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21-3196
�"a 01'1�" Name: SVB Housing, LLC Address: 2310 West Bristol Ave Tampa, FL 33609 0111200••� pogad duation 5 , 6e Water Connection Fee City of Zephyrhills m 5335 Eighth Street 01no, k' Zephyrhills, FL 33542 BNR-003196-2021 Phone: (813) 780-0020 Fax: (813) 780-0021 Issue Date: 12/20/2021 Permit Type: Building New (Residential) Class of Work: Multi/5+ units Construct Building Valuation: $23,040.00 Electrical Valuation: $505,000.00 Mechanical Valuation: $260,590.00 Plumbing Valuation: $2,614 62 Total Valuation: $791,244.62 Total Fees: $161,169.96 Amount Paid: $161,169,96 Date Paid: 12/20/2021 1:15:33PM Contractor: PARK & ELEAZER CONSTRUCTION Jrt r. Building, Valuation Fee, �41.30 $15,667.20 ___41 ark Impact Fee - Multi -Family $0.00 $2,614.6� Transportation Impact Fee $0.00 $418.75 Transportation Impact Fee - City *x",IA"", $ 5,13-1-22%, pdrtM&hts Sewer -,Connection Fee UiJ10ing,'Farmit Fee $0.00 $0.00 $23,040.00 $"_071:i 3/4 Water Meter Residential Connection Fee $0.00 $75,750.00 Public Safety Impact Fee -Admin $5,345.01 $13,012,30 LOU124AMIRITAHETT �P- a 3111 entities such as water nagement, state agencies or federal agencies. !I 111i 1,11171ffli 111WHIFF I III accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. 17 NO OCCUPANCY BEFORE C.O. --------- 1A SIGNATURE PEf IT OFFIOEU 11 24AN 10 WTITIRIT01-:1 I L1 RU HINESE"I 1:04 1111 a 0.11101 J, allyj A r. INSTR#2021237242ORBK10477 PG144 Page 1 of 14 11103/2021 08:42 AM Rcpt: 2373758 Rec: 120,50 DS: 1331.40 IT: 0,00 Nikki Alvarez-Sowles, Esq., Pasco County Clerk & Comptroller This Document Prepared by and Return to: Sunstate Title Agency, Inc. 5536 6th St Zephyrhills, Florida 33542 Our File Number: 8-33050 Iva 11*3 Vol "IA THIS INDENTURE, made October I'll, 202 1, by and between ROBERT CHARLES SIN40NS and G. S. DUFFIELD, Individually and as Successor Co -Trustees of the MARIANNE M, SIMONS REVOCABLE LIVING TRUST, dated May 28, 2008, herein after referred to as Grantor, and SVB HOUSING LLC, A FLORIDA LIMITED LIABILITY COMPANY, hereinafter referred to a Trust'] ee, whose post office address is: 2310 W. Bristol Ave, Tampa, FL 33609 (Wherever used the terms "Grantor" and "Grantee" shall include singular and plural, heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporation, wherever the context so admits or requires,) Grantor, in consideration of the sum of Ten Dollars ($10,00) and other good and valuable considerations, receipt of which is hereby acknowledged, does hereby grant, bargain, sell and convey to Trustee, his successors and assigns, all Grantor's interest in and to the following described real property lying and being situated in Pasco County, Florida to wit: TOGETHER WITH all appurtenances, privileges, rights, interest, dower, reversions, remainders and casements thereunto appertaining: TO HAVE AND TO HOLD said =1 estate with the following powers and for the following uses and purposes, to wit: 1. The Trustee is vested with full rights of ownership over the above described real estate and Trustee is specifically granted and given the power and authority: (a) To protect and conserve said real estate and improvements located thereon and to pay the taxes assessed thereon; (b) To sell said real estate, for cash or credit, at public or private sale, to exchange said real estate for other property and to grant options to sell said property, and to determine the price and terms of sales, exchange and options; (c) To execute leases and subleases for terms as long as 20 years, to subdivide or improve said real estate and tear down or alter improvements, to grant easements, give consent and make contracts relating to said real estate or its use and to release or dedicated any interest in said real estate; (d) To borrower money and to mortgage, pledge or encumber any or all of the said real estate to secure payment thereof, (c) To manage, control and operate said real estate, to collect the rents, issues and profits, to pay all expenses thereby incurred, and in addition, to manage and operate any business that may now or hereafter be operated and maintained on said real estate, and in general, to exercise any powers authorized by the provisions of Chapter 737, Florida Statutes, 1988; (f) The Trustee's liability hereunder, under the Trig Agreement or by operation of law to any persons firm or corporation is limited to the trust assets and the Trustee shall not become individually or personally obligated in any manner related thereto; 2. The Trustee shall hold said real estate and make distributions of said real estate of the proceeds derived therefrom in accordance with the terms and conditions of that certain Trust Agreement dated May 28, 2008. OR BK10477 PG145 Page 2 of 14 Our File Number: S-33050 3, No purchaser, grantee, mortgagee, lessee, assignee or any other person dealing with the Trustee need see to the application of any proceeds of any sales, lease, mortgage or pledge, but the receipt of the Trustee shall be a complete discharge and acquittance therefor. Any and all persons, including but not limited to grantees, mortgagees, lessees, transferee and assigns dealing with said Trustee need not inquire into the identification or status of any beneficiary under this deed or any collateral instrument nor inquire into or ascertain the authority of such Trustee to act in and exercise the powers granted by this deed or of adequacy or disposition of any consideration paid to the Trustee nor inquire into the provisions of said unrecorded Trust Agreement and any amendments thereto collateral hereto. 4. This conveyance is made in conformance with the provisions of Sections 689.071, Florida Statutes. S. By its acceptance of this conveyance, the Trustee covenants and agrees to do and perform the duties, acts and requirements upon it binding. 6. Each and every power hereinabove set forth may be exercised by any Trustee. Any instrument executed by any Trustee or any act taken by any Trustee shall be binding upon the trust and all of the Trustees as fully and completely as if all Trustees had executed the said instrument or taken said action. 