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Home My WebLink About22-5409® a 5335 EighthStreet Zephyrhilis, FL 3354BNR-005409-2022 Phone: (13) 780-0020 Fax: (313) 7 - t� 1 Issue gate: 01l10f20 3 1 ' C N esi 04 26 210140 00100 0280 Address: 4600 W Cypress St 200 TAMPA, FL 33607 i TOWNHOME 1400 Sty FT "AS School Impact Fee - Single Family $IF I percent Fee Fire Wall/Smoke Wall Inspection Mechanical Permit Fee Building Plan Review Fee Plumbing Valuation Fee uilding Permit Fee ibElectrical Plan Review�vAwma- Imoact Fee -Police Work:Class of Building Valuation: $211,560.00 Valuation:Electrical i Mechanical Valuation: rib 0 Plumbing Valuation: Total Valuation: 0 i Total Fees: t Date Paid: Amount Paid: $13,675.45 s Contractor: LENNAR HOMES LL $3,353.00 [driveway Fee $45.00 $33. 3 Mechanical Plan Review Fee $0.00 $15.00 Sewer Connection Residential Fee $2,090.00 $732,71 Address Fee $30.00 $114,05 Public Safety Impact Fee ®Admin $26,35 $18U0 Plumbing Permit Fee $145.78 $0.00 Transportation Impact Fee - City $34.80 $1,097.80 Transportation Impact Fee $3,445.20 $0.00 Electrical Kermit Fee $198.67 $769.56 Water Connection Residential Fee $1,010.00 $54.00 f ; f i ?. � : & it : � JF #' . ■' ' �' �1. • i s !` • 1 Complete Plans, Specifications add foe Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O. NO OCCUPANCY BEFORE " APPROVEDCONT TOR $IGNATURE PE PERMIT EXPIRES IN 6 MONTHS WITHOUT INSPECTION 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Phone Contact for Permitting 908 770 7763 Owner's Name CAL HEARTHSTONE LOT OPTION POOL 03 L P Owner Phone, �Number 8 �13_S74.�5700 Owners Address 1 23975 Park Sorrento, Ste, 220, Calabasas, CA 91302 Owner Phone Number Fee Simple Titleholder Name E/A� Owner Phone Number Fee Simple Titleholder Address NIA JOB ADDRESS 16880 Ripple Pond Loop LOT # SUBDIVISION Abbott Square��PARCEL ID#1 04-26-21-0140-00100-0280 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH INSTALL REPAIR 8 PROPOSED USE SFR 0 COMM OTHER TYPE OF CONSTRUCTION BLOCK FRAME STEEL DESCRIPTION OF WORK BUILDING SIZE SQ FOOTAGE HEIGHT BUILDING r - ------21156------------ 7 10 VALUATION OF TOTAL CONSTRUCTION 1 FYIELECTRICAL PROGRESS ENERGY W R E C AMP SERVICE PLUMBING $ 21156 747Iles z I I MECHANICAL VALUATION OF MECHANICAL INSTALLATION GAS 10 ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS F____7 FLOOD ZONE AREA DYES Do BUILDER COMPANY Lcrinar I Ionics, LLC [��FEE GURREI SIGNATURE REGISTERED Y/ N Y/N Address 4301 W(Scout Blvd Suitc 600 Tampa, FL 33607 License # CGC1518166 ELECTRICIAN COMPANY Edmonson Electric, Inc. SIGNATURE REGISTERED [��E CURREN L=N Address License # PLUMBER COMPANY !Bayonet Plumbing, Heating cge AC, Inc SIGNATURE t REGISTERED Address License # I CFC042998 V IV I MECHANICAL COMPANY Bayonet Plumbing, Heating & AC, Inc SIGNATURE 7 REGISTERED / N Address e / License# I CAC058062 V COMPANY [EC_.�S�terling Q�uality R�oofing,�Inc OTHER REGISTERED Y/ N FEE CURREN Y/N SIGNATURE F_ Address 7 License # 1 CCC057991 RESIDENTIAL Attach (2) Plot Pla s,, I sets of Building Plans (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) rking days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities I durnpster, Site Work Permit for subdivisions/large projects COMMERCIAL Attach (2) complete sets of Building Plans plus a Life Safety Page; (1) set of Energy Forms, R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 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 authorizing same OVER THE COUNTER PERMITTING (copy of contract required) Reroofs if shingles Sewers Service