HomeMy WebLinkAbout21-3042r ?I
City of Zephyrhills
5335 Eighth Street
mullo".
Zephyrhills, FL 33542
BGR-003042-2021
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 10/18/2021
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 inal 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.
111111117"Kil IMICIFF I I III III
•• ••)KOD-II1441
CONTRACTOR SIGNATURE
JI
PE IT
ITHOUT APPROVED INSPECTION
City of Zephyrhills
5335 811 St
ZeDhirhill
mt-'r-I
HOW
Permit No.
0
licensed under Chapter 468, Florida Statutes as a(n):
Contractor Engineer_ Architect_ Building Inspector_
License No.
On or about did personally inspect the:
Check: Roof Deck Nailing --iz Dry in Flashing and Drip edge
Check which was used: 30# felt— Peel and Sticketh (List)
At the following
address: :3 zL�13 6 111(5-
0 ',1 a t P xv ani'l -a t i
Aftf
Signature:—�:
Sworn t
",nd�ubscribed befor
e this days
BY:
Not ry ublIc State of Florida
INGRID ROSARFO
My COMMISSION # GO 987406
EXPIRES: May 12,2024
-
Bonded Thru Not Public Under* niters
6,13-780-0020
Date R6661vod
.S
oa
City of Zephyrhills Permit Application Fax-313-730®002e
Building Department
Phone Contact for Perms tin
Owner Phan ;Num r .
E:
�. •!k QWherTkonelornoer
Fee Simolo Titloboldot-Addreas
UPI
.'. ADDRESS
SUBDIVISION
WORICPRO"ED
El
�N$TALL
PROPOSED USE
FR
DESCRIPTION"OPWORK
NED ' .. p , `I DEMOLISH
4i
Ili r�il�
tJ1LD1 IC VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ AMP,SERVIPE PROGRE$S'ENI5kGY
PLUMBIN
ME HANICAL VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING SPECIALTY OTHER
FINISHED IPWOR ELEVATIONS FLOOD ONE AREA =YES NO
ELECTRICIAN -
Address.
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PLUMBER
d
MECHANICAL
Addressz
OTHEW
SIGNATURE
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INSTR#2021221418OR BK10462 PG1 064 Page 1 of 1
10/18/2021 11:25 AM Rcpt: 2365646 Rec: 10.00 DS: 0.00 IT: 0.00
Permit No. I - Parcel ID No
NOTICE & COMMENCEMENT
8'0'0 of County of
THE UNDERSIGNED hereby gives notice that Improvement will be made to certain real prop and In i
the following Information Is Provided in this Notice of Commencement1. - ", a ance with Chapter 713, Florida Statutes,
Description of Property: Parcel Identification No. i 2 -;Lp'- N-3 a -0 0tad 0- LQ
street Address: a?5
�6 5,
2, General Description of
as
Owner information or Lessee lnfarmatlicn If the Lessee contracted for the Improvement:
h- 'e �fflkJl -
Interest In Property: - VIV614 k;ity state
Name of Fee Simple Titleholder.
Address
4. Contractor:` 4VII, ;j city state
Name ARN J?Z-7
Address
Contractor's Telephone No.: %$
_ �O3
5. Surety:
Address
Amount of Bond;
6, Lender:
City
Telephone No.:
I
ON
Address __ City State
Lender's Telephone No.:
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provide by
Section 713,113(iXaX7), Florida Statutes: d
Name
Address CRY
Telephone Number of Designated Person: state
8. In addition to himself, the owner designates
Of -
to receive a copy of the Uenor's Notice as provided In Section 713.13(9)(b), Florida Statutes.
Telephone Number of Person or Entity Designated by Owner: ---------
Expiration date Of Notice of Commencement (the expiration date may not be before the completion of on and final payment to the
contractor, but will be one year from the date of recording, unless a different date Is specified):
Under penalty of perjury, I declare that I have mad the foregoing notice of commencement and that the facts stated therein are true to the best
of my know4edge and belief,
STATE OF FLORIDA X?
7
COUNTY OF PASCO SHARON MENDOZA
NOWY Publi, - State nf Florida Signature of Owner or Lessee, or Owner's or Lessee's Authorized
Cnm,missW = GG 362073 Officen'DI"Wilor/Partner/Manager
My Co"m Es lle, Aug 4. Z023
86nd d through National
NotaryAssn'
bignatorys Title/Office
The foregoing Instrument was acknowledged before ma this i-A,.Y ofVJ, 202j, by
as (type of authority, e.g., officer, trustee, attorney In fact) for
{nam f party on hall whom Instrument was oxamted).
Personally Known DR Producqq identification Notary signature _tip _82�� 0 S tk�
Type of Identification Produced n q)"me (Print)
0
xis
2
3 E
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E
0 C>
0
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ra Cs 0
0 't5
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