HomeMy WebLinkAbout19-21426 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21426
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
PERMIT INFORMATION LOCATION INFORMATION
Permit#:21426 Issued: 6/24/2019 Address: 6377 COBBLE BLISS ST
Permit Type: NEW SINGLE FAMILY DWELLING ZEPHYRHILLS, FL.
Class of Work: 101-NEW CONST/SFR Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 461,076.45 Total Fees: 16,360.19 Subdivision: SILVERADO
Amount Paid: 16,360.19 Date Paid: 6/24/2019 Parcel Number: 04-26-21-0110-00900-0060
CONTRACTOR INFORMATION OWN ER'INFORMATION
Name: LENNAR HOMES LLC Name: LENNAR HOMES LLC
Addr: 4600 W. CYPRESS ST STE 200 Address: 4600 W. CYPRESS ST STE 200
TAMPA, FL. 33607 TAMPA, FL 33607
Phone: (813)574-5743 Lic: Phone: 813-574-5700
Work Desc: CONTRUCT SINGLE FAMILY 4,093 SQ FT
APPLICATION FEES
PLUMBING FEE 352.50 ELECTRI AL FEE 528.75 MECHANICAL FEE 246.75
TRAFFIC IMPACT FEE 1% 36.32 TRAFFIC IMPACT FEE 99% 3,595.68 SCHOOL IMPACT FEE-sfr/100% 7,728.00
SCHOOL IMPACT FEE-sfr/1% 77.28 PARK FEES SF 769.56 POLICE IMPACT FEE 254.00
FIRE IMPACT FEE 273.00 PUBLIC SAFETY 5% 26.35 BUILDING FEE 2,472.00
l
� I
Inspections R uired
F OTER 2ND ROUGH PLUMB mlbu I NS ULATION EI LI N G
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME MISC. MISC.
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.REINSPECTION FEES:
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
"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 and 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.
A� � w " &I f"�*
CONTRAtfbR IGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
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 Received _ — Phone Contact for Permitting 813 363 __ 2891
1 1 : 1 1 : 1 : 1 T : :
Owner's Name Lennar Homes,LLC Owner Phone Number 813.574.5700
Owner's Address 4600 W.Cypress St.Ste.200,Tampa,FL 33607 Owner Phone Number
Fee Simple Titleholder Name I N/A Owner Phone Number
Fee Simple Titleholder Address N/A
JOB ADDRESS 6377 Cobble Bliss Street LOT# 0060
SUBDIVISION Silverado Ranch Subdivision Ph 6,8,9A PARCEL ID# 04-26-21-0110-00900-0060
dam, (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED II./ II NEW CONSTR B ADD/ALT 0 SIGN Q 0 DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR COMM = OTHER
TYPE OF CONSTRUCTION BLOCK 0 FRAME = STEEL =
DESCRIPTION OF WORK Single Family Residence/Pool/Screen Enclosure/Fence
BUILDING SIZE U/R SF 409= SQ FOOTAGE 3255 HEIGHT 2 Story
✓ BUILDING $ VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ G AMP SERVICE ® PROGRESS ENERGY Q W.R.E.C.
PLUMBING $
MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING Q SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES CIO
L� .
BUILDER COMPANY Lennar Homes,LLC
SIGNATURE REGISTERED Y/ N FEE CURREN
Address 4600 W.Cypress St.Ste.200,Ta a,FL 33607 License# CGC1518166
ELECTRICIAN COMPANY Edmonson Electric, Inc.
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address 1034 Skipper Road, Tampa, L 3361 License# I EC13005408
PLUMBER COMPANY Bayonet Plumbing, Heating &AC, Inc
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address P.O. Box 5308, Bayonet, FL 34674-5308 License# I CFC042998
MECHANICAL COMPANY Bayonet Plumbing, Heating &AC, Inc
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address P.O. Box 5308, Bayonet, FL 34 74-5 98 License# CAC058062
OTHER COMPANY KSterling Quality Roofing, Inc
SIGNATURE REGISTERED Y/ N FEE CURREN LI.LN
Address 4211 Shoal Line Blvd, Spring Hil, FL 34607 License# CCC057991
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,Stormwater 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,Stormwater 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,*Oired for all NEW construction.
. : : : : ■
s:Direction ■
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2600,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 gFDEED : The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for:omp}ia 'nce any'
applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors to undertake work, they may bo requiredtoba |icenoedinaccondencevvithotateand \oco| regulagiono. If the
contractor is not licensed as required by |aw, both the owner and contractor may be cited fora misdemeanor violation
under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the
intended work, they are advised to contact the Pasco County Building Inspection Division—Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or oontnmoboro' he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contnyctor, that may beao indication that haio not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction nf new buildings, change of
use in existing bui|dingo, or expansion of existing bui|dinQm, an specified in Pasco County Ordinance numbar8Q-07 and
90-07. as amended. The undersigned also undamtendu, that such feea, as may be due, will be identified ot the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power na|aooe If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco CountyVVater/Sswvar Impact
fees are due,they must be paid prior to permit issuance in accordance with applicable Pasco Countyordinances.