Upgrades A/C Fences (PloUSurvey/Footage) Driveways -Not over Counter if on public roadways.needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any applicable deed restrictions, UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are advised to contact the Pasco County Building Inspection Division —Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I certify that 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 "owner', I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the "owner" prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is my responsibility to identify what actions I must take to be in compliance. Such agencies include but are not limited to: Department of Environmental Protection -Cypress Bayheads, Welland Areas and Environmentally Sensitive Lands, Water/Wastewater Treatment. Southwest Florida Water Management District -Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses, Army Corps of Engineers -Seawalls, Docks, Navigable Waterways, Department of Health & Rehabilitative Services/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 owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned, FLORIDA JURAT (F,S. 117.03) OWNER OR AGENT Subscribed and sworn 70(or 5 affirmed) l�rm;r) before me this IMIW22 by Christophar Smith Who _i_s/arepersonally known to me orb as identification. Subscribed and sworn to (or affirmed) before me this 7.02z by Christopher Smith Who is/are Personally known to me or hasthave produced as identification. 51� N Notary Public otary Public Commission No. GG 296057 Commission No, GG 296057 Stephanie Farmer Stephanie Farmer Name Name of N StM1104FAMER V E VIRTUAL REVIEW ASSIST Private Provider Plan Compliance Affidavit Private Provider Firm: Virtual Review Assist, Inc. Private Provider: Debra Anne Klahr, BU 1967 Address: 747 Southwest 21d Avenue Gainesville, FL 32601 Phone: 813-391-2959 Email: lupy(&,virtLiati-eviewassist,com Project: New SFT Address(s): 6880 Ripple Pond Loop I hereby certify that to the best of my knowledge and belief the plans submitted were reviewed for and are in compliance with the Florida Building Code and all local amendments to the Florida Building Code by the following affiant, who is duly authorized to perform plans review pursuant to Section 553,791, Florida Statute and holds the appropriate license or certificate: Naine: Debra Anne Klahr Plan Sheets: 1,2,3,4,5,6,7,8,9,I0,10.1, LI, FP-I,SN, SNI,S3,S4,S5,SS,D1,W,PAI.0,PAI.1, PAI.2,PAI.3,PAI.4, SHI.0,SHI.1,SHI.2,SHI.3,SHI.4,SHI.5 Florida License/Registration/Certification #(s) and description: FS468 Certified Standard Plans Examiner License #: PX2300 Signature of Reviewer: SWORN AND SUBSCRIBED before �m Debra Anne Klahr being personally known to me or having produced as identification and who being fully sworn and cautioned, state that the foregoing is true correct to the best of his/her knowledge or belief. hL Signature of 9040 Print Name Not Public: NOTARY STAMP BELOW My commission expires: l.UC;ERO K1t4G 310390 26 E%p1ReS,, ju� 2, 20 VIR1 UAL BEV! EW ASSIST Notice to Building Official of Use of Private Provider Effective January 20, 2003 Parcel Tax ID: 04-26-21-0140-00100-0280 Services to be provided: Plans Review X Inspections Note: If the notice applies to either private plan review or private inspection services the Building Official may require, at his or her discretion, the private provider be used for both services pursuant to Section 553,791(2) Florida Statute. 