HomeMy WebLinkAbout19-21562 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21562.
BUILDING PERMIT
PERMIT INFORMATION LOCATIONINFORMATION . ' 1'
Permit Number: 21562 Address: 3879 CORREIA DR
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: NEW CONST/COMM Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: PARK PLACE CENTER
Est. Value: Parcel Number: 19-26-22-0010-00000-0070
Improv. Cost: 15,400.00 OWNER INFORMATION
Date Issued: 8/05/2019 Name: PARK PLACE SEVEN LLC
Total Fees: 4,917.08 Address: 35310 STATE RD 54
Amount Paid: 4,917.08 ZEPHYRHILLS, FL 33541
Date Paid: 8/05/2019 Phone: 813-997-0636
Work Desc: BUILD OUT 1,650 SQ FT OFFICE/WAREHOUSE
CONTRACTORS APPLICATION FEES
SUNSTATE ALUMINUMN INC BUILDING FEE 146.40
FIRST CLASS ELECTRIC INC ELECTRICAL FEE 75.00
CARR CONTRACTING SVCS INC PLUMBING FEE 90.00
BAHR'S PROPANE GAS &A/C, INC. TRAFFIC IMPACT FEE 99% 2,443.72
�. MECHANICAL FEE 90.00
` TRAFFIC IMPACT FEE 1% 24.68
FIRE PLAN REVIEW FEES 24.00
h�b�J n O/FIRE INSPECTION FEES 15.00
�" SUIJ SEWER CONNECTION COMMERCIAL 1,034.55
WATER METER RES 3/4" 473.78
S' WATER CONNECTION COMMERCIAL 499.95
Ins ections Required
OTER 2ND ROUGH PLUMB MISC INSULATION CEILING
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 wit '
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
NTRACTOR SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Jacqueline Boges
From: City of Zephyrhills Support <support@zephyrhillsfl.zendesk.com>
Sent: Monday,August 5, 2019 2:46 PM
To: Jacqueline Boges
Subject: [Request received] 3879 correia dr
EXTERNAL EMAIL
##- Please type your reply above this line -##
Hello Jacqueline Boges,
We are working to resolve your request promptly and will keep you updated. One of our Support Analysts will keep
you updated on the progress of your request.
Best Regards,
FATHOM Support Team
TO ADD ADDITIONAL COMMENTS, reply to this email,or click the link below:
https://zephyrhilisfl.zendesk.com/hc/requests/28596 7
...................................................................................................................................................................................................................................................................................................................................................................................
Jacqueline Boges
- _- Aug 5, 1 1 :46 AM MST
service 3879 correia dr
This email is a service from City of Zephyrhills Support .
1
Sunstate Aluminum-3879 Correia Dr-1,650 sq ft
Column Es
SQ. FEET PRICE
MAIN OR LIVING: 1,650
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 6,000.00
I
FEE SHEET $ 70.00
ADDRESS $ 30.00
DRIVEWAY $ 45.00
BUILDING: $ 146.40
ELECTRICAL: $ 75.00
PLUMBING: $ 90.00
MECHANICAL: $ 90.00
SUB-TOTAL $ 401.40
TOTAL $ 401.40
SEWER: $ 1,034.55
WATER: $ 499.95
IRRIGATION: $ -
TOTAL: $ 1,534.50
WATER METER: $ 473.78
IRRIGATION METER $ -
FIRE DEPARTMENT FEES
PLANS TOTAL: $ 24.00
INSPECTION TOTAL: $ 15.00 1 wall
PERMIT TOTAL
TOTAL: $ 39.00
PUBLIC SAFETY IMPACT FEES
POLICE $ - paid at shell
FIRE $ -
5% $ -
TOTAL: $ -
SUB-TOTAL $ 2,448.68
PARK IMPACT FEES $ -
SIF'S: $ -
100.0% $ -
1.0% $ -
TOTAL: $ -
T I F'S: $ 2,468.40 1,496 per 1000
99% $ 2,443.72
1% $ 24.68
TOTAL: $ 4,917.08
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received L
M= M= Phone Contact for Permittinoig
Owner's Name 9ne-
Owner Phone Number Vka
Owner's Address l Owner Phone Number
Owner Phone Number
JOB ADDRESS E; LOT#
SUBDIVISION PARCELID#1
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTRR ADDIALT SIGN DEMOLISH
FRI INSTALL REPAIR
PROPOSED USE SFR Q COMM u OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME STEEL
DESCRIPTION OF WORK LA I (!)kj�—k rq;:t y -F5a�1
BUILDING SIZE SCI FOOTAGE HEIGHT
=BUILDING
V n� VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL'7.5 ':' AMP SERVICE
T—
FM) DUKE ENERGY W.R.E.C.