CONSTRUCTION LIEN LAW(Chapter 713. Florida Statutes, msmnomndmd): |f valuation of work io $2'SOO.UOor more, |
certify that |' the app|iomnt, have been provided with o copy of the "Florida Construction Lien Law—Homeowners
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver itto the"mwner" prior tocommencement.
CO0TRACTOR'S/OW0ER'GAFFIDAVIT: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work and installation as indicated. | certify that no work or installation has
commenced prior to issuance of permit and that all work will be performed to meet standards of all |mvva regulating
conotruction. County and City nodao, zoning nagu|ediono. and land development regulations in the jurisdiction. | also
certify that | understand that the regulations of other government agencies may apply to the intended wmrh, and that it is
my responsibility to identify what actions | must take tobeincompliance. Such agencies include but are not limited to:
- Department ufEnvironmental Protection-Cypress 8ayhaado. Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
' Southwest Florida Water Management District-VVa||o, Cypress Bayheads, Wetland Anaom, Altering
Watercourses.
' Army Corps ofEnginaere-GemwaUs. Docks, Navigable Waterways.
' Department of Health & Rehabilitative Services/Environmental Health Unit-VVa||a, Wastewater Treatment,
Septic Tanks.
- US Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Authority-Runvmayn.
| understand that the following restrictions apply to the use offill:
- Use of fill io not allowed in Flood Zone"V" unless expressly permitted.
' If the fill nnotaha| is to be used in Flood Zone ^A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed bv the State ofFlorida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, |certify that fill will be used only to fill the area within the stem wall.
- If fill material is to be used in any area, | certify that use of such fill will not adversely affect odomani
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots |ays than one (1)
acre which are elevated by fill, on engineered drainage plan is required.
If I am the AGENT FOR�THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. | understand that m oeponobe permit may be required for electrical work,
p|umb|nQ, oigna, wmUa, poo|o, air nonditioning, gom, or other installations not specifically included in the application. A
pennitioauodahoUb000nstruedhobea |ioenaetopnnomedvvithihevvorkaDdnotomauthority violate, cancel, alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit,prevent the Building Official from thereafter
requiring correction of errors in plans, tr uti n or violationsofanyoodes 'Eve permit issued shallb invalid
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time th'e work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90) consecutive days,tlie 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 TQOBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
OWNER OR AGEN' 0111 IA— CONTRACTOR
—440i(ol
- -' -
Subscribed and sworn (or affirmea)More-me this Subscribed and swo 0( r&ffirmed)bYore me this-
Who is/are personally known to me or hasihave PFOdUG Tv o�rs/are Personally known to me or hasihave pfeda
_---7-�:ms identification. as identification.
Notary Public. __Notary Public
Commission No. FB98637 Commission No. FF98537
EfismaM.Holleran Gliuma M.BoDcruu
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Single Family Dwelling
Plan Review Comments
1. F.F.E; shall be a minimum of 8" above the road elevation and an engineered site plan.
2. Lots shall be graded-to comply with R401.3 of the F.B.C.
3-. Compaction test required if 24"or more of fill dirt is brought in at any one place.
4: Tie in survey required before pouring concrete.
5. Driveways require a R.O.W. use permit. All 4 sides of driveway_ thru the sidewalk shall have
expansion material.
6. All setbacks shall be met.
7'. All property markers shall be uncovered and.marked at time of first inspection_ .
8: All A.D.A.'requirements shall be met:
9; No electric,plumbing;mechanical, or framing shall be covered without an inspection and.
.
approval first.
10.All Garages shall comply with section R302.6 of the F.B.C. (Fire Separation).
11. Appliances shall not be installed in a location where subject to mechanical damage unless
protected by approved barriers. M303...4 of the F.B.0
12. Water heaters shall comply with section P607.3 of the E.B C.
13. Foundation supports for A/C units shall be raised at least 3" above finished grade. M1308:1
14. Return air in all bedrooms. F.B.C. M1620.4
1.5. Smoke detectors are to be installed in accordance with R313.1 of the F.B.C.
16. All glazing requirements are to be in accordance with R308.4 of the F.B.C.
17. All means of egress are to be in accordance with R311 of the F.B.C.
18. "Green gypsum,board" shall not be used as a backer in showers or tubs.R702.4.2 F.B.C.
19. Combination-type AFCI breakers are required at all locations requiring an AFCI,type breaker.
20. Carbon monoxide alarms will be required in new construction that uses fossil-burning heating
or appliances or an attached garage. They shall be installed in accordance with the F.B.C.