1— Ste , the fee owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services indicated above. Private Provider Firm: VIRTUAL REVIEWA Private Provider: DEBRAANNEKLAHR Address: 747 SW 2ND AVENUE - SUITES 1 Telephone: 813-376-3088 Fax: N/A I have elected to use one or more private providers to provide building code plans review and/or inspection services on the building that is the subject of the enclosed permit application, as authorized by s. 553.791, Florida Statutes. I understand that the local building official may not review the plans submitted or perform the required building inspections to determine compliance with the applicable codes, except to the extent specified in said law. Instead, plans review and/or required building inspections will be performed by licensed or certified personnel identified in the application. The law requires minimum insurance requirements for such personnel, but I understand that I may require more insurance to protect my interests. By executing this form, I acknowledge that I have made inquiry regarding the competence of the licensed or certified personnel and the level of their insurance and am satisfied that my interests are adequately protected. I agree to indemnify, defend, and hold halessthe local government, the local building official, and their building code enforcement personnel from any and all claims arising from my use of these licensed or certified personnel to perform building code inspection services with respect to the building that is the subject of the enclosed permit application. I understand the Building Official retains authority to review plans, make required inspections, and enforce the applicable codes within his or her charge pursuant to the standards established by s. 553.791, Florida Statutes. If I make any changes to the listed private providers or the services to be provided by those private providers, I shall, within I business day after any change, update this notice to reflect such changes. The building plans review and/or inspection services provided by the private provider is limited to building code compliance and does not include 1. Qualification statements ' and/or resumes of the private provider and all duly authorized representatives. 2., Proof of insurance for professional and comprehensive liability in.the. amount of $1 million per of 5 years subsequent to the performance of building code inspection services, (signature) Print Name; Address Telephone No.: ST,kTE OF FLORIDA couNTY OF HILLSBOROUGH Individual BDforeme, ties day of -------- 20—, personally appeared who executed the foregoing instrument, and acknowledged before me that same, was executed for the purposes therein expressed. print Name,:ShLtstopher Smith its: Aut or ze aent Address:_ZDD_N�� Mian,iij FL 33172 Telephone. No, 813-574-5700 Corporation Befbrerne,this_ 22ND day of —MAY 2o 2.2 personally appeared of Lennar HomesL—L—Q—. a -corporation, on behalf of the state corporation, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed, MM=. NEEHISEEMMM M (signature) Print Name: Telephone Partnership B eforo me, this day of 20 personally appeared p artner/ageot on behalf of a partnership, who executed the foregoing instrument and acknowledged before me that same was executed,forthepurposestherem expressed. Personally known X or Produced identi cation_ Type of identification produced Signatare of Notar PrintName —ASHLEE —CALLAHAN Notary Public Stamp: S public-T. st�tl� DI Florida,. !Kotgy Florida Corarnissi on Expires rjImIssior, GG 244456 NOVEMBER 30,2022 Explees NOY 50, 101 Mrs 5 IN I N AYM� Page 2 of 2 I—COMMERR IAL BUILDING SERVICES