE MATERIALS AND SERVICES AND ARE NOT.PAID IN 'FULL HAVE A RIGHT TO ENFORCE THEIR CLAIM FOR PAYMENT AGAINST YOUR PROPERTY.,TH18 CLAIM IS KNOWN AS A -CONSTRUCTION LIEN. IF YOUR. CONTRACTOR OR A' SUBCONTRACTOR FAILS TO PAY -SUBCONTRACTORS, SUB-SUBCONTRACTORS;OR MATERIAL SUPPLIERS,, THOSE PEOPLE WHO ARE OWED MONEY MAY LOOK TO YOUR PROPERTY FORPAYMENT,EVEN IF YOU HAVE ALREADY PAID YOUR CONTRACTOR IN.'FULL.IF YOU FAIL TO PAY YOUR CONTRACTOR,YOUR CONTRACTOR MAY ALSO HAVE ALIEN ON YOUR PROPERTY.THIS MEANS IF A LIEN IS FILED YOUR PROPERTY COULD BE SOLD AGAINST YOUR WILL TO PAY FOR LABOR MATERIALS,.OR OTHER SERVICES THAT YOUR CONTRACTOR OR A SUBCONTRACTOR.MAY HAVE FAILED.TO PAY.TO�ROTECT YOURSELF,YOU.SHOULD STIPULATE IN THIS CONTRACT THAT BEFORE ANY PAYMENT IS MADE;YOUR CONTRACTOR IS REQUIRED TO PROVIDE YOU WITH A WRITTEN RELEASE OF LIEN FROM ANY PERSON OR COMPANY THAT HAS-PROVIDED TO*Y0U A"NOTICE TO OWNER. FLORIDA'S CONSTRUCTION LIEN LAW IS COMPLEX,AND IT It RECOMMENDED THAT YOU CONSULT AN ATTORNEY. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees and independent contractors the right to take photographs of the Premises where Installation Services will.be-performed and all mork performed at the Premises related to this Contract,and irrevocably grants to,Lowe's all right,title and. interest in and to the photographs for use in all markets and media,worldwide,in perpetuity.Customer authorizes Lowe's toi.copyright,use and publish the. photographs in print and/or electronically,and agrees that LoWe's may use,such photographs for any 4awfUl purpose,including,but not limited-to,marketing, advertising, publicity,,illustration,training and Web content,By initialing-here, Customer.agrees to the foregoing. )Customer to initial to the left]. .Work 1 to COMM ce on.reasonable availability of Contractor andfor any special order o.F cu tornier made Good(s)which is anticipated to be [fill in date].Estimated completion date is. ' G/14A,- 4-A III-in date].Or Said estimated substantial completion date is not of the essence.A statement of any contingp9cles"that would materially chiifige said estimated subitantial completion date is as follows: if appllcable, insert&;stat9meet-of skA<*ntingencies). This Contract provides that all claims by Customer or Lowe's will be resolved by.13INDING-ARBITRATION.Customer and 1_6wi0s'GIVE UP THE RIGHT TO 60 TO.COURT to enforce'this Contract(EXCEPT for matters,tMt maybe taken to SMALL CLAIMS:CdURT).Lowa.!t-and Customer's d",will-be determined by a NEUTRAL, ARBITRATOR arid:NOT a judge or-jury.Lowe%i and Customer-are enffqed­to,a*FAR-.HEARIN.G.-,But.the . ..procedures.are SIMPLER AND.MORE LIMITED THAN RULES APPLICABLE.IN COURT.Arbitrator decisions areas•errforceabie 4.s any court order and are.subject to VERY LIMITED REVIEW BY A COURT.FOR MORE DETAILS:%Review the section 111:16d'ARMTRATION AGREEMENT,WAIVER OF JURY TRIAL AND WAIVER OF CLASS ACTION ADJUDICATION found,In the Terms and Conditions of-this Contract. DO NOT SIGN THIS CONTRACT UNTIL CQMPLETE AND YOU.HAVE-READ THE TERMSAND CONDITIONS 0.ONTAIkED'ON ALL PAGES OF THIS CONTRACT..BY SIGNING-BELOW,You ARE ACKNOWLEDGING THAT.YOU HAVE READ,.UNDERSTAND ,.AND AGREE TO THE TERMS AND CONDITIONS'.SET FORTH ON ALL PAGES OF THIS CONTRACT..YOU ARE ENTITLED.TO A COPY OF THIS-*CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S)BELOW THIS ^ DAY OF Lowe's Home Centers, LLC 7 Owner 'OPV Lowe's Au ri d!ae±eA"&# 'Co-owner or Witness Customer 4ckn*wIqcr9e*s;reffeiptof a*true.copy of this contract which was completely rriplet6ly-filled in-prior to Custother's execution hereof.You,the buyer,may cancel this transaction at any time prior to midnight of the third business day afterthe dat6ofthis transaction.Sae the attached notice of caneWlation form forAn explematicin' of this right. 