HomeMy WebLinkAbout22-5235 (2)City of Zephyrhills
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5335 Eighth Street
Zephyrhills, FL 33542
BAR-005235-2022
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 11/17/2022
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.
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.
CONTRACTOR SIGNATURE
PERMIT EXPIRES IN 6 MONTHS W
PEf]T OFFICE()
JTHOUT APPROVED INSPECTION
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NOTICE OF _COMMENCEMENT
Permit Na
Property Identification No, I Z CO "Z� D 10 -1177)
i X "#T 177 t,-;7W
a) Street Address: W, L
ki fkagwagg y'r%J gzaagii.
DS' 01 , 0 01
IT: 0 re,
Nikki Et�q
"^oL.Anty Clerk & Comptroller
& M64A M�Iffila �1
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3,Owner Information ;? e
a) Name and address: BL'il-01)fl —
b) Name and address of fee simple titleholder (if other than owner)
c) Interest in property
4.Contractor Informali n
0 "Q a) Name and address: A L
b) Telephone No.: '=C, ti Fax No. (Opt.)
-578urety information F
a) Name and address:
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt,)
44Ander
a) Name and address: Phone Na.
7. Identity of person within the State of FI 'd I i ted b . T whom notices or other documents may be served:
n "� OR, 7�77
a) Name and add 1) h , z 7, Fax (Opt
b) Telephone N _, nor, Notice as Provided in Secto.
$.In addition to himself owner d,,i;.I, following person to ree,'o copy of a Lie
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: L Fax No, (Opt.)
9.Expirstion date of Notice of Commencement (the expiration dateis—...year from the date of recording unless a diff--t date is
specified):
C- \ 3'-�) Is q D)
WARNING To OWNFR- ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTE$, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDING YOUR NOTICE F COMMENCEMENT.
STATE OF FLORIDA
COUNTY OF PASCO si re of crorOwner u orlud5KC-00m(.�.-M--w
e- a t h LJ Y1 V--
Print Nwne
twasacknowledged before me this day of
im Li C.gofficer, trastee, attorney
m 'ct ,rsimally 1,..— 11 Produce
T I ype of Identification Produced am
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best ofmy knowledge and belief.
Steve Hazahvood lgnaturoofN ralPen S ingAbove
Notary Public
State of Florida
01 Comm# HH166247
EA Expires 5/8/2025
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City of Zephyrhills Permit Application
Building Department
�Phone Contact for Permittinq
11 lr�
7' Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS
LOT #
SUBDIVISION
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PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED
NEW CONSTR Lyl- I
ADD/ALT
SIGN E�fl DEMOLISH
El
INSTALL
REPAIR
PROPOSED USE
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"Ale
SFR
COMM
OTHER
TYPE OF CONSTRUCTION
BLOCK
FRAME
STEEL
DESCRIPTION OF WORK Loeno-!-1119 -I �q*- lei �"; 3�101( a, �'-" I=
BUILDING SIZE SO FOOTAGE HEIGHT [:=
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=MECHANICAL
=GAS ROOFING
FINISHED FLOOR ELEVATIONS [::=
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SPECIALTY = OTHER
FLOOD ZONE AREA =YES
BUILDER 4COMP PANY DWOC
SIGNATURE REGISTERED J N FEE CURREI\ Y/N
Address Fsu fC Y
lYt License #
COMPANY ELECTRICIAN E
SIGNATURE � REGISTERED Y / N FEE C�URREN
Address License #
L Y
PLUMBER COMPANY F-
SIGNATURE REGISTERED FEECURREN Y/N _ L_ T _J
Address License #E====
EMECHANICAL COMPANY
SIGNATURE REGISTERED ;;;FEE �CIJRREr,
Address License #E=:===
OTHER COMPANY E
SIGNATURE REGISTERED ;;;;;�FEE C�URREN
Address License #E------===
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 w/ 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 Forrns. 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 & 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
If 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)
EEZMMM��
MINIMUM
4" 3000 P51 GONG TE 5L �116"X6"X1t�l1G a GOr~1G
THR OUT CAR FIBER
I
OVER 6 MIL V1 VAPOR BARRIER OVER GLE��1 � � GOB PRE
GO AGTE e TREATED 1L _
INTERIO
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1, -.,t o -� (,3 n — have read and fully understand and agree to the
provisions of this instrument.
The undersigned states and affirms that he or she is desirous of constructing, renovating, andd*,,g to or
N said
reroofing his or her own domicile, that he or she actually occupies, or will occupy by &CU9
domicile, and same is not for rent, lease or sale. That he or she shall comply with the following
conditions:
2 ' "
OWNER'S SIGNATURE DATE 1
ADDRESS L-- 5 'b-CIL' ?, -1
PHONE
WITNESS PERMIT
I/Masterforms/OwDersAffidavit/Nov07