DIVISION VIRESIDENTIAL BUILDING PERMIT DATA SHEET FIRE MARSHAL #01 - Required Permits Building -T Mechanical Electrical Amp Inspection Only 1 Inspection 0n1v [j In LJ Inspection Only Roof El Medical Gjas. EO] Fire Sprinklers El On Site Piping re Fire Alarm El Potable Backflow Assembly li Ej Fire Line Backflow Preventer El rrigation Backilow Assembly Demolition El Walk-in Cooler Refrigeration 1:1 Fence/Wall El Grease Trap mimnym Ty e Construction Occupancy Load Classification: Assembly may Care/Educational E= " :Mercantile an"Y OW,"Fact Hazardous nal E= ory Residential 3Storage E= Building Use: Single Family townhouse Alteration Level I Level 2 Level 3 VNew Construction E] Interior Finish E] Interior Remodel E] Exterior Remodel El Addition E3 Revision Overall Size: Number of Stories: Total Sq. Ft.: 26-8 x 71 1 1763 Living Area: Covered Area: # of Bedrooms: 2 1400 363 # of Baths: 2 Cost per square foot: Estimated Value. 1 i 1 Roof T e: Shin n E]Tile - El Built-up El Metal EJ Other Squares: 19 Zoning: Wi I orne liebris. Energy Code: i Eli405-2020 Inside k�2utside --Vlood Zone: X Base Flood Elevation: Finish Floor Elevation: —Yes--V:,,',—± S, Hydrostatic Vents? ED�] No Sq. Ft. Enclosed Space Below BEE: # of Vents: Size of Vents: Total Sq. �In. Permanent Openings Central —A/C 9 Heat Pump El Window A/C Gas AIC ®Gas eat Electric Heat On S in anit SStorm Sewer Catch Basins au�ia Sewer Potable Water Underground Fire Line Setbacks Front Rear Left Right As per Approved Site Plan £'UP f f � t t � - UP f c Z V1 t} LTt ENCE ` pc1T HOJ,p}, "'t4 .# NO. 67540 ST�OF �1� �{'3f01VAL ti ' Datum: NAVD 8k a " C201 DESCRIPTION; LOTS 2530. BLOCK ),ABBOTT SQUARE PHASE IA, ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 89, PAGES 28-35, OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA. PROPOSED ELEVATIONS AND GRADING SHOWN HEREON ARE TAKEN FORM THE ENGINEERING PLANS OF f 'ABBOTT SQUARE RESIDENTIAL, PREPARED SY'WRAPROVIDED BY CLIENT Y �_� i I zsolPi I' .his SITE PLAN Prepared for and CcttiFied To: Lennar Homes ALL ELEVATIONS REFERENCED TO NORTH AMERICAN VERTICAL DATUM OF 1988 s (NAVD 88) Scale: 1 " = 20' � 2 r ww Qv °b TW-- TOP OF WALL i m BW= BASE OF WALL. 2" OAK x 10.00' PUBLIC UTILITY EASEMENT _ PROPOSED DRAINAGE FLOW (00,001 PROPOSED GRADE E-00.00 -=- EXISTING GRADE NOTES: LOT GRADING TYPE A PROPOSED PAD ELEVATION -- 10&50' FRONT SETBACK = 20' SIDE SETBACK T5' SIDE SET BACK (CORNER LOT) �15 REARSETBACK 15' LOT = 20235 SO. FT LIVING AREA =x SO. FT. PORCH = x SO. FT. GARAGE = x SO. FT. COVERED LANAI = x SO, FT - PATIO = x SO. FT. POOLAREA = N_ZA_SO.FT. CONC. DRIVE = x SO- FT- A!C & CONC PAD ,__SO. FT - SIDEWALK = x SO. FT. LOT SOD = x SO. FT. R/W SOD -_A__SO. FT - LOT OCCUPIED = x R/e AREA TO IRRIGATE = x a7P PROPOSED: MINIMUM FLOOR ELEVATIONS: LIVING AREA: 107,17' GARAGE AREA: ELEVATIONS REFERENCED TO NORTH AMERICAN VERTICAL DATUM OF 1988 SURVEYABBREVATIONS A' ARC,CNGTH AGxAIR CONDHIONER to -DEED D_F,' DRAINAGE EASEMENT Ale AtUMiNUMFENCE EL OR ELEV PI EVATION 9E=SPA FLOOD ELE.VA11ON FOP w EDGE Or PAVEMENT 13M=EENCHMM.'C C CURVE 'EMT -CAS M;:,NF F/Cu FENCE CoPNER IC I CALCULATED FCM ^ FOUND CONCRETE INTER NE �yipNUR1EN1 CMi CUVIN INK PFNCF F, 1OUNDI:ONOPE CM=CO2RUGArtt)M_iAL PIP FCTELMIRm FOUNDIRON ROD FN&D-FOUND NAIL d DISK TOLC_CONN ONC>CORET D CST-CONCR - For FOUND OPEN PIPE CST= CLEAN S-G .F iGANGLE TIM FPP EOUNf)PINCHED PIPE JOB #5829 SITE PLAN (NOT A SURVEY) APPARENT FLOOD HAZARD ZONE: "X` COMMUNITY NO. 120235 (MAP NUMBER 12 10 1 C-0289-F) EFFECTIVE DATE: 09/26/2014 `NV - INVERT E-IKENSED 8DSNESS