55106 REVA2113 FILE COPY 0 2004 by Low&s.0 Lowe's and the gable design are registered tredernaft of LF corporation. .......... To:City of Zephyrhilis Page 6 of 6 2018-07-18 20:25:50(GMT) 15014210814 From:Solution Source Inc. 01 UTION" :ti.• ° :y S:�t��>fFkoricf�t.icc�n5ecic �•`+ �''� 1� 3":,r, ~' t1 �1vBCentrbl.[7r. ,�i11i'3Yv1't..ESl7}I5t311. '°�. �' "__ `. •(, .. �: .I"{arlt[1'ii}f;i~l.w3;it?b. r�Csa7tncr E;OnErat:Ftfi' '�'-?� .. "':�_ ... ,:•, ,. iF'hcntra 81;::;i���fi3� CC f"'133?4J{1 i (Fri::}01,421,0814. ''.SIGNATURE hUTH RI'TY' .......... FORM F Old TM E 'PURPOSE OF OBTAINING BUILDING PERMIT ... Shawn lemison C C133 ,001 .solution Source RooQ (PrtiniNameHere) (Print Business Nam.q.Herc) ........ do hereby designate the following individual(s)as having the authority to sign and submit applications and related documents for the pw-pose of obtaining building permits under my Contractor Cert'rticate of Competency. I further acknowledge and accept,as a licensed contractor,my responsibility,and liability for each project permitted under the authority designated on this form which supersedes acid repeals all other previously subrnitted signature authorlify forms,•and that nay failure to assume and fulfill said deity may tx -grounds for the initiation ofdisciplinaly action against my contractor's license. DE-91GNA.7TU STG1_ ERS: (X'•LEASE? PRINT): 1.) Sammantha Temison Designated signers irraybet trlrciitrbpravidaxp►operitlentif;catirrnattlre+equertofthel7e;niitaf:ice.7irenntnheraf e i na s_iener t ynot `l'hisoriginaifm• rrtustbe submitted for desihnratingsignatureattthority,yo rsnustreturrthisformw•iththeORIGINAL notary seal to our office. No copiesorfaxes eacce 'e.are happy to-provide this service;howevei,,we're.sprrethe rightto suspend this sezviceatanyRine due toitsabuseor misust shammmison State of Florida,County of W)1_4s rrns� h . Sworin to.(or affirmed)and subscribeii'before me this day of t i1,1 20 by S 1 iit�n�fii`aon whois ersonaIty lrnowna me or who has produced (type of ID)as identification. RY°4* ClNDY ANN EMCH tI f-.1' i r• r � 'i Notery Puh!!c State at Flatida 4: Signature of Notary Public State of Florida Pri'b€t�, Jper WI tram f Notary or t rough a tiao t ( Assn. My Commission Expires, 1 flo-0.e : r€� rr.�rzy o trticrns'ourc:exctrn--c air risCo my-srrliri;iOrrsourr:r::i csin CITY OF / / ® BUILDING ZEPHYRHILLS DEPARTMENT OF ADDITION OR CORRECTION DO ­NOT REMOVE ADDRESS DATE PERMIT f Y7PCJq 6v g� 6- g � 222 7 1 THIS JOB HAS NOT BEEN COMPLETED. The4ollowing additions or corrections shall be made before the job will be accepted. 7AC , DI 1l1' ! It is unlawful for 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 RE-INSPECTION or other material,until the proper inspector has had ample time to approve the installation. OFFICE HOURS 7:30AM-4:30 PM MON.-FRI. INSPECTOR y i M w City of Zephyrhills Ii 4 53358 t"St 1t1 Zephyrhills FL 33542 (813)780-0020 ROOFING INSPECTION AFFIDAVIT Permit No.: Jq 29 -7_ I, 5hawrh t earl licensed under Chapter 468,Florida Statutes as a(n): Contractor t!Engineer____Architect—Building inspector— License No. ' )` bt>1 On or about did personally inspect the: Check: Roof Deck Nailing_, Dry in V/ Flashing and Drip edge Check which was used: 30#felt Peel and Sticky0ther(List) At the following address f\�j e/1 ne d(y Ap-'-1 &Q4.144 t f[/S -P 3 2— Based upon that examin ,I have determined the installation was done according to the Hurricane Mitigation Retrofit nu Ba on Section 553.844,Florida Statutes). Signature: STATE OF FLORIDA COUNTY OF PASCO Sworn to and subscribed before this day Notary P blic State of Florida °1►RYPUB CINDYANNEMCH W.1" Notary Public•State of Florida ; My Comm1 Comm5sion Expires Jul 0 6,2022 Bonded through National Notary Assn.