7. The Successor Trustee shall have all of the title, powers and discretion herein given to the Trustee, without any act of conveyance or transfer. A certificate signed by any Trustee or any Successor Trustee under this instrument and acknowledged by him/her before a notary public shall be conclusive evidence upon all persons and for all purposes of the facts stated in the certificate representing the terms of this instrument and the identity of the Trustees who from time to time are serving under it. In Witness whereof, the Grantor has signed and sealed this deed the date above written, 72= itnaS 'Witness Name Printed Name Printed MARIANNE M. SIMONS REVOCABLE LIVING TRUST, dated May 28, 2008 BY. The foregoing instrument was acknowledged before me_�l day of October, 2021 by ROBERT CHARLES SIN40NS and NINA G.S. DUFFIELD, individually and as successor co -trustees of the Marianne M. Simons Revocable Living Trust, dated May 28, 2008 who is/are personally known to me or who did produce drivers license as identification. Printed Name of Notary My Commission Expires: E -'k SUSAN A MORROW M -State of FkwWa Notary Public Commission P GG 944754 � Or, " MY Comm. Expires Feb 25, 2024 onded National Notary AM tmaj, I 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Cate Received 727 23d 2>Q9 � Phone Contract for Perm fitM Ia11S sa11 s: _. az ` SVB Iloe sing, LLC Owner's Name Owner Ptrone Number Q er's Address 2310 W Bristol Ave Tampa, FL 33609 Owner Phone Number Simons 9ananneMTros[ Fee Simple Titleholder Name �.,,e_.......e.� Owner Phone Number hot 9 Sfmoss Rd, 2aphyrhtlh; FL Fee Semple Titleholder Address JOB ADDRESS 6d 19 Sinn ns t2d, Zepinpr(utts, FL 3354i � LOT # SUBDIVISION E�_�PARCEL ID# 04-26-21_O1)00-00200-0000 (OISTAtNED FROM PROPERTY TAX NO-TICE) WORK PROPOSED � NEW CONSTR F_� ADDiALT SIGN DEMOLISH INSTALL REPAIR PROPOSED USE SFR COMM OTHER TYPE OF CONSTRUCTION BLOCK FRAME STEEL ( onsmucz+otn of'neu 3 storT- 32,394 SF' resident9al apartment btulditng. DESCRIPTION OF WORK �._._...._ ,.... _.� BUiLDINGSIZE SCnFOOTAGE 32,394 HEIGHT 3(34„ BUILDING S 4 600 ©00-00 � VALUATION OF TOTAL CONSTRUCTION � 7 � � '` y U �� t11 r "ELECTRICAL $ SOS,000 AMP SERVICE J F 44D S E E Y W R.EC .. L , PLUMBING $ 514 925 MECHANICAL $2606 VALUATION OF MEGHANiCAL INSTALI_AJ10N GAS WROOFING SPEGiAt.TYa OTHER .., FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA YES NO r i Park &. L"leazer Constnuction, LLC` +' BUILDER i COMPANY _ SIGNATURE �� REGfSTEftEG Y 1 N FEE GURREN Y/ N 2+63 Ciulf to Bao B}vdC1 I ;3765 _ ' Address License # CGC1525197 1 4 2 ELECTRICIANCOMPANY 1 SIGNATURE =6V> REGISTERED Y f N PEED iRREN Y i N Address. License # PLUMBER COMPANY � SIGNATURE REGISTERED t YIN FEE CURREN YIN Address License # MECHANICAL COMPANY ���... e�,i SIGNATURE REGISTERED YIN FEE CURREN Y I N m Address License# OTHER COMPANY _ SIGNATURE `... ,Y REGSTEREO YIN FEE CURREN Y I N Address License # RESIDENTIAL Attach (2) Plot Plans, (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum tan (10) working days after submittal date, Required onsite, Construction Plans, Stonmvater Plans ve Silt Fence installed, Sanitary Facilities & i dumpster. Site Work Permit for subdivisionsAarge projects COMMERCIAL. Attach (2) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Founs. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stom water Plans wr` Silt Fence installed, Sanitary Facilities & 1 dumpste€. Site Work Permit for all new projects- All commercial requirements must meet compliance SIGN PERMIT Attach (2) sets of Engineered Flans. -PROPERTY SURVEY required for all NEW construction. Directions: Fill out application completely. ONtner & Contractor sign back of application, notarized If over $2500, a Notice of Commencement is required. (A/C upgrades over $7600) °* Agent (for the contractor) or Pouter of Attorney (for the coiner) would be someone Win notarized letter from owner authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades AID Fences (Plot/Survey/Footage) Driveways -Not over Counter if on public roadways -needs ROW �,ntractor's Material and Test Certificate for Aboveground Piping Procedure: Upon completion of work, inspection and tests shall be made by the contractor's representative and witnessed by an owner's representative. All defects shall be corrected and system left in service before contractor's personnel finally leave the job. A certificate shall be filled out and signed by if representatives. Copies shall be prepared for approving authorities, owners, and contractor. It is understood the owner's representative's signature in no way prejudices any claim against contractor for faulty material, poor workmanship, or failure to comply with approving authority's requirements or local ordinances. . j! 0 , is i t il -- Property Address: 6419 Simons Rd, Zephyrhills, Fl, 33541 Date: 6-09-202_'J Accepted by Approving Authorities (Names): City of Zephyrhills Fire Marshall's Office Address- 5335 8 St, Zephyrhills, Florida, 33542 Installation conforms to accepted plans: E Yes El No Equipment use is approved: F!] Yes E] No If no, explain deviations: Has person in charge of fire equipment been instructed as to E Yes No location of control valves and care and maintenance?: If no, explain: Have copies of the following been left on the premises?: 1. System components instructions R Yes No 2, Care and maintenance instructions R Yes El No 3. NFPA 25 E Yes El No Supplies Buildings: North West Corner of Bldg First Level Under Landing on 2-1/2" Fire Riser, iTemperature Year of Make Model Office Size 1 Quantity Manufacture Rating VIKING VK 494 2022 1/2" 225 200 Spr - ------ - -- ----- ------ -- - - ----- - ---- ---- inklers VIKING VK 300 2022 1/2" 8 200 VIKING VK 460 2022 1/2" 39 155 VIKING VK 3021 2022 1/2" 10 200 -- -- ----------- - - ------- ------- ------ - -------- - - __---_L___ - ------------- ------- - --- ----- 4101TATIA IAA I at I I 1VrQ 11 a K MC4 a LZI M M 111A.1111111 SIZA M I a K1401 a Hydraulic I Nameplate proviaea,e U Yes a Na IT no, explain: Data At Final Inspection I Nameolate I i N= t " M_ I SMOMMM DATE We are only performing fire sprinkler system visual rough/ pressure test inspections at this time. Revised: 2013-May-02 Building Inspections Forms and Handouts G:kDSDSystem\Handouts\Building\Plumbing\ContractorsAboveGroundPiping.docx Page 2 of 2 I SVB HOUSING LLC 2310 WEST BRISTOL AVE TAMPA, FL 33609 I Lax J#j;=jr�L#jjl 1116-117M arms- lit Fiscal Year 2022 Page: 1 of: 1 Purchase Order # 2 0 2" 2 4 0 Fax: 813-780-0005 refund due permit #3196 - 6419 simons rd- overcharge on some permit fees GLAccount: 01000322-322000 $92,82653 Cross Reference: 001-0000-322-lilt •$92,82653 92826.53 BILLING CONTACT ANDREW PARK PARK & ELEAZER CONSTRUCTION 2363 Gulf To Bay, Ste 200 Clearwater, Fl 33765 Payment Date: 12/20/2021 Reference Number Fee Name Transaction Type Payment Method Amount Paid ) I TOTAL $161,169.96 January 04, 2022 5335 8th Street, Zephyrhills, FL 33542 Page 1 of 1 ^ ���m '� /| ���� 4� o1�K/ . J���m �� � BILLING CONTACT ANDREW PARK PARK & ELEAZER CONSTRUCTION INVOICE NUMBER INVOICE DATE 12,EFERENCE NUMBER FEE NAME 8NR-003106- O21 3/4Water Meter Reaid*nUa|ConnectionFee Address Fee Apartments Sewer Connection Fee Apartments Water Connection Fee Building Permit Fee" - correct amount Park Impact Fee -Multi-Family Plumbing Permit Foe°=correct amount Plumbing Valuation Fee***correct amount Public Safety Impact Fee -Admin Public Safety Impact Fee -Police Transportation Impact Fee Tronaportadon|mpaotFoe-Cdy 6419Bimonn Rd 042821 0000002000000Zephyrhi||a. FL33541 City of Zephyrhills 53358thStreet TOTAL $0.00 $XOO $0.00 $13,012.30 $23,040.00 $0.00 $2,614.62 $1,307.31 $5.345.01 *5.81220 $0.00 $0.00 *101.189�98 Page 1n[1 January O3.2022 53368th Street, Zephyrhills.FL33542 w=9 Request for Taxpayer Give Form to the Form Identification Number and Certification requester. Do not (Rev. October 2018) Department of the Treasury send to the IRS. Internal Revenue Service 0- Go to wwwJrs.gov1FbrmW9 for instructions and the latest information. 1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank. SVB Housing LLC 2 Business name/disregarded entity name, if different from above ra a) 3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the 4 Exemptions (codes apply only to following seven boxes. certain entities, not individuals; see El individuaysoie proprietor or El C Corporation El S Corporation El Partnership El Trust/estate instructions on page 3): 0 M single -member LLC Exempt payee code (if any) 0.2 '46 Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership) 0. P 0 2 Note: Check the appropriate box in the line above for the tax classification of the single -member owner. Do not check Exemption from FATCA reporting M LLC if the LLC is classified as a single -member LLC that is disregarded from the owner unless the owner of the LLC is code (if an y) )another LLC that is not disregarded from the owner for U.S, federal tax purposes. Otherwise, a single -member LLC that . is disregarded from the owner should check the appropriate box for the tax classification of its owner. Other (see instructions) ► (Applies to accounts maintained outside the U.S.) 6 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional) 2310 West Bristol Ave 6 City, state, and ZIP code Tampa, FL 33609 7 List account number(s)- �ere_(qptio_nal) Taxpayer Identification Camber (TINj Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid backup withholding. For individuals, this is generally your social security number (SSN). However, for a I social security number resident alien, sole proprietor, or disregarded entity, see the instructions for Part 1, later. For other entities, it is your employer identification number (EIN). If you do not have a number, see How to get a TIN, later. or Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Employer lld..tift.t�io-.u-b�®r� E Number To Give the Requester for guidelines on whose number to enter. 1 8 7 1 8 8 2 1 1 1 4 7 6 Under penalties of perjury, I certify that: 1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and 2, 1 am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has notified me that I am no longer subject to backup withholding; and 3. 1 am a U,S. citizen or other U.S. person (defined below); and 4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct. Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual retirement arrangement (IRA), and generally, payments other than interest and divid6twWp.y&w W4`Colt required to sign the certification, but you must provide your correct TIN. See the instructions for Part 11, later. Section references are to the Internal Revenue Code unless otherwise noted. Future developments. For the latest information about developments related to Form W-9 and its instructions, such as legislation enacted after they were published, go to www.irs.gov1FdnnW9. Purpose of or An individual or entity (Form W-9 requester) who is required to file an information return with the IRS must obtain your correct taxpayer identification number (TIN) which may be your social security number (SSN), individual taxpayer identification number (ITIN), adoption taxpayer identification number (ATIN), or employer identification number (EIN), to report on an information return the amount paid to you, or other amount reportable on an information return, Examples of information returns include, but are not limited to, the following. * Form 1099-INT (interest earned or paid) # Form 1099-DIV (dividends, including those from stocks or mutual funds) proceeds) - Form 1099-B (stock or mutual fund sales and certain other transactions by brokers) • Form 1099-S (proceeds from real estate transactions) • Form 1099-K (merchant card and third party network transactions) 1098-T (tuition) 0 tr a th n e s r acti ons) • Form 1099-C (canceled debt) • Form 1099-A (acquisition or abandonment of secured property) J Use Form W-9 only if you are a U.S. person (including a resident alien), to provide your correct TIN, If you do not return Form W-9 to the requester with a TIN, you mi 3 g, be subject to backup withholding. See What is backup withholdin later. Cat. No. 10231X Form W-9 (Rev. 10-2018) 12/17/21, 2:34 PM Mail - Jackie Boges - Outlook RE: Sit B Housing Permit Application William Poe <WPoe@ci.zephyrhills.fl.us> Fri 12/17/2021 11:39 AM To: Jackie Boges <jbciges@ci.zephyrhills.fl.us> Jackie, Below are the credits we will be taking to Council for approval. We can issue the approved pen -nit with the below fees waived pending Council approval. * Phase I - Credits Transportation Impact Fee Credit for Right-of-way 66 84126 Sewer Connection Fees for liftstation ownership $42,L27,00 Park Impact fee credits for land 228.74 Phase 2 or 3 — Credits Park Impact fee credits for 760.00 TOTAL CREDITS S 176,000 William Poe City Manager City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 813-780-0000 Ext. 3501 Sent: Thursday, December 16, 20211:49 PM To: William Poe <WPoe@cizephyrhills.fl.us> Subject: Fw: SVB Housing Permit Application Hello Billy did you finish