HomeMy WebLinkAbout20-143 TQ.
r�on�ui� City of Zephyrhills PERMIT NUMBER
5335 Eighth Street
Zephyrhills, FL 33542 BNR-000143-2020
Phone: (813)780-0020
Fax: (813)780-0021 Issue Date: 06/17/2020
Permit Type: Building New (Residential)
Property Number Street Address
32 25 21 0100 01800 0180 35617 Stella Vast Drive
Owner Information. Permit Information Contractor Information
Name: D R HORTON INC Permit Type:Building New(Residential) Contractor: DR HORTON INC
Class of Work:SFR Construct
Address: 12602 Telecom Dr Building Valuation:$266,079.30
TAMPA,FL 33637 Electrical Valuation:$1.00
Phone: Mechanical Valuation:$0.00
Plumbing Valuation:$0.00
Total Valuation:$266,080.30 /
Total Fees:$15,503.69
Amount Paid:$15,503.69
Date Paid:6/17/2020 1:30:32PM
Project Description
CONSTRUCT SINGLE FAMILY
Application Fees
Transportation Impact Fee-City $36.32 Public Safety Impact Fee-Admin $26.35
Electrical Permit Fee $309.38 SIF 1%Fee $83.28
Park Impact Fee-Single Family/Townhome $769.56 Public Safety Impact Fee-Fire $273.00
Address Fee $30.00 School Impact Fee $8,328.00
Plumbing Permit Fee $206.25 Building Permit Fee $1,402.49
Mechanical Permit Fee $144.38 Transportation Impact Fee $3,595.68
Public Safety Impact Fee-Police $254.00 Driveway Fee $45.00
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 subsequent reinspection.
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 permit 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 add fee 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.
0 ,
CONTRACTOR SIGNATURE PE IT OFFICE
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
PLOT PLAN -
" DESCRIPTION:(AS FURNISHED)
LOT 18, BLOCK 18, SILVERADO RANCH SUBDIVISION PHASES 7; 9B,"'11A.AND 11B
AS RECORDED IN PLAT-BOOK 77, PAGE(S) 79-86, OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA.
TRACT "A" a
PRIVATE DRAINAGE AREA
0
_. 59'20"E' 00 _
S89' 50. .
GRAPHIC SOS
LOT-18 0 •15 30
BLOCK 18' .
TQ 5.750 S0. FT t m
" .ON LOT CALCULATIONS - •(�n D E B _ -
LOT = 5,750. SQ. FT.
II RAINAGE TYPE
LIVING AREA = 1.828 . SQ. FT.'
GARAGE = 430 `SO. FT." 5.2' .. A/C 5.2'
ENTRY 16 SO. FT. 28.7' o
LANAI = 88 SQ. FT. p .6 vER O
PATIO.. = 0 SQ. FT. O
DRIVEWAY = 360 SO. FT. 11.0' O
A/C PAD = 12 ". SO. FT. m 39.67'..
SQ. FT.IMPERVIOUS US = 48% LOT 19'. 0' a LOT 17
.2762 SQ. FT. Tn' PROPOSED
SOD, 2,988 SQ."FT. BLOCK" 18 CAU o BLOCK -18
OFF LOT CALCULATIONS . b6�w n FlN ED FLOOR
RIGHT OF,WAY = 855 SQ. FT... ELEVATION-137.00' 'n
DRIVE APRON = 230 SQ. FT. O O"
PUBLIC S/W = 250 SO. FT.
SOD' ..=,375 SQ. F. O
TOTALS O O
AREA = 6,605 SO. FT.
DRIVEWAY = 590, SQ. FT.., COVRED •3• 0
ENTRY n m�..
SIDEWALK = 278 SO. FT. Z s.z' 21 3' '' 14.0' s.2'
SOD 3,363 SQ: FT. :16,0
- i�eI' .:DRIVE.". p in
4 LIE
.y:r
FLNM
ool.
PREPARED FOR:
Z l
,, �N7� N
[Ifit-HOWIN•,M�sp PI 1 RIGHT OF WAY" PI
y� 311.44'. I Z33.56'
N89'59'20"W. 545.00' Y '�'
'- (REFERENCE BEARING) -
STELLA VAST- DRIVE
BUILDING SETBACKS TRACT'G' -
FRONT: 22' 60' WIDE PRIVATE RIGHT OF WAY.
REAR: 13'
SIDE: 5' (50' LOTS)
7.5' (55' & 60'"WIDTH LOTS)
SIDE STREET: 15'
NOTES:
1.. ELEVATIONS'SHOWN ARE PER LOT GRADING
PLANS PROVIDED BY THE"CLIENT. LEGENDw.