=PLUMBING
$ 71/ zef
- L
=MECHANICAL 9,N',, , *yl- O
VALUATION OF MECHANICAL INSTALLATION CAL
=GAS Q ROOFING Q SPECIALTY OTHER 04)
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES NO
BUILDER MPANY
SIGNATUR REGISTERED Y/ N FEE CURREI`
Address License# F
ELECTRICIAN COMPANY
SIGNATURE REGISTERED L_Y_L N_J FEE CURRET, L_Y_LN_j
Address License# U_c000_Z570
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRErl Y/N
Address & -TG 4--f, License# I � L4
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREI, Y/N
Address License# X?,g 7/(q
OTHER COMPANY
SIGNATURE F_ REGISTERED Y/ N FEE CURREI,
Address License#
HHHHi HHHHIIIIIIIIIIIIIIf H!HHHHHH1111111 1 a 111111111111111 f+f I I I I I I I I I I I 1 2 1111111111111 1
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 wl Silt Fence installed,
Sanitary Facilities&I 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 required for all NEW construction.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
It over$2500,a Notice of Commencement Is required. (AIC 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 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 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 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/Wastewater Treatment.
- 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/Envilonmental 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 W" 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 ATTORNEY BEFORE RECORDING YOUR NOTICE O MMENCEMENT.
FLORIDA JURAT(F.S.117.03)
OWNER OR AGENT CONTRA _f•—
Subscribed and sworn to(or affirmed)before me this Sub rm e�C `before me this
by y
Who is/are personally known to me or has/have produced o is/are personally known to me or has/have produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed,printed or stamped
Square Feet Dollar Amount
16-5
Valuation o
Building
Electric 7'.-5
Plumbing qD.
Mechanical. at 0,
RadAp
Connection Fees:
Sewer
Water 4]011 . -V
Meter
School impact Fee:
Transportation Impact Fee:
City of Zephyrhills
Water and Sewer Impact Fee Calculation
Land Use Type:
Mixed Use Warehouse
No. of Square Feet 1650,'
Impact Fees
Within City Limits Outside City Limits
Water Facilities Capacity Fee $ 499.95 $ 624.94
Wastewater Facilities Capacity Fee $ 1,034.55 $ 1,293.19
TOTAL $ 1,534.50 $ 1,918.13
V
ZFPHYRHG LLS FIREDEPARTMENT
38410 6th Ave Zephyrhills, FL: 33542
FIRE SERVICE USER FEES increase 1/1/2018
Occupancy No.:
Plan No.: Contractor: ��"`� ��
Business Name: Billing Address:
Business Address:?A-10) C V-V1V k>,
Business Phone No.: v Billing Phone No.:
Business Fax No.: Billing Fax No.:
Contact: Contact:
PLAN REVIEW FEES INSPECTION FEES PERMIT FEE
Annual-
Education,healthcare,De
tention&Correctional Public
Assembly,Business, schools,
Storage,Mercantile and Churches
Site Plan N/C Industrial. no charge Sprinkler $50
Multi-Family/Commercial .03 sf up to 800 sq ft $ 24.00 Standpipes $50
(Minimum Charge$24.00 801-1,500 sq ft $ 34.52 Fire Pump $50
Plan Revisions DBL 1,501 -2,500 sq ft $ 60.02 Hoods $50
2,501-3,500 sq ft $ 90.02 Fire Alarm $50
SPRINKLER SYSTEMS 3,501-5,000 sq ft $ 127.52 LP Gas $50
�0.-25 Heads $50 5,501-7,500 sq ft $ .187.52 Natural Gas $50
.26 plus,Heads $100 7,501-10,000 sq ft $ 262.52 Fuel Tanks- per tank $50