up what is needed to be refunded? they are wanting to pick up this permit this week. Sent: Thursday, December 16, 20211:48 PM To: Forrest Eleazer <Lorrest@ t.rkeleazer.com> Subject: Re: SVB Housing Permit Application i Sent: Wednesday, December 15, 20216:37 AM To: Jackie Boges <j!2ogesL@ci�-zephyihi�lls.fl.us> Cc: Scott Sutek <cott@davistuckergLoup.com> Subject: RE: SVB Housing Permit Application I hftps://outlook.office.com/mail/id/AAQkADQlYWEzOGFkLTZiZGItNGFhMil hNjJILTVIMTJmZjhjNGNhZQAQAOXhcKOhKkkPrO3xne5SIgs%3D 1/4 WiMPAWSM2,741 EXTERNAL EMAIL Jackie, ZMIEEE�• «- Do you think it will be possible to pick up the permit this week? I am trying to line up subcontractors to start on the building next week so we can meet the owner's schedule to be open before the school year. To make that happen its critical we get the permit this week. PARKE ELEAZER C ON S T R UIC I ION Forrest Eleazer I Managing Partner 2363 Gulf to Ray alvd, Suite 200 Clearwater, Florida 33765 Office:,(Z27) 216-6591 Mobile:,(Z27) 235-2509 www.pa rkeleazer.com From: Jackie Boges �<jLoggs@ Lzep ills.fl.us> gi_ ±yLh Sent: Tuesday, December 14, 20219:15 AM To: Forrest Eleazer <forrest@ arkeleazer.com> Subject: Re: SVB Housing Permit Application received emails for sub have not completed the mechanical contractor working on that one right now. Plan review is complete. MEMMM Sent: Tuesday, December 14, 20218:37 AM To: Jackie Boges <jhLoges@ci.zep1yLhills.fl.us> L_ Cc: Scott Sutek <5cott@davistuqkergLoupcom> Subject: RE: SVB Housing Permit Application EXTERNAL EMAIL Jackie, I would like to follow up on the status of the building permit. I know we needed the sub contractors registered and I informed them and they advised that they were on it last week. Can you tell me if they have all registered PARKE ELEAZER O N 5 T R, iU Cto Forrest Eleazer I Managing Partner 2363 Gulf to Bqyklvd, Suite 200 Clearwater, Florida 33765 Office:Q27) 216-6591 Mobile:,(Z27) 235-2509 Www.parkeleazer.com Sent: Tuesday, December 7, 20219:23 AM To: Forrest Eleazer <forrest@pgrkeleazer.com> 12M7/21.2:34Pw mo - Jackie 8nqoe'Outlook Cc: Scott Sutek Subject: Re: SVB Housing Permit Application WE do not have any of the subs in our contractor file. Could you have them to send over registration subject line so that i can quickly obtain information for input. RMB Sent: Monday, December 6, 20214:55 PM Cc: Scott Sutek <5cott@davistuckergLoup.com> Subject: SVB Housing Permit Application EXTERNAL EMAIL Jackie, Attached is the permit application for the building permit with all of the subcontractor information completed. I believe this is the last thing you needed to issue the building permit. PARKE ELEAZER o0mmrQ,u<m0m FornestBeazer I Managing Partner 2363 Gulf to , Suite 200 Office:(ZI7) 21U6-6591 Jackie8oQes Senior Code Support Specialist City ofZephyrhi||a 5335SthStreet ZephyrhiUs,FL33S42 813-780'0020Ext. 3513 Disclaimer: Fla. Stat 668.6076 "Under Florida law, e-mail addresses arepublic records. Ifyou do not want your e-rnail address released in response to a public -records request, do not send electronic mail to this enti� Instead, contact this office by phone or in writing," ]ecNeBoges Senior Code Support Specialist City ofZephyrhi||s 533G8thStreet Zephyrhi||s,FL33G42 813-780-0020Ext.3513 1 FxMi1 3/4 12/17/21, 2:34 PM ZMMEEEsr. �* r, M.. Disclaimer: Fla. Stat. 668.6076 "Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing." Jackie Boges Senior Code Support Specialist City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 813-780-0020 Ext. 3513 Disclaimer: Fla. Stat 668,6076 "Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing." William Poe City Manager City of Zephyrhills 5335 8th Street Zephyrhills, FL 33542 813-780-0000 Ext. 3501 Disclaimer: Fla. Stat. 668,6076 "Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public -records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing." t z, . m`�k;;wi.aCalP:if'WcsalfilC RJt YI[.tlk >af.51. a: , Mil t iR 1C'1! , IC tw.wi GricsE¢, Y y � Yr� i t �3 tl41 t3 pile ^dMl,yl �w I� II ( t Ik�iyl �V�A�LU�A�W�N�Of TOTAL OT +�oo�r�yo�N n DommwoS38aS5 EMMECHANCAL GU,S A VALUATION OF WCHAMM (WTALLAMON EDW CM fROORNG RF Tv OTHER dIX1111M11111wIWMMMk t Ik k `W, � �Q 4 II II S k■y T'.. Y. ' .�:'.c. „.a t iY � SAY t�>- ..a,. a,*{.. r),tl,�,ibo -11-11*� 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department NOTICE OF DEED RESTRCTIONS: The undersigned understands that this permit may be subject to'deed"restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibilityfor compliance with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILMES: 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 Omer and contractor may be cited for a misdemeanor violation under state law. It the Omer or intended contractor are uncertain as to Mat 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, it the Omer has hired a contractor or contractors, he is advised to have the contractors) sign portions of the "contractor Block" of this application for which they Wit 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 pernattfirg privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES 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, nail 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 orfinal 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 oath 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 1, the applicant, have been provided Win a copy of the 'Florida Construction Lien Lew—Homeoveiere Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the "Omer', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "Omer" prior to commencement. CONTRACTOR'SIOWNERS AFFIDMAT: I certify that all the information in this application is accurate and that all work will be done in compliance Win 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 Mat 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 Bayhreads, 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 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 oaster 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 penult 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 FLORIDA JURAT (F.,9.117,03) OWNER OR AGENT Subscribed and sworn to (or affirmed) before me this --by __ Who is/are personally known to me or has/have produced as identification. Public Commission Name of Notary typed, pant® or stamped `�" Z 6 n ad and sworn to (or ana elov re Me this