21. All plumbing,mechanical, and electrical shall be separate from unit to unit. This includes all
underground.plumbing and.electric.
22. All 2016 N.E.C. Codes will be enforced:
21 Tamper-Resistant Receptacles in accordance with 406.11 of the 2016 N.E.0
24. n accordance with the Land Develop_merit Code,lots shall be sodded before final at least 10,
feet around the structure.
25:.R403.5.3Hot water pipe-insulation
Insulation for hot.water'pipe with-a minimum thermal resistance (R-value) of R-3 shall.be applied to the
following:
Piping,3/<inch (1.9.1 mm) and larger in.nominal diameter.
Piping.serving more than:one dwelling unit.
Piping located,outside the conditioned space.
Piping from the water heater to:a-distribution manifold._
Piping.located under a floor-slab.
Buried in piping,'
Supply and return piping in recirculation systems other than demand recirculation systems.
25. Blower door test shall be provided before C.O:
26. A copy of the energy cacls shall be with-permit at all times
27. Copy of final insulation report shall-be provided with permit before fnab
28:No fence, pool or screen enclosure :is issued with:thispermit
F.F.E.-Finished Floor Elevation
F.B.C- Florida Building Code 6a'Edition
R.O.W.-Right of Way
A.D.A.-Americans with Disabilities Act N.E.C.-National Electric Code (2016)
PASCO COUNTY
BUILDING CONSTRUCTION SERVICES
PA OV-V 'd 8731 Citizens Drive Date:7/12/2019
.—S C
,COUNtY, fto�imA'y Suite 230
0PRi SPACES,VIBRI);r PLACES..
New Port Richey,FL 34654
727-847-8126
NOT A PERMIT
Receipt#: 1874211
FEE DESCRIPTION ACCOUNT CODE UNITS INVOICE# FEE AMOUNT PAID RECEIPT# DATE
Impact Fee Residential Solid 24503100-329010 1.00 1478855 $33.66 $33.66 1874211 7112119
Waste Single Family
TOTALS: $33.66 $33.66
13ecelpt Paid By Check# CC Auth# Cashier ID Workstation Receipt Data Amt Pal
1874211 Check 01257334 EBESS BCCCP58W 07/12/2019 $33.66
Total Payments:
Pavor Address Phone
LENNAR HOMES LLC TAMPA DIVISION
4600 WEST CYPRESS ST STE 200
TAMPA, FL 33607
Comments:
,6377 COBBLE BLISS ST 1
While you will be paying your bill with Pasco County BuildIngConstructlan Services,the full amount of the credit card or e-checkfees,NOT shown above,Is
collected by First Billing payment services.
myreports/reportsl/PASCOPROD/PASC0/ReceiptM_V7.rpt 7/1212019 Page 1 of 1
tNsTR#2019102475 OR 6K 9924 PG 363 Page 1 of 1
06/17/2019 02:30 PM Rcpt:2064233 Rec:10.00 DS:0.00 IT.,0,00
Paula S.ONei4 P&D., Pasco County CCerk&Comptro[Cer
r
Permit No, Parcel•ID No 04-26-21-0110-0090D-00S0
NOTICE OE COMMENCEMENT
State of Florida county of Pasco -
THE UNDERSIGNED hereby gives notice fret improvement will be made to certain real property,and In accordance with Chapter 713,Fladila Statutes,
the following information Is provided in this Notice of Commencement
1. Deseip8on of Pmpedy:Legal SILVERADO RANCH SUBDMSION PHASE SA PB 78 PG 33 BLOCK 09 LOT 09
street Address: 6377 Cobble Bliss Street Zephryhills FL 33541
2. General Description of Improvement Single Family Residence/Pool I Screen Enclosure!Fence
3, Owner Wormallon: Lennar Homes,LLC.
Name
460 Cv 0 WW mr Ste ess St. �200 Tampa FL 33607
Address City State
Interest in Property: i
Name of Fee Simple Titleholder. NIA
(if other than owner)
4. Address
Contractor city state
actor Lerinar Homes LC.
Name
.4600 W Cypress St,Ste 200 Tampa FL,33607
Address CRY ate
Contractor's Telephone No.: 813.574.6700
& Surety:Pio NIA
Name
Address City State
Amount of Bond:S Telephone No..' '+
6. Lender: NIA ,
Name
Address city f
fees.Telephone No.:
7. Persons wlthln the State of Florida designated by the owner upon whom notices or other,documents may be served as provided by, .