2. .ELEVATIONS ARE BASED ON"NAVD 1988
DATUM. "' — 'BUILDING SETBACK UNE PI "POINT OF INTERSECTION
3._ FOR-ALL LOTS'WHERE SIDE-YARD _ _ PC POINT OF CURVATURE
CENTERUNE PT POINT OF TANGENCY '
SETBACKS ARE LESS:THAN 7.50 FEET,,A - RIGHT OF WAY LINE RP RADIUS POINT
MINIMUM'5.00 FOOT WIDE DRAINAGE AND PRC POINT of REVERSE CURVATURE
ACCESS EASEMENT IS REQUIRED PER PASCO .- PROPOSED ELEVATION FCC POINT OF COMPOUND.CURVATURE
COUNTY LAND DEVELOPMENT CODE. TYP TYPICAL
m PROPOSED DRAINAGE FLOW CS CONCRETE SLAB
THIS PLOT PLAN IS,INTENDED FOR•PERMITTING PURPOSES CONCRETE ��� cnRcuuTED.
ONLY. THIS'IS NOT INTENDED.FOR THE CONSTRUCTION OF A/c AIR CONDITIONER PB PLAT BOOK
THE PROPOSED HOUSE. REFER TO HOUSE PLAN AND PGS, PAGES
OPTION LIST FOR,CONSTRUCTION. ALL BUILDING SET BACK S/W SIDEWALK SO. FT., SQUARE FEET
LJNES SHOWN HEREON IS PER DATA FURNISHED BY CLIENT' D&AE DRAINAGE&ACCESS EASEMENT F.EM.A. FEDERAL EMERGENCY MANAGEMENT AGENCY
AND IS FOR INFORMATIONAL PURPOSES ONLY. F.I.R.M. FLOOD INSURANCE RATE MAP
_ NAVD _ NORTH AMERICAN VERTICAL DATUM
THIS IS NOT A SURVEY NGVD NATIONAL GEODETIC VERTICAL DATUM
" _ - D&UE DRAINAGE&UTIUTY,EASEMENT
THIS IS A PLOT PLAN ONLY PDE PRIVATE
ITY EDRAINA EASEMENT
FLOOD NOTE: SURVEYOR NOTES:
I HAVE EXAMINED THE F.I.R.M.'MAP NO. 12101CO2B8F." - 1. THE SURVEYOR HAS NOT ABSTRACTED.'THE'
'THE'"-
DATED SEPTEMBER 26. 2014. AND FOUND THE.SUBJECT PROPERTY LAND SHOWN HEREON FOR EASEMENTS. RIGHT
APPEARS-TO LIE IN ZONE-X',.AREAS DETERMINED TO BE OUTSIDE THE OF WAY. RESTRICTIONS'OF RECORD WHICH
0.2%ANNUAL'CHANCE FLOODPLAIN.THE SURVEYOR MAKES NO - MAY"AFFECT THE TITLE,.OR USE•OF THE LAND.
GUARANTEES AS TO THE ABOVE INFORMATION. PLEASE CONTACT THE "
LOCAL F.EM.A.AGENT FOR VERIFICATION. 2., NO UNDERGROUND IMPROVEMENTS HAVE.BEEN
LOCATED EXCEPT AS SHOWN..
BEARING BASIS:
BEARINGS SHOWN HEREON ARE BASED ON THE CENTERUNE OF SIELLA - 3. NOT VALID WITHOUT THE AUTHENTIC'
VAST DRIVE BEING N09T59'20-W. PER PUT.' ELECTRONIC SIGNATURE-AND THE AUTHENTIC
ELECTRONIC SEAL.OF A FLORIDA"LICENSED
REVISED: AMERICAN SURVEYOR AND-MAPPER.
(FIELD DATE:)=-30 FEET S U"F4z EY 1 N G k,Do Y mes Igitallysignedb Ja W
SCALE: ,y�;::.'14 leman
8e MAPPING INC.
°" N:cn=James W.Boleman„
APPROVED BY: - 'o=American Surveying&'
'� Mapping,Inc,ou=HB, .
180820 LOT 18. CERTIFICATION OF AUTHORIZATION-NUMBER LB#6393 �°' r"":.emall=kiolemanoasmcorpate.co FOA5M
BLOCK 18 3191 MAGUIRE BOULEVARD, SUITE 200 alp;•••"+ n,c=us-7 THE.