by % _N rn Who Ware P to me or has/have produced as identification. --Notary Public Commission No, Name o ;P, Notary Public Stag of F'Iorlda 6ond�d through Natlahal Notary keen. � � From: William Poe Sent: Friday, November 5,2O21 11i0Ak4 To: Bill Burgess; ]acque|ineBoges Subject: RE: Contact Info Below I approve releasing the building permit without collecting the transportation fees. |amworking onthe developer's _ agreement, but it will not be complete for a few more weeks and I do not want to hold up the project. Billy _ ~ William C. Poe, Jr. City Manager City OfZephV[hills 53358th Street, Zeph»rhiUS,FL33542 PH:/8l3\78O-QOI1 FAX:(823)70O-0DO5 City of Pure Water From: Bill Burgess <bburgess@ci,zephyrhills.fl.us> Sent: Tuesday, October 26, 20213:55 PM To: Jacqueline Boges <jboges@ci.zephyrhills.fl.us> Cc: William Poe <WPoe@ci.zephyrhills.fl.us> Subject: FW: Contact Info Below I This is the one we spoke about. Planning took in the building plan. I have reviewed and approved them. They are in rny office. Myunderstanding isthat they will have adevelopers agreement ontransportation impact fees. VVemay have to get with the City Manager to see if we can permit prior to that agreement. If you can get with this gentleman and walk him through what is needed to permit that would be great Any other questions from him, | will be glad to anawer—Thanks,0iU Sent: Tuesday, October 26, 20213:42 PM Subject: FW: Contact Info Below Please see the contact information below for Scott Sutek. Hewould like tospeak with you regarding what bstill needed to obtain a permit to begin construction on the Dorms for SVQ. . . . ....... City of Zophyrhilis Water and Sewer Impact Fee Calculation Land Use Type: Residential Development zma�� Impact Fees For Type A Within City Limits Outside City Limits Water Distribution System $ 641.00 $ 801.25 Wastewater Collection System $ 1,288.41 $ 1,610.51 Wastewater Treatment Plant Capacity $ 721.59 $ 901.99 TOTAL $ 2,651.00 $ 3,313.75 (B) Duplex 9 �. • �-,- Within City Limits Outside City Limits Water Distribution System $ $ Wastewater Collection System $ $ Wastewater Treatment Plant Capacity $ $ TOTAL $ $ (C) Apartment or Condominium with Master Meter No. of Living Spaces . . ........ 29 Impact Fees For Type C ,I / Within City Limits Offside City Limits Water Distribution System $ 13,01230 $ i 16,265.38 Wastewater Collection System $ 26,154.72 $ 32,693.35 Wastewater Treatment Plant Capacity $ 14,648.28 $ 18,310.40 TOTAL $ 53,815.30 67.269.13 �� 111. &oil. No. of Spaces = Within City Limits Outside City Limits Water Distribution System $ $ Wastewater Collection System $ $ Wastewater Treatment Plant Capacity $ $ TOTAL $ $ (E) Travel Trailer EMM= Within City Limits Outside City Limits Water Distribution System $ $ Wastewater Collection System $ $ Wastewater Treatment Plant Capacity $ $ TOTAL $ $ 813,780-0020 City of Zephyrhills Permit Application Fax-813-790-0021 Building Department NOTICE OF DEED RESTRIC71ONS: 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 darter and contractor may be cited for a misdemeanor violation tinder state law. If the owner or intended contractor are uncertain as to Mat 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 contractions) 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 permiffing privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees map 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 89-077 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 CoUPty Water/Soper briefer fees are due, they must be paid prior to permit issuance in accordance Wilt applicable Pasco County ordinances. CONSTRUCTION LIEN LAW lChaptor 713, Florida statutes, as amended): If valuation of work is $2.500,00 or more, I certify that 1, 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 'ovmer. 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. CONTRACTORWOWNERS AFFIDAVIT: I certify that all the information in this applicaeon is accurate and that all work will be done in compliance Win all applicable laws regulating construction, zoning and land development. Application is hereby made to oblair, 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 [am 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 identity what actions I must take to be in compliance Such agencies include but are not limited to: Department of Environmental Protection -Cypress Bayheads, Welland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. Southwest Florida Water Management District -Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. AnTry 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 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 trine 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 well, 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 fl) 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 pennitting 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, after, 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 perm is commenced within six months of permit issuance, or if work authorized by the permit Is Suspended or abandoned for a period of six ((i) months after the time the work is commenced. Art extension may be requested, in eitifing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extensior. I; 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 FLORIDA JURAT (Ff5, 117.03) OWNER OR AGENT Subscribed and sworn to (or affirmed) before me this Who is/are personally known to me or has/have produced as Identification, Commission R-ime, of Notary —typed printed or stamped and sworn to, (or affirme&before me Who is/are Personakknown to me or has/have produced as identification. Public Commission No, Named ,4p, City of Zephyrhills PermP 021 Building Deparinne Date Resolved Owner's Name Sf, It Howling, Phone Contact for Permittin I"L(' Owner Phone Number I�Jr`c"' veT" cu"'-"33(d") Owner's Address�Owner Phone Number Fee Simple Titleholder Name Owner Phone Number — ----------- nillon" Rd, wp Iyr 11 Fee Simple Titleholder Address .JOB ADDRESS Li,419 Sircon, Rd, Zuphyrhilk, Ft LOTO SUBDIVISION PARCEL (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT SIGN INSTAI I EJ REPAIR DEMOLISH PROPOSED USE SrR Q COMM OTHER TYPE OF CONSTRUCTION BLOCK F RAIA E S-1 EUL DESCRIPTION OF WORK _u1-111 -7�0- i2,394 SF iesidential apaurnni hudding BUILDING SIZE SO FOOTAGE 3 HEIGHT L 'N'r A,4kx1t k q k C'EA.I.If K Itt"" Ic .Elc cc I. F.TIVIIEVIT, k