Section 713.13(1)(a)(7),Florida Statutes
Lennar Homes LLC 2$
Name
4600 W Cypress SL Ste 200' Tampa FL.333607
Address cHy. state
Telephone Number of Designated Person: 813.s74.s700 j
8. In addition to himself,the owner designates NIA. °f C� t'x U.1
to receive a copy of the Uenoes Notice as provider!in Section 713.13(1)(b),Florida Standes. U7 'LJ a: .-r
Telephone Number of Person or Entity Designated by Owner, t J` 0 •U
'J U) J c l
9. Expiration date of Notice of Commenc tment Is one year trem4he date of recording unless a different date Is spedfied: 0 0£w S W
9 � (— LUt
WARNING To OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT: LL' U) C
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1„SECTION 713.13, FLORIDA STATURES, AND'CAN t l- a r Li 2 3
REECCOLT IN YOUR PAYING RDED AND POSTED ON THE JOB SITE BEFOORREETHHEE FIRST N TO SPECROPERTY. A TION Yi U INTEND TO OBTAIN ICE OF COMMENCEMENT
CONSUST LT � fl � C� `<
9- L.t_ ;
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT., ' r-- L_ M U
! t ? JOiV c2S
STATE OF FLORIDA :� I_ ? u j t1
COUNTY OF PINELIAS SIgmrtuwV Owner er's Authorized OftiteNDbectoriPariner/Manager 0
Vice President
Signatory'sTrdefdffce iTt (] L!
tiiLt � 7 O '
The foregoing Instrument was acknowledged tretote cute dvs g day of APnT t."�v` by t f--- -y- 0- <C }- LU
Steve Robert Smith as Vice President (type of earn , ,tr slee,attorney in tart)for r tf 3 0 0 >- Q -"
Lennar Homes LLC (name of party om Instrument was executed). t t (.) J C� 2
Personally Known 2 OR Produced ideritiflcation CI Notary Sign!re� "� ��"— -- 0 � Z� �
Type of IderBficadon Produced Name(Pdrd) Eilssa Holleran )r t cn -j to
t i U) !� LL
Verification pursuard to Section 92EES,Florida Statutes, Under perratges of penury,i declare that I have read the foregoing and that the facts stated In z t-- d
It are flue to the best of my knowledge and belief.'. �_ii-� N 0 Zi-------------------
a
Fii35Jtt;.tiOtLEitl4tl S! re of Na Person Signing Above
GlmNpio6SFf9668;4f•
EitiGatJun>rd,3010.'
rpdatelbcstbcs fomu DindsillUvAgRStUrvawicitC0.1137ptf
Lennar Homes-6377 Cobble Bliss St:4,093 sqft
Column Es
SO. FEET PRICE
MAIN OR LIVING: 4,093 $ 112.65
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 461,076.45
FEE SHEET $ 2,350.00
ADDRESS $ 30.00
DRIVEWAY $ 45.00
BUILDING: $ 2,472.00
ELECTRICAL: $ 528.75 l
PLUMBING: $ 352.50
MECHANICAL: $ 246.75 I
SUB-TOTAL $ 3,600.00 ( (J/,
TOTAL $ 3,600.00
SEWER:
WATER: /
IRRIGATION: $ - b 36 r
TOTAL: $ -
WATER METER:1 / C
IRRIGATION METER $
FIRE DEPARTMENT FEES
PLANS TOTAL:
INSPECTION TOTAL:
PERMIT TOTAL
TOTAL: $ -
PUBLIC SAFETY IMPACT FEES
POLICE $ 254.00
FIRE $ 273.00
5% $ 26.35
TOTAL: $ 553.35
SUB-TOTAL $ 4,153.35
PARK IMPACT FEES $ 769.56
SIF'S: $ 7,728.00
100.0% $ 7,728.00
1.0% $ 77.28
TOTAL: $ 7,805.28
T I F'S: $ 3,632.00
99% $ 3,595.68
1% $ 36.32
TOTAL: $ 16,360.19
PASCO COUNTY, FLORIDA
Permit No. -.7_lq2,6
Date Permitted k
Builder Name/Owner Name Control
County Parcel No. SubDIv: jvflz-
Address/Locatlon 3 7-7 &a Rtss ST
Classlflcation/Type of Use S 1)v le-4,,X4,
TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit,.
Exempt n Yes ❑ No How Determined
Impact Fee Amount Zone No. TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House Amount $ 2,e
(057) Mobile Home
(058) Other Residential
23) Collection Fee
Exempt 6 Yes 0 No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit -Recreation Total
Zone TOTAL AMOUNT
Exempt []Yes F1 No Howgetermined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total
Exempt n Yes ❑ No How Determined Total Amount
RESOURCEFEE ERU
TOTAL AMOUNT
Prepared By Checked By
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
. BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrence,but simply receipt of-a copy of this form,placing
the building permit owner on notice of this assessment and the conditions of payment for same.
DATE RECEIVED BY
RECEIPT NO. DATE BY