JOB No. ORLANDO, FLORIDA 32803 ¢'
r ;+ ' Date:2020.07270957:57-OS'o0'FIRM
DRAWN BY. ose
(407) 426-7979 DATE
PLOT PLAN-0621/2020 dGWWW.AMERICANSURVEYINGANDMAPPING.COM •'DAMES W. BOLEMAN PSM 5485
� .# ..
D.R. Horton-35617 Stella Vast Dr:2,362 sqft
Column ts
SQ. FEET PRICE
MAIN OR LIVING: 2,362 $ 112.65
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 266,079.30
FEE SHEET $ 1,375.00
ADDRESS $ 30.00
DRIVEWAY $ 45.00
BUILDING: $ 1,477.50
ELECTRICAL: $ 309.38
PLUMBING: $ 206.25
MECHANICAL: $ 144.38
SUB-TOTAL $ 2,137.50 n
TOTAL $ 2,137.50
SEWER: I V
WATER:
IRRIGATION: $ -
TOTAL: $ -
WATER METER:
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 $ 2,690.85
PARK IMPACT FEES $ 769.56
SIF'S: $ 8,328.00
100.0% $ 8,328.00
1.0% $ 83.28
TOTAL: $ 8,411.28
T I F'S: $ 3,632.00
99% $ 3,595.68
1% $ 36.32
TOTAL: $ 15,503.69
City of Zephyrhills Permit Application Fax-813-780-ob21
Building Department
Date Received, 1(als"D ecxueh alw-CCAW-korfm, ctmn
Phone Contact for Permitting
7. ]Owner's Name Owner Phone Number
Owner's Address1 ]7.(42r)?1:T�:,J C ro nnlyl i MT 3�L Owner Phone Number
-Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS F��(o Lid 101, \1) 0;yJ:_DQ 2all2but I let- 'ns-41 LOT#
SUBDIVISION PARCEL ID# 7_';7-7_1- 0(90
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR R A6D/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE 0 SFR 0 COMM OTHER
TYPE OF CONSTRUCTION BLOCK FRAME STEEL
_Q)DESCRIPTION OF WORK FN e "i Z-
BUILDING SIZE F SQ FOOTAGE Sql HEIGHT F
nrr-sIZZ . . . . . . . . . . . . . . . . . . .
BUILDING $
VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL AMP SERVICE Q PROGRESS ENERGY 0 W.R.E.C.
=PLUMBING $
=MECHANICAL ' $ VALUATION OF MECHANICAL INSTALLATION
GAS ROOFING SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
• . . . .. . . . . . . . . . . ., . . . . . . . . . . . . . . . . . . . . . . . . . .
7 - - - - - - - 7 - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - ----- -
BUILDER COMPANY ■
SIGNATURE
REGISTERED I Y/ N I FEt CURRES I Y/N I
Address (00z` It COM- License# lcuab
ELECTRICIAN COMPANY arA Elerf)2-t C
SIGNATURE REGISTERED Y/ N FEE CURREM1 _Y7N I
Address j6hins Nu Zor License# ILE 0
03�
PLUMBER cc
—
MPANY lj
PLUM REGISTERED Y/ N 'FEE CLARtN Yl N
SIGNATURE
Address 147-13 TOW --S362s License# IC P C 6
MECHANICAL COMPANY
SIGNATURE REGISTERED FEE CURREN _ff y N_J
0 7 hc
Address n C� Wew Tr, License# co 33 (4
5-q 6,r
OTHER
COMPANY rV
SIGNATURE
REGISTERED Y/ N I' FEE CURREN I Y/N
Address J 3 License# 572 3 3
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 Pla-ns,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&I dumpster;Site Work Permit for su6dIvIsions/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&I 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
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 author!zI'n
OVER THE COUNTER PERMITTING (copy of contract required)
-*.........
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/FVge)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE QF DEED RESTRICTIONS: The undersigned understands that this permit may bo subject to"daed"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 hirbde oonhactor 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 \cum, 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. FVrtharnnoro, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor B\o&' of this application for which they will be responsible. If you, as the owner sign as the
oontnactor, that may ba on indication that he |o not prop er|y]|cenood and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION )K8PACTI]T\L\77ES IMPACT AND RESOURCE RECOVERY FEEG: The undersigned unde��nde
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buUdings, or expansion of existing bui)d\nQs, as specified in Pasco County Ordinance number 89-07 and
90-07. as amended. The undersigned also underotanda, that such fees, as may be due' will be identified et the time of
permitting. It is further understood that Transportation Impact Feea'and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. (f the project doeanotinvo|vaaoarUficateofoocupenoyor
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco {}ountyVVotar/Sevver 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, osomnendmd): \f valuation of work ia $2.5OO.00or more, |
certify that |, the applicant, have been provided with o 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 itto the"ovvner"prior tocommencement.