. STANDPIPE SYSTEM 10,001-15,000 sq ft $ 375.02 Sparklers $100
®`Per Riser $50 15,001-20,000 sq ft $ 525.02 Fire Works $500
FIRE PUMP 20,001-30,000 sq ft $ 750.02 Camp Fire(recreation: $25
®.Per Pump $100 30,001-40,000 sq ft $ 1,050.02 Controlled Bum(15# $100
FIRE ALARM SYSTEM 40,001-60,000 sq ft $ 1,500.02 Hood/Duct $50
0-25 Devices $50 60,001-80,000 sq ft $ 2,100.02 Place of Assembly $50 Annual
80,001-($2,100.02)per
26 plus Devices $100 ea add 1,000sq ft $ 0.06 Fire Protection $25
SUPPRESSION SYSTEMS (Business closed until Flammable Application $50 Annual
Wet $50 violations corrected) Waste Tire Storage $50 Annual
Dry $50 SPRINKLER SYSTEMS Generator<KW $100
CO2 $50 0.Hydro Undergrounds $45 Generator>30 KW $100
Other $50 Hydrostatic Test $65 per system Bio-Hazard Waste $100 Annual
KITCHEN EXHAUST Acceptance Test $45 per system Fumigation Tenting $50
Hood/Ducts $50 Hydrant Flow $75 Torch Pot/Applied $50
OTHER Haz.Materials $50' Annual
LP Installation per tank $50 FIRE ALARM SYSTEM
Fuel-Tank Installation $50 System Acceptance $50
(Per Tank) $50 Recall Acceptance $50
Natural Gas Installation $50 OTHER
(Per System) Fire walusmoke wall $15 per wall
®Spray Booth $50 LP Gas $25 per tank
Natural Gas_ $25 per system
Tent 10'xl0'or greater $15 per tent Li
Fire Pump $45
Fire Suppression $30
System Acceptance
Exhaust Hood/Duct $30
Re-inspection DBL
(other than annual)
Inspection scheduled I DBL
and cancelled less than
24 hours
Construction Insp. N/C
u-' Emergency Vehicle Acc $50 5
�2411
PLANS TOTAL INSPECTION TOTAL PERMIT TOTAL
I t. . j C�
GRAND TOTAL a
Comments:
Date: .Inspector:
see.back
ntn
ip'`.m.�'`:"• .-_:. "N:""- _...,.,. �`:L. .-_....., __.�.,..-�.�,.d y..�.�_....T...zr.-.-.._-:x-v^_:+r�:za�s^^cn:v.v rt:•aas.:ew=�esx.*e, _-,.,nm-.m,.m...,,.��.s- - -_,...�..-,.-
FALSE ALARM FEE
1 st Alarm N/C
2nd Alarm N/C
3rd Alarm -N/C
4th Alarm $100
5th Alarm $150
6th Alarm $200
NON COMPLIANCE $150
Cont.`Ai�nual Inspection Epees
3-11 Units price per unit $ 5.36
12-25-Units price per unit $ 4.82
!i6-56 Units price per unit $ 4.29
51-100 Units price per unit $ 3:75'
100 or more Units price per unit $ 2.68
Fire Safety re=inspection'types
First Re-inspectioi N/C
Second re-inspecl $75:
Third re-inspectior $' '126.00
Ihspectionischeduled but-cancelld 24 hrs $ 50.00
TOTAL
AM
a
PASCO COUNTY
' BUILDING CONSTRUCTION SERVICES
��S 8731 Citizens Drive Date:6/27/2019
COUNTY FLORIDA Suite 230
OPEN SPACES.VIBRANT PIACPS• New Port Richey, FL 34654
727-847-8126
NOT A' PERMIT
ERMIT �*
Receipt#: 1869856
FEE DESCRIPTION ACCOUNT CODE UNITS INVOICE# FEE AMOUNT PAID RECEIPT# DATE
CP204 ADDRESS TAPE 20013368-341304 3.00 1473879 $120.00 $120.00 1869856 6/27/19
3879,3883,3885 CORREIA DR.
TOTALS: $120.00 $120.00
Receipt# Paid By Check# CC Auth# Cashier ID Workstation Receipt Date Amt Paid
1869856 Check 1072 LMESSICK BCCCP15W 06/27/2019 $120.00
Total Payments: $120.00
Payor Address Phone
PAUL CORREIA PARK PLACE SEVEN LLC 8139970636
Comments:
1926220010000000070
While you will be paying your bill with Pasco County Building Construction Services,the full amount of the credit card or a-check fees,NOT shown above,is
collected by First Billing payment services.
myreports/reports//PASCOPROD/PASCO/ReceiptAA V7.rpt 6/27/2019 Page 1 of 1
PASCsa
COUNTY FLORIDA
OPEN SPACES. VIBRANT PLACES.