r TKC t tlEf E k VALUATION OF TOIALCONS-1 RUCHON [7]ELFCTRICAL AMP S E R \11 C, F ri,PROGRESS ENERGY W R F C- MPLUMBING ffl 11-15 M'.. MECHANICAL rY 9 07 L-----i VALUATION OF MECHANICAL INSTALLATION GAS --V] ROOFING E-1 SPECIAIAY = 0THFR 'J FINISl IED FLOOR ELEVATION' 3 L' jI p , FLOOR ZZONE AREA =YES 1087" TOTI'T111' OIL I BUILDERSCOMPANY REGISTERED PEE CORREN G �AJI 111, License # Address 63 (nill'Bi ffii,� Hilvd, Cleinwann. VI, 33765 15251+17 El'rCTRICIAN COMPANY " 3 ONATURE RECASTERED WE.URREN Address License PLUMBER COMPANY SIGNATURE Addross License ai MECHANICAL COMPANY slot Address, License A OTHER COMPANY SIGNATURE REGISTERED L/ _�N Address License 0 F— If I a It I It I I I a i i It I t 1 1 4 1 4 t 4 S I I I I I a I t I I I I I I I RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) ",1 of Energy Focus; R-O-W Permit for new construction, Miriiinum ten (10) working days after submittal date Required onsile, Construction Plans, Slonewater Plans w/ Sill Fence installed, Sanitary Facilities & 1 dumpiner, Site Work Permit far subdivisionsharge projects COMMERCIAL Attach (2) coniplele sets of Building Plans plus at Life Safety Rage; (1) set of Energy Forms. R-0-VV Permit for new uonstruclics 1 Minimum ten (10) working days after submittal date. Required ensile. Consmiction Plans Stoerfvoter Plans w/ Silt Fence installed Sanitary Site work Pevnift for all new projects. SIGN PERMIT Attach (2) sets of Engineered Plans *—PROPERTY SURVEY required for all NEW construction. V". Al %- k-11%, VA, 1 4 I'A, IL-Vt V11V111V`%-N-`v le"411111111 A, 111 1*111+ A, * tl+'�.A' 'E"16- VAI-41 It, 4"k -4 If - Directions: Fill out application completely. Ov,ncT A, Contractor sign basis of application, notarized If over $2600, it Notice of Commencement is required, (A/C upgrades ovorl7500) Agent Jim the comforter) or Politer ofAflefe0y (for the ON10r) would be someone with notarized label from Owner audiolizing sine OVER THE COUNTER PERMITTING (copy of contract required) Reroofs If shingles Sowers Service Upgrades A/C Fences (I'louSurvey/Foolage) Driveways -Not over Counlet if On Public ioadways-niseds ROW 813 780 0020 City of Zephyrhills Permit Application Fax 813-780 0021, Building Department NOTICE OF DEED RESTRICTIONS: The undersigned understands that (ION permh may be subject to"deed` restrictions" which may be. more (OsifictiW than Counly regulations.The undersigned assumes responsibility for cornpliancis with any applicable deed restrictions. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the Owner has hired a contractor orcontfactors to undertake work, they they 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 Mat licensing requirements may for the intended work, they are advised to contact the Pasco County Building Inspection Divislon—Licensing Section at 727,847- 8009. Furthermore, if the owner has hired a contractor or cordfaclois, lit, is advised to have the contractors) sign portions of the, 'contractor Block" of this application for which they Wit 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 Imanitting privileges In Pasco County, TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands trial Transportation Impact Fees and Recourse Recovers Fees may apply to Hie construction of new buildings, change of use In existing building& or expansion of existing buildings. as specified in Pasco County Ordinance number 89-07 and 90,07, as amended The undersigned also understands, (list such fees, as maybe due, will be identified at the time of permitting. It is furthorunderstood that Transportation Impact Fees and Resource Recovery Fees must be paid poor to reserving a "certificatte of occupancy' or final power release It the project does not involve a certificate at occupancy or final power release, the fees must be paid print to permit issuance. Furthermore, if Pasco County Water/Sevier Impact fees are due, they must be paid prior to permit issuance in accordance Win applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended); If valuation of work is $2,500 00 or more, I cerfily that 1, the applicant have been provided with a copy of the 'Florida Construction Lien Protection Guido' prepared by the Florida Departme'll 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 fear) to deliver it In the 'ey'ner'prior to cauthencement, CONTRACTOWWOWNERS AFFIDAVIT: I certify that all the information in this application is accurate and that oil work MI be done in compliance with all applicable laws regulating construction, zoning and land development Application is hereby made to obtain a pennit to do work and installation as indicated. I certify that no vast: or installation has commenced poor to Issuance of a Pont* and that all work will be performed to meet standards of nil laws regulating conshuGlion. County and City codes, zoning regulations. and land development regulations in the jurisdiction. I also certify that I understand 11181 the regulations of other government agencies may apply to Ilia intended woth, and that it is my responsibility to identity Mat actions i (Trust lokf to be in compliance. such agencies Include but are not llrniledlo: Department of Environmental Protection -Cypress Bayheads, Welland Areas and Environmentally Sensitive Lands, WaterfWastewater Treatment. Southwest Florida Water Management DIstrot-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. Army Corps of Engineers -Seawalls, Docks, Navigable Waterways. Departmerr! of Health & Rehabilitative Services/Environmental Health Unit -Wells, Wastewater Treatment, Septic Tanks, US Environmental Projection Agency -Asbestos abatement, Federal Aviation AuthorAy-RLInW8yS, i understand that the following restrictions apply to the use of filb 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 (inne of permitting which is prepared by a professional ongineei licensed by the State of Florida, If the till 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 stern 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 Ilia 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 ovaiet of the permitting conditions set forth in this affidavit prior to Gonimencing construction. I understand that a separate permit they be required for electrical work, plumbing. signs, wells, pools, air conditioning, gas, Of 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 Ilia leehnical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a cut rection of errors in plans, construction Of violations of any codes, Every permit issued shall become Invalid unless Life vioik authorized by such permit is commenced within six months Of permit issuance, Orif work authorized by the permit Is suspended Or abandoned for a period of six (6) months after the finle the WOrk is COTordenced. An extension nuty be requested, in writing, from the Building Official for a period not to exceed binary (90) days and vAll 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 OWNER OR AGENT,,,_ ( w.. CONTRACTOR I-_.