HomeMy WebLinkAbout20-22698 CITY OF ZEPHYRHILLS
' 5335-8TH STREET
(813)780-0020 22698
BUILDING PERMIT
'PERMIT INFORMATION °LOCATIONINFO:RMi4TION z: . .
Permit Number: 22698 Address: 35933 SADDLE PALM WAY
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: SILVERADO
Est. Value: Parcel Number: 05-26-21-0080-00500-0210
Improv. Cost: 4,576.00 !'OWNER INFORMATION-
Date Issued: 4/06/2020 Name: SANDERS, ERNEST & DAISY
Total Fees: 97.50 Address: 35933 SADDLE PALM WAY
Amount Paid: 97.50 ZEPHYRHILLS, FL 33541-2907
Date Paid: 4/06/2020 Phone: �SZ- Z 3 6 P 3a4115
Work Desc: CONSTRUCT SCRN RM 165 SQ FT W/ALUMINUM ROOF ON EXIST DECK
CONTRACTORS APPLICATION FEES
ALLIED ALUMINUM INC BUILDING FEE 97.50
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7
Inspections,Re uired
FOOTER 2ND R U H PLUMB Misc INSULATION EILIN
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.
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.
6Aa____f &, 6"407
RACTOR SIGNATU PERMIT OFFItYR
PERMIT EXPIRE 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
\ t•
City of Z04yrlulls
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner:
Date Received: 3-
Site: (3 M,3 3 wd ii
Permit Type: CScr n eAda ZZv+P- Pr �
Approved w/no comments:❑ Approved w/the below comments Denied w/the below comments: ❑
/ ) ems
This comment sheet shall be kept with the permit and/or plans.
_ MAR 2 4 2020
Kalvi - lans Examiner Date Contractor an r Homeown(Required when comment t)
INSTR#2020049883 OR BK 1 0074 PG 376 Page 1 of 1
03/23/2020 08:45 AM Rcpt:2147142 Rec:10.00 DS:0.00 IT:0.00
Nikki Alvarez-Sowles,Esq.,Pasco County Clerk&Comptroller
Permit No. Parcel ID No �f ui-XV 46so o",n
NOTICE OF COMMENCEMENT
stateof /�� -1 County of .���
THE UNDERSIGNED hereby gives notice that Improvement will be made to certain real property,and in accordance with Chapter 713.Florida Statutes.
the fallowing information is provided In this Notice of Commencement d�
1. Description of Property.Parcel Identification No.
Shad Address: 3 33 -S�1y ? I✓ //•J .�J
2. General Description of Improvement ���rE.E3f/�.�S.L G®i6/I� �/•�GGlC
3. Owner Information or Lessee information If the Lessee contracted for the Improvement
/ 3' S
e 7 "R}Address r.✓ / Gty Z,E� Lis state S¢/
Interest In Property.
Name of Fee Simple Titleholder.
(If different from Owner[Mad above)
Address //' City State
4. Contractor.
city State
Contractors Telephone No.:
5. Surety.
Name
Address City State
'Amount of Bond:$ Telephone No.:
8. Lender.
Name
Address City state
Lenders Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(aX7),Florida Statutes:
Name
Address City State
Telephone Number of Designated Person:
B. In addition to himself,the owner designates of_
to receive a copy of the Llenoes Notice as provided In Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner.
8. Expiration date of Notice of Commencement(the expiration data may rat be before the completion of construction and final payment to the
contactor,but will be one year from the date of recording unless a different date Is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1 SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPI<RTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK 0 RECORDING YO R NOTICE OF COMMENCEMENT.
Under penalty of per)ury,I declare that I have read the foregoing notice of con n a the fads stated therein are true to the best
of my knowledge and ballot.