PC-PONT OF CURVE PCC POINT OF COMPOUND CURVE (RI=RECORD RNG^RANGE LE - LANDSCA 'EASEMENT PCP PFRMANENT CONTROL POINT SRO - RAIL ROAD SPIKE LFE- LOWS! FLOOR ELEVATION rE POOL EQUIPMENT rAic-RIG41'or WAY LS- tiCENEED SURVEYOR Ph- ACE SEC -SFC11ON Iell-ei APDRED IF POINT OF INTERSECTION Von -SET NAIL AND DISK OFF - MITERED END SECTION PIC=PARK RKA ON L8#8183 NCF=NO QRNER FOUND e tROE1111,;NE SO v SET I/2 RON RCD Glad 81 ED O/A- OVERALL NOB POo' StdONING Lee -TFM O AKY;-_`NCH MARK OHW^ OVIOC IEAD WOFDi POC IONTOr COMMENC(MENT TOBa TOPQFBANK OR ^OFFIOALRECORDS POT - POINT ON IINC TWP- IOWNS'{IP (P ^PLAT PS=PLAT BOOK ACPONT OF REVERSE CURVE PRM-PERMANENT REFERENCE MONUMEN' U.E-UTltIY_`ASNME-NT V`-VON, FENCE Date of Site Plat'. 8-10-22 1.) Current title information on the subject property had not been This certifies that sketch of the hereon describe furnished to Initial Point Land Surveying, LLC, at the time of this property was rt al`•! F§ I#� upeonslon and DWGAV530LEU-A7E SITE 2,) This sketch was without the benefit of a title search. meets the ale D$Practice for prepared No instruments of record reflecting ownership, easements or su eys #Lard of Lar Su 4f &Igne vile rights -of -way were furnished to the undersigned, unless otherwise S re q Drawn by: DJB } Checked byJH shown hereon. &) Roads, walks, and other similar items shown hereon were take from engineering plans and are subject to survey_ purst$nt ta'Secacin 47; (. F art) St tt I (�at2; t��' [ 1EVISIONS d,) This SITE FLAN does not reflect nor determine ownership. 4' �1 Q,3'(,t �"lQ.e0( F L" 6.) This SITE PLAN is subject to matters shown on the Plat of tp `ABBOTT SQUARE PHASE IA" 6.) Dimthereofensions shown hereon are in feet and decimal portions - + - Jeff M v� FLORIDA 6'\AND MAPPER N : 7.) Contractor and owner are to verify all setbacks, building dimensions, and layout shown hereon prior to any construction, NOT VALID WITHOUT THE ORIGINAL and immediately advise Initial Point Land Surveying, LLC, of any SIGNATURE AND SEAL OF A FLORIDA deviation from information shown hereon. Failure to do so will be LICENSED SURVEYOR AND MAPPER at users sole risk. SEC, 11, TWP. 25 S, RNG 21 E- PASCO COUNTY, FLORIDA (ABBOTT SQUARE) 3�3 G VINYI FENIC-E�,�, AS'1 IALT G - WObt?FENCE CHAIN LINK FENCt ALJM.NUM FENCE 1708 Water Oak Drive Tarpon Springs, Florida Phone: (727)-831-1990 FlorldaPLS7723Cgmaiisom , LBk 8183 Kr& xotyp +utkxsaw��% N d* � Initial Point Land Surveying, LLC. Builder N r Name l Control County Parcel No, i> obi:~ G i Classification/type of Use TRANSPORTATION IMPACT FEE Rate: Sq. Ft Unit; _ Exempt El Yes No How Determined Impact Fee Amount 3 Zone No. TAZD SCHOOL I PAC' FEE Account (0)Single-Family detached House Amount $ (057) Mobile Home (OSS) father Residential (123) Collection Pee Exempt Yes No How Determined_ Land Account Land Credit hand Total Recreation Account Recreation Credit Recreation Total Zone Total Amount $� Exempt Cles . 0No How Determined LIBRARY FEE Land Account Land Credit Land Total Facility Account Facility Credit Facility Total Exempt Yes o How Determined Total Amount RESOURCE FEE ERU Total Amount PERFORMEDPrepared By Checked By NO CERTIFICATE OF OCCUPANY WILL BE ISSUED OR FINAL INSPECtION AMOUNTS LISTED HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITrING OFFICE OF PASCO COUNTY ACKNOWLEDGEMENT BELOW DOES NOT IMPLY ACCEPTANCE OF CONCURRENCE, BUT SIMPLY REECEIPT OF A COPY OF THIS FORK PLACING THE BUILDING OWNER ON NOTICE OF THIS ASSESSMENT AND THE CONDITIONS OF PAYMENT FOR SAME. DATE RECEIVED BY RECEIPT NO DATE By