HomeMy WebLinkAbout23-6069City of Zephyrhilis
5335 Eighth Street
ephyrhills, FL 3354
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue Date: 05/02/2023
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04 26 21 0150 00600 0080 6219 Back Forty Loop
Name: LENNAR HOMES LLC Permit Type: Building New (Residential) Contractor: LENNAR HOMES LLC
Class of Work: SFR Construct
Address: 4301 W Boy Scout Blvd 600 Building Valuation: $361,920.00 y
TAMPA, FL 33607� s.
Electrical Valuation: $54,288.00
Phone:
Mechanical Valuation: $25,334.40
Plumbing Valuation: $36,192.00
Total Valuation: $477,734.40
Total Fees: $21,026.70Cj
Amount Paid: $21,026.70 .w
Date Paid: 5(212023 11:37:50AM f,
z
CONSTRUCT SINGLE FAMILY 2580 SQ FT
Plumbing Permit Fee $220.96 Plumbing Plan Review Fee $0.00
Mechanical Plan Review Fee $0.00 Address Fee $30.00
Electrical Permit Fee $311.44 Irrigation 314 Meter (Calc) $794,92
Park Impact Fee - Single Family/Townhome $769.56 Transportation Impact Fee - City $36,32
School Impact Fee - Single Family $8,328.00 Sewer Connection Residential Fee $2,400.00
Driveway Fee $45.00 Electrical Plan Review Fee $0.00
Public Safety Impact Fee -Admin $26.35 Water Connection Residential Fee $1,140.00
Transportation Impact Fee $3,595.68 314 Water Meter Fee (Calc) $794.92
Building Permit Fee $1,849.60 SIF 1 percent Fee $83.28
Building Plan Review Fee $180.00 Mechanical Permit Fee $166.67
Public Safety Impact Fee -Police $254.00
I SP CTI FEES: (c) With respect to Reinspection fees will comply with Florida Statute 5 ®80(2)(c) the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection, whichever is greeter, for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your leader or an attorney
before recording your notice of commencement."
Complete Flans, Specifications add fee Must Accompany Application. All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
I NO OCCUPANCY BEFORE C.O.
N RACTOR SIGNATURE F E IT OFFICE
EXPIRESPERMIT IN 6 MONTHS WITHOUTINSPECTION
CALL FOR I - 8 HOUR NOTICE
813-780- C 1 "0'Zep r''IIS Pe,� A P"Ca"On
Fax-813-780-0021
Building , Department
F
Date Received
PhoneCo.a. for In
908 770 __ 7763
Owner's Nam.
Own., Phone Number
813.574.5700
Owner's Address
1 23975 Park Sorrento, Ste. 220, Calabasas, 9=1 302
Owner Phone Number
E====
Fee Simple Titleholder Name
Owner Phone Number
E====
Fee Simple Titleholder Address
N/A
JOB ADDRESS
6219 Back Forty LOOPLOT
#
SUBDIVISION AbbGttSgUarePARCEL ID#
(OBTAINED FROM PROPERTY TAY, NOTICE)
WORK PROPOSED
NEW CONSTR F1 ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK E:] FRAME STEEL
DESCRIPTION OF WORK Single Family Residence / Pool / Screen Enclosure / Fence
BUILDING SIZE SO FOOTAGE [�J$Q HEIGHT
VBUILDING
i 361920 VALUATION OF TOTAL CONSTRUCTION
BsB ELECTRICAL PROGRESS ENERGY W.R.E.C.
LP eP54288 AMP SERVICE
PLUMBING $
36192
MECHANICAL VALUATION OF MECHANICAL INSTALLATION
25334.4 4
=GAS Z ROOFING Q SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES Do
BUILDER COMPANY Lermar Homes, LLC
SIGNATURE REGISTERED Ei�� �FEECIRREN��
L I CGC 1518166
Address 43601 4BSjc.;.t 1B;Kd ;S.ft;e600 gTmpa, F 33607 License #
ELECTRICIAN COMPANY Edmonson Electric, Inc.