STATE OF.FLORIDA
COUNTY OF PASCO
Signature r era or Lessee's Authorized
Officer/Director/Partner/Manager
Ignato pE Mde/Office
�' /�ng inst./wrpant was acknowledged before me this f 2 by
bit �!�as d 1iLw (type of authority:e.g.,officer,trustee,attorney In fad)for
(name of.Dartv-oabahalf?1whmnMstrumant was executed}
Personally Known (LR Produced Identification❑ Notary Sig lurer'
Type of Identification Produced Name(Print)
e of Florida
tti
G 277151
NEE
3
wpdatalbcs/nogcecommencement_pc053048
STATE OF FLORIDA,COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A { ¢
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
WITNESS MY HAND AND 0 ICIAL S AL THIS
DAY OF 2
�LVAREZ-SOW ES,CLERK&COMPTROLLER �3 �
DEPUTY CLERK
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813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
• NOTICE OF DEED RESTRICTIONS: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 compliance with any applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES:If the owner has hired a contractor or contractors to undertake work,they
may be required to be licensed in accordance with state and local regulations.If the contractor is not licensed as required by law,both the owner and
contractor may be cited for a 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 contractors,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 contractor,that may be an indication that he Is not property 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 of new buildings,change of use in existing buildings,or
expansion of existing buildings,as specified in Pasco County Ordinance 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 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 release.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 County Water/Sewer Impact fees are due,they must be paid prior
to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended):If valuation of work is$2.500.00 or more,I certify that I,the applicant,
have been provided with a copy of the"Florida Construction Lien Law—Homeowner's 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 it to the"owner"prior to commencement
CONTRACTOR'S/OWNER'S AFFIDAVIT: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.I certify 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
laws regulating construction,County and City codes,zoning regulations,and land development regulations In the jurisdiction.I also certify that I
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 to be in compliance.Such agencies include but are not limited to:
Department of-Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/WastewaterTreatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material 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 by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I 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, I certify that use of such fill will not adversely affect adjacent
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 less than one(1)
acre which are elevated by fill,an 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.I understand that a separate permit may be required for electrical work,plumbing,signs,wells,pools,air conditioning,gas,or
other installations not specifically included in the application.A permit issued shall be construed to be a license to proceed with the work and not as
authority to 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 a correction of errors in plans,construction or violations of any codes.Every permit issued shall become 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 the 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,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 AT EY BEFORE RECORDING YOUR NOTICE OF COMMENCgMENT,
FLORIDA JURAT(F.S.1 .03)
OWNER OR AGENT CONTRACTOR
a—Ah
e�an b� (or affirmed)b are me this O $udZO and by r affirmed)before me this
!— re�pers�nallY k�� r�me or has7have produce o is/are personaliv kno�_or hasfhave produced
as identification. as identification.
%JL
11 aflAAAW 0 Notary Public Al7 C(� Notary Public
Commission Commission No.
Po. Notary HPublicle of FloridaName Nc�a pri0Jyh?fe I Name of Nogrry 1yyo,printed%dig�jpPubliC toe oMy CoGG 277151 `� Donne A Bognettiaw Expire23 My Commission GG 277151
a w Expires 01/0112023
813-780-0020 City of Zephyrhills Permit Application Fax-613-780-0021
' Building Department
NOTICE OF DEED RESTRICTIONS: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 compliance with any applicable deed restrictions.
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES:If the owner has hired a contractor or contractors to undertake work,they
may be required to be licensed in accordance with state and local regulations.If the contractor is not licensed as required by law,both the owner and
contractor may be cited for a 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 contractors,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 contractor,that may be an indication that he is not property 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 of new buildings,change of use in existing buildings,or
expansion of existing buildings,as specified in Pasco County Ordinance 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 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 release.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 County Water/Sewer Impact fees are due,they must be paid prior
to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW(Chapter 713,Florida Statutes,as amended):If valuafon of work is$2.500.00 or more,I certify that I,the applicant,
have been provided with a copy of the"Flodda 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 it to the"owner'prior to commencement
CONTRACTOR'S/OWNER'S AFFIDAVIT: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.I certify 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
laws regulating construction,County and City codes,zoning regulations,and land development regulations in the jurisdiction.I also certify that I
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 to be in compliance.Such agencies include but are not limited to:
Department of-Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/WastewaterTreatment.
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas, Altering
Watercourses.
Army Corps of Engineers-Seawalls,Docks,Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
- Use of fill is not allowed in Flood Zone"V"unless expressly permitted.
- If the fill material 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 by the State of Florida.