Welcome from the Addressing Department,
Every Second Counts in Emergency Response! In order to comply with E911 and National Emergency
i
Number Association (NENA)standards, all addresses in Pasco County are assigned by the Addressing
Department. To create a new address, there is a fee of$40.00 per address.
Please submit the number of addresses/sub addressee that are beinqrtquested.
Number of Addresses Re
1) $40.00 per address
Total Amount Due: GIS Services-
Payment options:
In person between 8:00 a.m. and 3:30 p.m. in any of our CENTRAL PERMITTING.OFFICES listed below:
Pasco County Govt. Center Pasco County Govt. Center Pasco County Govt Center
14236 60' Street, Suite 203 4111 Land O'Lakes Blvd, Suite 205 8731 Citizens Drive, Suite 230
Dade City, FL 33523 Land 0' Lakes, FL 34639 New Port Richey, FL 34654
By Mail
Pasco County Govt. Center
Addressing/GIS
8731 Citizens Drive, Suite 351
New Port Richey, FL 34654
Checks should be made payable to: Pasco County BOCC
CONTACT INFORMATION:
Requestor's name: vl�) L C0C2_Qx'- X'P u-c
Business name: �b Lk-_
Address: C0154
Phone Number:
E-mail Address: S-�-ts� 1. 12s()
If you have any questions you may contact the addressingdepartment at..
(727) 815-7154
Please fill out information for each address,you are requesting on the reverse side of this letter.
OFFICE OF GIS/ADDRESSING
(727) 815-7154 1 West Pasco Government Center 18731 Citizens Drive, Suite 351 1 New Port Richey, FL 34654
No vacant land shall be addressed until a permit is required.
A master of"shell" address is required for any structure that will house sub-addresses. The shell and sub-
addresses are considered to be separate addresses and charged individually.
All structures with individual outside entrances will be addressed using individual street addresses. This
structure is also required to have a shell address.
If they share a common door, they may be addressed using suite numbers.
All structures containing_units on more than one floor MUST use the floor number in their sub-addresses. For
example, first floor units would be 101, 102, 103, etc.
UNDER NO CIRCUMSTANCE MAY THE BUILDING NUMBER BE INCLUDED IN THE SUB-ADDRESS. ALL
SUB-ADDRESSES MUST BE NUMERICAL.
If you are building a single residence, please include a sketch showing where the structure will be located and, if
it's a corner lot, which street the residence will be facing.
Developers, please include a site plan (key sheet is,acceptable) showing the phase to be addressed. You do not
need to list all of the parcel ID numbers.
First Address—provide Parcel ID in Section-Township-Range-Subdivision-Block-Lot format.
Parcel ID:
❑ Structure that is a:
❑ Shell ❑ Residential X Commercial ❑ Non-profit ❑ Educational
❑ Non Habitable that is a:
❑ Landmark ❑ Gatehouse ❑ Tower ❑ Boat Dock ❑ Barn ❑ Recreation
❑ Utility that is a:
❑ Cable Box ❑ Phone Box ❑ Traffic Control ❑ Electrical Box ❑ Lift Station ❑ Sign ❑ Well ❑ Meter
❑ Temporary that is a:
❑ Construction Trailer ❑ Event Trailer ❑ Sales Trailer ❑ Tent ❑ Power Pole
❑ Other that is
Second Address—provide Parcel ID in Section-Township-Range-Subdivision-Block-Lot format.
Parcel ID:
❑ Structure that is a:
❑ Shell ❑ Residential ❑ Commercial ❑ Non-profit ❑ Educational
❑ Non Habitable that is a:
❑ Landmark ❑ Gatehouse ❑ Tower ❑ Boat Dock ❑ Barn ❑ Recreation
❑ Utility that is a:
❑ Cable Box ❑ Phone Box ❑ Traffic Control ❑ Electrical Box ❑ Lift Station ❑ Sign ❑ Well ❑ Meter
❑ Temporary that is a:
❑ Construction Trailer ❑ Event Trailer ❑!Sales Trailer ❑ Tent ❑ Power Pole
❑ Other that is