Y/N SIGNATURE REGISTERED ktrm CURREN
Address V License#
PLUMBER COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE REGISTERED g�� �IEE LIRI�IEI���
Address I License #
MECHANICAL COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE CtREGISTERED Y/ N FEE CURREN Y/N
Address License #
OTHER COMPANY C Sterling Quality Roofing, Inc
N
T,
C SIGNATURE REGISTERED Y/ N FEE CURREN Y ND_�
Address License # Eg57991,N���
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 & 1 clumpster; 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 & 1 clumpster. 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 (Plot/Survey/Footage)
Driveways -Not over Counter if on public roadways -needs ROW
THE
NORTHEAST 11/4 OF
THE
S'-"UTHWP--ST
1/4 OF
SECTION 4-26-21
0 PHASE 1A
Structure Table
BOOK 61
TYPEV DBI
71-75
%
WITH SKIMMER (C213)
EGP:94.40
RIM;94M
24" RCP(NW)IE:90,00
)C T A"
CS-50
TRACT 'A"
SILVERADO PHASE 1A
TYPE'C'DBf
PB 61, PG 71
EOP:90.42
RIMMA2
24"RCP(SE)1E:97.40
OWNER:
SD7-1
SILVERADO
TYPE 9 CURB INLET
EOP:95.44
FFER &WALL ESMT, Pe 61, PG 71
RIM:9517
60" RCP(S)IE:79.20
VELOPMENT
60" RCP(NW)[E:79.86
DISTRICT
SD7-2
TYPE 9 CURB INLET
EOP:95,82
RIM:95,65
60" RCP(SE)IE:80.26
f
I
60" RCP(N)IE:80.26
9b U1
RE 'A'
F:98.57 0
PAM97:90
197.67 —96',2-,
END
9 71 D7A
0
RE 'A'
F 5
:9&57
PAM97.90
L—:Mo
167'- 60" RCP @ 0.309' J/
I
97.73
96.32
SEE SHEET C209
MATCH LINE
0 TYPEV
FF:98,17
PAD:97.50
96.19
TYPE'B'
U M9837
PAD,,97.7G
36.39
L TYPE
EFF M�'47 PAD:
AM9, M
09 1 U Z —97,751 96.84T V-�—
f—TRACT 102-49, - 24" RCP @ 5,35%—
TYP—, 7W ' - , , I ig,, Pro &) n 17-/ FF:98.47 I , I
DESCRIPTION: LOT 8, BLOCK 6,ABBOTT SQUARE PHASE 16,
ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 89,
PAGES 57-62, OF THE PUBLIC RECORDS OF PASCO COUNTY,
FLORIDA,
ALL ELEVATIONS REFERENCED
TO NORTH AMERICAN
VERTICAL DATUM OF 1988
(NAVD BE)
his SITE PLAN Prepared for and CerCified To:
Lennar Homes
9
LOT 8
BLOCK 6
3.0'X6.0
PATIO
35X3 S'
373 CIS —
LOT
=-5Q59—SO. FT
LIVING AREA
-JiJ_Q_SCL FT,
PORCH
FT
GARAGE
FT.
COVERED LANAI
w_N/ASCL FT,
PATIO
-J_8SO. FT,
POOL AREA
FT,
CONC. DRIVE
FT.
AIC & CONC PAD
> 1 Z SO. FT
SIDEWALK
FT
LOT SOD
FT.
R/W SOD
FT.
LOT OCCUPIED
=%
AREA TO IRRIGATE
%
SITE PLAN
(NOT ASURVEY)
PER?
SEC, 4, TWP, 26 S, RNG 21 E.
PASCO COUNTY, FLORIDA
(ABBOTT SOUARE)
Scale: 1 = 20'
LOT 7
BLOCK 6
58W0816'E(P) 112.42'(P)
1"11/ 25 1 0 (P)
52.0
U,
PROPOSED
2 STORY RESIDENCE
0,6
ca PLAN 2551
ELEV'EF
GARAGE
47,
ENTRY
JCONC
WALK
47.3
2,;
278 r__
S88'0816'E(P) 112,42 (P)
lo�
LOT 9
BLOCK6
� - 10.00 PUBLIC UTILITY EASEMENT
PROPOSED:
NOTES:
LEGEND:
MINIMUM FLOOR
ELEVATIONS: LOT GRADING TYPE =A
LIVING AREA: 98.57'
PROPOSED DRAINAGE FLOW
GARAGE AREA:
PROPOSED PAD ELEVATION - 97,90
(00,00) - PROPOSED GRADE
ELEVATIONS REFERENCED
TO FRONT SETBACK = 20
E-00.00- EXISTING GRADE
NORTH AMERICAN VERTICAL SIDE SET BACK = 7,5'
PROPOSED ELEVATIONS AND GRADING
DATUM OF 1988
SIDE SETBACK (CORNER LOT) =10
SHOWN HEREON ARE TAKEN FORM THE
REAR SETBACK= IS
ENGINEERING PLANS OF
ABBOTT SQUARE RESIDENTIAL, PREPARED
APPARENT FLOOD HAZARD ZONE:'X COMMUNITY NO. 120235
BYWRA'PROVIDED BY CLIENT
SURVEY ABBREVATIONS (MAP NUMBER 1210IC-0289-F) EFFECTIVE DATE. 09/26/20T4
A)= A CLVNGTH
'111 - DEED
INV-INVERT
PC - POINT OF CURVE
RECORD
LEGEND
A/C -AIR CONDITIONER
AF-ALUMINUMFENCE
I"_ DRAINAGE EASEMENT
'OR
LB -LICENSED 13UISNESS
PLC- POINT OF COMPOUND CURVE
FIND - RANGE
VNYLFENCF.