- If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction,I 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, I certify that use of such fill will not adversely affect adjacent
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 less than one(1)
acre which are elevated by fill,an 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.I understand that a separate permit may be required for electrical work,plumbing,signs,wells,pools,air conditioning,gas,or
other installations not specifically included in the application.A permit issued shall be construed to be a license to proceed with the work and not as
authority to 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 a correction of errors in plans,construction or violations of any codes.Every permit issued shall become 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 the 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,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 AT EY BEFORE RECORDING YOUR NOTICE OF COMMENCgMENT_
FLORIDA JURAT(F.S.1 .03)
OWNER OR AGENT ONA(ACONTRACTOR
�e�an b� (or affirmed)b ore me this O $ub� and bwami r affirmed)before me this
ho is/are pers aally aow r^me or ha have produce j o Islare personalh' oQwu a me or has/have produced
as identification. I as�identification.
_4
41
Notary Public Q Notary Public
Commission Commission No.
• NotaryPublic Slate of Florida
Name No prvt wmgt new Name of Notary typi, ted"didtrjpPublic toe o lonoa
y My Commisston GG 277151 iP Donna A Bognetti
a a Expires 01/01/2023 My Commisston GG 277151
a 1./ Expires 0110112023
AS SUM' SURVEY (FINAL) SEC. 05 TWP. 26 S, RNG. 21 E.
LOT 21, BLOCK 5 BEARING BASIS;
SILVERADO RANCH SUBDIVISION PHASES 6, 8 & 9A WEST BOUNDARY OF SUBJECT PLAT BEING N 02'35'32" E
PASCO COUNTY, FLORIDA. T THIS SURVEY IS SUBJECT TO ANY FACTS THAT _i,+
1�, MAY BE DISCLOSED BY A FULL AND ACCURATE t,.
TITLE SEARCH. ALSO SUBJECT TO SETBACKS,
EASEMENTS AND RESTRICTIONS OF RECORD.
0
CURVE DATA M UNDERGROUND FOOTER, STEM WALL, AND
CURVE RADIUS ARC CHORD BEARING DELTA II UNDERGROUND UTILITIES ARE NOT LOCATED OR
C136 225.00. 63.56' 63.35 N 62.07 32 W I 16'11 O6" P&M SHOWN.
C137 1 225.00 49.64 49.54 N 47.42 47 W 12'38 25' P
C141 1 350.00 86.12 85.91 S 56-29 18 E 14'05 55' P&M DO NOT SCALE THIS PRINT. DIMENSIONS AND
¢ NOTES TAKE PREFERENCE.
U
PURPOSE OF SURVEY:TO OBTAIN HORIZONTAL
AND/OR VERTICAL DIMENSIONAL DATA TO SHOW
CONSTRUCTION IMPROVEMENTS.
PREPARED FOR e CERTIFIED TO:
CALATLANTIC TITLE, INC. 410,02"
NORTH AMERICAN TITLE INSURANCE CO. TRACT E ' = 10' UTILITY EASEMENT
EAGLE HOME MORTGAGE, LLC as DRAINAGE AREA "' = 10' DRAINAGE EASEMENT
EARNEST THEODORE SANDERS AND E9
DAISY SANDERS
c,
p SS:
3 A C 'RT •>�
rye• , }' / / �,�a�. :: :r_� _ '��-y� /�`f%�J_K-=-- _fja`�, gl•
BLT 22
LOCK 5
oro. pf 2,
0p,
ry
#�S/0 RY
OC "I
1 CCOV S �,
700, ICY
••
y �34 0° k2, �0o•a TREE LEGEND:
F,R / °q?C LOT 20
w a �ryO� J �N o BLOCK 5 2" OAK
q14- > i�..'• ,.�,?s" W M� _ 4" CABBAGE PALM
�oNe * \ e• + 2" MAGNOLIA
2" HOLLY f.
\ C CGRe\ ��' Oi 2• (t
q,�,FsA
r
FLOOD ZONE REVISED PERAco
LETTER OF MAP REVISION roJ ti6 LEGEND:
CASE NO.: 1 8-04-4636X �ag�oo� E-00,0 = EXISTING GRADE
it
DATED: MAY4,2018
I i`.