�.- Subscribed and sworn to (or affirmed) before m S Su4scfiperl and sworn to (or affinneobefore me this ta tA,4A____ A I latQ-11144r Iffi' -Am,/ft p�, ...... . ... .... .. a 1.01i I Who Ware to me of hasireweleoduced in us $rp qhp istaic personally ki, laea produced as Identification as identification, . 7 . ..... . ... Public, Notary Public 77-_7777— No -IJ .. or's . ... ...... .. iamrr6d Commission No. Nagle 0 wff"'Commission # GG 981286 my Comm, Expires Apr 23, 2024 flonded through National Notary Asvr. , AM ,A& ISON CHRISTOPHCR FIRISCH JNotary Public - State of Florida PARK&.ELEAZER CONSTIRL)CTION City of Zephyrhills - Building Department 5335 to Street Zephyrhills, FL 33542 Data: 8/31/2021 To Whom It May Concern,- 1, Andrew Park, license holder for Park & Eleazer Construction, LLC, authorize the following agents to apply for, sign for, and pick up permits under my license number CGC1525197. Please allow only the person(s) listed below to sign. This letter of authorization supersedes all others previously on file, Forrest Eleazer Thomas Pavel Jesse Bochichio -�andy Austin Ijaw Qualifier's Printed Name Qualifier's Signature STATE OF FLORIDA COUNTY OF PINELLAS The foregoing instrument was acknowledged before me this It day of e 'A -1— who is O�r �on� �lClr�l 20-11 by to me or has —A �-% produced as identification. Notary Signature JAMISON CHRISTOPHER BRISCH Notary Stamp: Notary Public, State of Florida Commission # GG 981286 My Comm. Expires Apr 23, 2024 Bonded through National Notary Assn, ffm (-,, if try R,,,\, Ri\,(i C,tito )nn If Ianr\Atnfizr 1171 Q27rr, II ir,-nco ±V-(' ('1 Q7 OR BK10477 PG147 Pg. 4 of 14 The covenants, conditions, restrictions and easements set forth below shall bind, and the benefits thereof shall inure to, all persons and entities having any right, title or interest in the Property or any part thereof, their representatives, agents, heirs, personal representatives, successors and assigns. These terms shall be Included either within the body of the deed or by separate reference, GRANTEE: SV8 Housing LLC Todd Lovinger, Manager SVB Residential ULC Todd Lovinger, Manager GRANTOR: 4. NINAG.S. DUFFIELD, BARB ARA SIMONS AND ROBERT $1 NSASALLOFT THE C OR CO -TRUSTEES Mo H LIC ESS OF THE MARIANNE M. SIMONS REVOCABLE LIVING TRUST AGREEMENT, u/t/d 5/28/Z008 -aid, as trust resald Barbara Simons, as trustee aforesaid OR BK10477 PG146 Page 3 & 14 All that tract or parcel of land lying in Section 04, Township 26 South, Range 21 East, Pasco County, Florida, being a portion of lands being described in Official Record Book 7896, Page 1672 of the Public Records of Pasco County, Florida and being more particularly described as follows: Commence at the Northeast Comer of Section 04, Township 26 South, Range 21 East Pasco County, Florida, said point a found 4"X4" concrete monument with disk stamped Pasco Co. See. Car"; thence South 0 1 *55'09" West along the East Line of the Northeast 1/4 of said Section 04, a distance of 2623.15 feet to the East 1/4 Comer of said Section 04, said point being a found 5/8" Iron Rod, no identification; Thence South 89*56'18" West along the South Line of the Northeast 1/4 of said Section 04, a distance of 1333.53 feet to the point of intersection of said South line and the East line of lands described in Official Record Book 7896, Page 1672 of the Public Records of Pasco County, Florida, said point also being the point of beginning; thence South 02*07'06" West along said East line, a distance of 347.47 feet to a point; thence North 88*26'52" West, a distance of 259.10 feet to a point; thence North 02107'06" East along a line 440.44 feet East of and parallel to the West line of said lands, a distance of 229.33 feet to a point; thence South 90'00'00" West along a line 230 feet South of and parallel to the North line of said lands, a distance of 131.54 feet to a point; thence North 02'07'06" East along a line 309 feet East of and parallel to said West line, a distance of 230.16 feet to a point on the North line of said lands; thence North 90'00'00" East along said North line, a distance of 390.80 feet to the Northeast comer of said lands. thence South 02'07'06" West along the East line of said lands, a distance of 119.04 feet to the point of beginning. C'e'ITY OF ab FLORIDA CERTIFICATE OF OCCUPANCY"",, � �F r � R@ 8B99����.. ®! Be®e � .SAT t ! .�\.Z, .� V. gig ATEv PARCEL I. ® I I I o TYPE OF BUILDING:1 :. 1PERMIT #REMARKS: ?... �� �� � c� ` � � ,. � �l� pax} �� FINAL DATE: ILL BURGESS_ BUILDING OFFICIAL/ z WHITE: Contractor ear caner � l � � �.,�� i , x� � ��.�. YELL Bldg, Dept., lf, A DRINKING ATE I I L SAMPLE COLLECTION LABORATORY REP TINE FORMAT Cj 6681 Southpoint Pkwy, r Jacksonville, FL , 2216 . 904.363 9350 . Fax 904 363 9354 ' 8 a74 Lj 4965 SW 41 wt Blvd B Gainesville,, H 32608.352 377,2349 Fax 35I 395 6639 • E 2001 11 10200 USA Today Way Miramar, FL 33025 954,889.2288 ^ Fax 954 889 2281 . E82 35 i �T 2 2 1 8 0 4 2� 9610 Princess Patin Ave, • Tampa, FL 3 i19. 813,630,9616 * Fax 813,630,4327 ° E84589 El 380 Northfake Blvd- suite 1048 ^ Altamonte Springs, FL 32701 ^ 407.937,15 • E53076 Q 26+39 N. Monroe St , Suite D, Tallahassee, FIL 32301- 850-219.6274 • Fax 85(}_219.6275• E811095 Loh Receipt Data Tirrie . S2027A W' NO F ...E baoced Analysis Dato & T rrie: Sample Acceptance Cr erle: ` I � Sample Preservation n Ice 13 No On lae 0'C Disinfectant Check, ate 11 This Sample does not meet the following NELAC requrremerits: Report Number: Sub -Contract Lab ID: Analysis Requested: (check all that apply) Total Coliform/E. cuff 010tal ColiformlPecal ZLEnterococci j Col Rhje 0 HPC Other; Publie Water system (F WS) Nsme: laws D.C.: PWS Address: ✓ 77 r < City 4a,f Zr PWS or PWS Owner's Phone Fax #: Collector: DAVID STEVENS� Collector's Phone #_ 13-2 5-1045 Type of Supply: (check only tine) Communit Water S stem L Non -'transient Non-communih, W. Transient Non-cammunit Wate S stern Lirrrited se S stern Bottled Water Private Weil Swarimin Pull 7ther: Reason for Sampling: (check all that apply) Qistribution Rou to Qist_nhutian R .mat Raw tri eyed or assessment l auv triggered or assr ssment ' it"on i Well Survey Clearance Re laoeme als oheck_t a of sarrMle bean_ tc re aced; @oil Water Notice Qther: Sample Collection Date: v w � OC N#: AD-DO45 Effeelive 01/95, EleatronicWFB Revlsilu) 19Fi9i20't5 Sample Sample Point Sample Sam Disin- pN _ Anal itsis # (Location or Specific Address) Collection pie fectant y Nan Total Fef C. cali> Data an Time (24 fype Residual Coliform C.ollfc p Enter or1 i Qualifier" Sample hrclock (fit lL Coii h P.'