CO0TR/\CT(]R'G/O\NNEFL'SAFFIDAVIT: | certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable \avva regulating construction, zoning and land development. Application is
hereby made to obtain e permit to do work and installation as indicated. \ 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 |asa regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. { also
certify that | understand that the regulations of other government agencies may apply tothe intended vvork, 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 ofEnvironmental Protection-Cypress Boyhaods. Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
' Southwest Florida Water Management District-Wells*, Cypress Bayheoda. Wetland /neoa' Altering
Watercourses. '
' Army Corps ofEngineeno-GeavmaUe, Docks, Navigable Waterways.
- Deportment of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment.
Septic Tanks.
- UG Environmental Protection Agency-Asbestos abatement.
- Federal Aviation Autho[\tv-Runvvaya. `
| understand that the following restrictions apply to the use offill:
- Use of fill |a not allowed in Flood Zone'V' unless expressly permitted.
' If the fill hnateho| is to be used in Flood Zone "K, it is understood that e drainage plan addressing e
"conOpeOoating volume" will be submitted at time of permitting which is prepared by o professional engineer
licensed by the State ofFlorida.
- If the fill,material is to be used in Flood Zone "/Y' in connection with a permitted building using stem vvo||
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 od'ocaOt
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 |eao than one (1)
acre which are elevated by fill, an engineered drainage plan iarequired.
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 a separate permit may be required for electrical vvork,
p|u[nbing, signs, vva||o, poo|s, a|[ condiboniog, goe, or other installations not specifically included in the application. A
permit issued shall be construed to be m license to proceed With the work and not as authority to vio|ato, cancel, o|tar, or
set aside any provisions of the technical codes, no.r 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 requeoted, in writing, from the Building Official for o period not to exceed ninety /00\ 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 T0 YOUR PROPERTY. IF YOU INTEND T0 OBTAIN FINANCING, CONSULT
D
Q
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.coriiply with R401:3:of the F.B.C.
3:. . Con action 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.aR.O.W. use permit: All 4 sides.of:drivewaythru the sidewalk shall have
.. .
expansion material..'
6: All setbacks shall be met.
7: All property markers shall be uncovered_a'd.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:C
.12. Water heaters shall.:comply with section P607.3 of-the RB 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
15. Smoke detectors are to be installed in'accordance 'With-R3-13:1.of the.F.B.C. -
16:All glazing requirements are to be.in:accordance with R308A of the F.B.-C.
17. All means of egress are to be in accordance with k3 i l of the RB.C.
. .. . .
18."Green gypsum board"shall'not.be used as a backer in showers or tubs.R702.:4:2 R&C.
19: Combinatiori-type AFCI breakers are erequired 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 NX.C. Codes-will be enforced:
23. Tamper- Resistant Receptacles in accordance with 406.41 of the 2016 N.E.0
24. In accordance with the Land Development 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.I; inch (19:1 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 enemy:cacls shall be:with permit at all times
27. Conn of final insulation report shall be provided with permit before rnal
2 pool or'screen
8 No.fence, seen enclosure :is issued with:this permit.
F.F.E.-Finished Floor Elevation
F.B.Cm Florida Building Code 6t'Edition
R.O.W:-Right of Way
A.D:A.=Americans with Disabilities Act N.E.C.-National Electric Code (2016)- .
i
i
PASCO COUNTY, FLORIDA
Permit No.
Date Permitted �!rZ -Z62
Builder Name/Owner Name � Control#'
County Parcel No. 32_2,6-2,1 QI Q-r 2 01 SubDiv: r wl - f,
Address/Location6 7
Classification/Type of Use
TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit:
Exempt ❑Yes ❑ No How Determined
Impact Fee Amount $. ��a. ,�_ Zone No. TAZ:
SCHOOL i (056)FE 9 y , ,r j�
Account (056 Sln le-Famll Detached House Amount $ ( 2-5
(057) Mobile Home
(058) Other Residential
123) Collection Fee
Exempt ' n Yes ❑No How Determined
PARKS AND'RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zone TOTAL AMOUNT $ �
Exempt ❑ Yes ❑ No How Determined
LIBRARY FEE '
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total
Exempt ❑ Yes ❑ No How Determined Total Amount
RESOURCE FEE 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 recelpt 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