LOWEST FLOOR ELEVATIONS:,
i„
LIVING AREA: 101.20' Ii
DESCRIPTION: GARAGE AREA: 100,68'
LOT 21', BLOCK 5, MAP OR PLAT ENTITLED "SILVERADO RANCH SUBDIVISION ELEVATIONS REFERENCED TO
PHASES 6,, 8 & 9A", AS RECORDED IN PLAT BOOK 075, PAGES 075 NORTH AMERICAN VERTICAL
THROUGH 080, OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA, DATUM OF 1988. MEAN SEA
LEVEL= 00.00 FT.
APPARENT FLOOD HAZARD ZONE: "X" COMMUNITY PANEL N0, 12101C 0288 F EFFECTIVE DATE: 9/26/14
Square Feet: 9325.55 f LENNAR HOMES
LEGEND:
(C)= CALCULATED DATA, (D)= DEED DATA, (M)= MEASURED DATA, (P)= PLAT DATA, g= CENTERLINE, A/C= AIR CONDITIONER, B/C= BACK OF CURB, C/S=
CONCRETE SLAB, CH= CHORD, CHB= CHORD BEARING, CLF=• CHAIN LINK FENCE, CONC= CONCRETE, COV.= COVERED, E/P= EDGE OF PAVEMENT, ESM'T= EASEMENT,
F/C= FENCE CORNER, FCM- FOUND CONCRETE MONUMENT, FIP- FOUND IRON PIPE, FIR= FOUND IRON ROD, FN&D= FOUND (JAIL & DISK;-FPP=-FOUND PINCHED
PIPE, LFE= LOWEST FLOOR ELEVATION, MAS.= MASONRY, OR= OFFICIAL RECORD BOOK, PB= PLAT BOOK, PCP= PERMANENT CONTROL POINT. PRM= PERMANENT
REFERENCE MONUMENT, R/W= RIGHT OF WAY, R= RADIUS, SIR=SET 1/2" IRON ROD & CAP No. 4493, SN&D= SET NAIL & DISK, IBM-- -TEMPORARY BENCHMARK,,
U P= UTILITY POLE, F= WOOD FENCE
JOHN R.BEACH&ASSOCIATES, INC. Drawn y I HEREBY CERTIFY THAT THIS SURVEY HAS BEEN-VAD;:"UNDER MY
SMS RESPONSIBLE CHARGE AND MEETS THE MINIMUM TECHNICAL
SURVEYORS AND MAPPERS Checked By STANDARDS AS SET FORTH BY THE FLORIDA BOARD OF
911 WEST ST. PETERSBURG DRIVE PRO ESSIONAL LAND .SURVEYORS IN CVIAPTER 5J-17.0,'O THROUGH''
ONE OLDSMAR, FLORIDA 34677 JRB 5 7.053, RIDA AD IS'fF VE CODE, PU, NT T(I SECTION
WAY (813) 854-1276 FAX (513) 855-8370 Scale:3D' DA ST r
S.
NOT VALID WITHOUT THE SIGNATURE AND Date: 5r /O Zoq
THE ORIGINAL RAISED SEAL OF A FLORIDA I FINAL 5/9/19 DJB SPKANRE DATE
LICENSED SURVEYOR AND MAPPER EA
Revisions: FORM BOARD TIE IN 2/5/19 JMM, FOUNDATION TIE IN 2/11/19 JMM FLORIDA,JOHN R. EACH
R , LAND SURVEYOR No. 2984 LB 4493
JEFF M. HA TLEY.
PROFESS12 L SURVEYOR & MAPPER No.7123
A
Authorization Letter
County or City ®� �� •
License holder: • _
(Last) (First)
License #
authorize the following people to
sign for permits under my licenser
I understand that this letter is valid until my county license expires
and/or written notification supersedes this authorization. Authorized
signers will be up dated at the time of updating license since they will
no longer be valid.
Donna Lotz L320-163-59-588-0
Signature Date:
Notary required
rL
W
j Pv Notary Public State of Florida
Donna A Bognetti
My Commission GG 277151
ja w/ Expires 01/01/2023
""1