. # Average of disinfectant residuals for distribution routine & repeat -sampless5 ( Free chlorine or ®Total chlorine (check one}. Unless otherwise noted, all tests are preformed in accordance with NELAC standards, and the results relate only to the samples. Disinfectant Residual Analysis Method: DPD Calorimetric QCEher: Date and time PWS notified by lab of positive rssuits: Person performing disinfectAnt analysis is (Cheek one of below): Date and time DEPIDOH notified by lab of positive restrils: 0 A certified operator (# ) t Date Repast Issued: ® Supervised by certified operator (# ____-_.. ) [� Employed by a certified lab [I Employed by DEP or DOH Lab Signature: ClAuthorized representative of supplier of water Title: TY WATER SERVICES ipr— satisfactory DEPIDOH USE ONLY QUALITY ® Incomplete Collection Information LTY W STEVENSSEER 0 Repeat Samples Required 39585 MEADOW LOOP ® Replacement Samples Required TEPHYRHILLS, FI.33542 Date Reviewed by DEPtDOLL 813-2 -1045 DEPIDQH Reviewing C1pliGial: S. iztdicalefia:Sampletype for ezthcampte. collected Swualc type ood sare ll-t)(stntre�eicnrs ,fig 1 peuimr cunaldiauce), C; = kepeaf Y'h k,;i Kasv, Ir =Erht}•Pciint to i�istnbuiran, P =Flint Relinquish By: VRtli7`�c��d'C.�xxs` lap S Special (clearance, do') � 2 Lab certification minih<r rcn the listed a mho" is included ai top vsub 11v bac rartory address. = s-� %.,� 3 €Tlense rude appropriate selection bate: `c, it Time: 4 Defined in Florida Administrariu Code Rule 62-160, Tatue t. e Cesnplcte for annu tnniy & i ©u fsansle U avn•cur mminly s3slenn semag populations up to Received y: snd virluding 4,440Sara not include mw or plain samples in tilt awraac ResutisKes A=Colubrnsare absem f'=Colirurmsarepresent;Cl=ccullveurinowtrb, i:3r( — moil ruzmetormto t atilt{62-5So.730 Reporting Format_ Date: Time: 2022 DRINKINGWATER MICROBIAL SAMPLECOLLECTION LABORATORY REPORTING FORMAT ® 6681 Southpoint F Jacksonville, FL 32216. 904,363 8350 - Fax 904 363,9354 � R82574 i 4965 SW 41 st Blvd - Gainesville, Ft 32608 > 352.377.2349 Fax 352.395 6639 - E82001 i 10200 USA Today Way" Miramar, Ft 33025 s 954.889.228Ei - Fax A54,885.2281 - E82535 9610 Princess Palm Ave. - Tampa, FL 33619 * 811630,9616 + Fax 813 630,4327 o E84589 J 380 Noriftlake Blvd., Suits 1048 . Altamonte, Springs, Ft 32701 ^ 407.937.1594 - E53076 1 2639 N_ Monroe St., Suite D, Tallahassee, FL 32301- 850,219,6274 • Fax 950.219.6275^ E811095 _ __ Lab Receipt Date &I Time: 0 P "2 022 Analysis Date, & Time: � Sample Acceptance Cri fia: it as Sample Preservation: ri lee 11 Not On Ice �'C Disinfectant Check of Defected 1) This Sample does riot most the following NFIAC requirements: Report Number: Sub -Contract Lab IDS Analysis Requested: (chick all that aRPIY) 0-Total Col6form/E. co/i 010tal ColiformlF cal O l~nterocact: i Colipha e 0 HPC Other: Public Water System (PWS) Name: PWS I.D.: —_ PWS Address:' <*_ City '. PWS or PWS Owner's Phone p: Fax Collector: DAVID STEVENS Collectors Phone #:813-205-1045 Type of Supply: (check only one) Camrntt it Water System ❑ Non -Transient Non -community Water System Transient Non-communit Water S stern Limit d lies S st to ❑ Bottled Water C Private Well C l wimmina Pool Qther: Pusan for Sampling: (check all that apply) istabutien Routine 0is ributionRe e Fraud in Bred or assessment Flawjtriaered trr assessment! additional Well Survey Rmilacem t Jsocheckt eofsamDlebein re laced Boil Water Notice Other: Sample Collection Chic: "' . DCtd#' AD-D045 Effective 49i95, Eleetrorhr; WEB Revision 11t1912015 Te 'tttltd k» tak#r2cGirYtl%I ;`>' „"'', ice t ltdGl'ka tilt? Sample Sample Paint Sample Sam Disin- pH _ _ Anal sis 4 (Location or Specific Address) Collecfion pie toctant Non- Total F , F. colt, C7ata lab Time (24 Type Residual coliform Coliform = =t=ntero , or. Qualifier` Sammie hr clock m !l. Coil he ' # s; l Average of disinfectant residuals for distribution routine & repeat samples." []Free chlorine or C ITotal chforims (check one). Unless otherwise noted, all tests are preformed in accordance with Disinfectant Residual Analysis Method; NELAC standards, and the results relate only to the samples. kjDPD Colodmetdc 00ther _ Date and time PWS notified by lab of positive results: Person performing disinfectant analysis Is (Check one of below): Date and time DFP/DDH notified by lab of positive results: �Acertified operator (#, ) X; f Date Report Issued: l Supervised by uedified operator (# } Employed by a certified lab [3 Employed by DEP or DOH Lab Signature: A Lfr? ®Authorised representative of supplier of water Title: 3 QUALITY WATER SERVICES 0 Satisfactory DEPt001-i USE ONLY ® Incomplete Collection information DAVID STEVENS l Repeat Samples Required 39585 MEADOW LOOP ® Replacement Samples Required 2EPHYRHILLS, FL 33542 irate Reviewed by DEPtDOH: 813-20S-1045 DEP1Q€}bl Reviewing Official: t. 7ndr �ttcthesv=upSetYf+etGceneh Vtmrileeoticroted Sample tYpceodesare D�L7i�tst6utiorl (n>nttnecornplianie}t`ssFe ak`Cbncic.R Raw,N -Eor NinstoDishilaiuor,P='lant RelinquishBy'_d/G?l/f ��f€"ir`..f Trgt 4 Sry i,eA (deimnee, etc) ._._._. ._ .._..... F. l,tlt> 4Crt1fi- on ntrznbcs for file Imcd tnethcxi in uwIh d at rot, with the ialx ratory address. e"r t a``� s Name circle app agnate selection, Lute: �"` a "� e i Time: d. Dermal in Florida 4dinim r uve Code Rule 67 t60, Tx6ic 1 � � �, '�'..�._....� 5. Complete for Community systems waving }x4misainns up to Received By: { t" • '- ' dam...,.,` and including 4970 Do not mdudc raw or pia h ,"uple,, m the average. ResuRs hey ,A C liforms are absent, P - Coliforms ore present; C 1� coallesent gr�,vrih, T NTc = tear nuticnxis to t-otunt (62•510. 30 RarK King Format Date: Time: SEP 22