CoNc ----
BEE- BASE FLOOD ELEVATION
Ft ELEV - ELEVAI fON
E P-EDGEOFPAVEMENT
LE- LANDSCAPE EASEMENT
LFE-LOWtSTPLOOR&EVATION
PCP - PERMANENT CONTROL POINT
P/E - POOL EQUIPMENT
RRS - RAR. ROAD SPIKE
SFW-R*UTOFWAY
BM
C TV
CURVE,
ESM7 - EASEMEND
LS -:-ICFNSED SURVEYOR
PIC - PAGE
SEC - SE C TKIN
WOOD FENCE
ASPHALT
IT)
I - CENT111IN
F/C = FENCE CORNER
FCM - FOUND CONCRETE
(M) - MEASURED
MES - MITERED END SECTION
PI-P JNrOF INTERSECTION
PK -PARKER RATON
SN&O � SET NAIL AND DISK
L848183
CHAN LINK FENCE
CH FENCE
C AN '�A
MONUMENT
PIPE - NO CORNER FOUND
I -PROPERTY
LINE
0 LS=
SIR -SET SET 1/2'UPON ROD
F" 'CORRU
ME' GATED METAL PIN
1-111 - COON �RON PIPE
O/A - OVERALL
POS - POINT OF
BEGINNING
TBM - TEMPORARY BE
BRICE
COL" COLUMN
C—C - CONCRETE
INI D I
-DOUNO ONROD
_ FOUND NAIL & DISK
OPAV-OVERHEADWIREPS)
O.R.OFFICIAL RECORDS
POC - POINT OF
P -POINTONIINE
COMMENCTMENT
LOS - TOP OF BANK
TOWNSHIP
ALUMINUM FENCE
C/S - CONCRETE SLAB
�.OfLo
P
Epp -FOUND OPEN FIRE
(PI PLAT
POL
RC - POINT OF
REVERSE CURVE
UE-UTIUTYEASEMENT
-CCIVERE. A
CST- CLEAR SiCE IT TRIANGLE
F -FOUND PINCHED PIPE
ImPB-PPATBOOK I
PRM - PERMAN
RIF REFERENCE MONUMENT
VT e VINYL FENCE
JOB Insaos2oBal
SURVEYOWS
NOTES:
SURVEYOR'S
CERTIFICATE
1708 Water Oak Drive
F.-t7d'Sre, —PI.D 3 1523
1.) Current title information on the subject property had not been
furnished to Initial Point Land Surveying, LLC. at the time of this
This certifies that sk"q1t the hereon described
property w upeivision and
Tarpon Springs, Florida
Phone: (727)-831-1990
DWGAS-PH I B-LB-BL6-SITF.
SITE PLAN
meets th ic o Practice for
FloridaPLS71230gmaii,com
2.) This sketch was prepared without the benefit of a title search.
e I Bard of Land
LB# 8183
No instruments of record reflecting ownership, easements or
rights -of -way were furnished to the undersigned, unless otherwise
BE
It BIT I iv ned
Drawn by CUB
hewn hereon.
ur-want 0 Section 4- by
I Wfley
Checked byJH
3.) Roads, walks, and other similar items shown hereon were taker
from engineering plans and are subject to survey.
Stat' "Wo Date:
%
SMI 7
4 This SITE PLAN does not reflect nor determine ownership
4'00'
0
RvInSiONS
This SITE PLAN is subject to FIR,
6' matters shown on the Plat of
�
IDA
ABBOTT SQUARE PHASE I B'
,LY084
Jeff M,
6,) Dimensions shown hereon are in feet and decimal portions
thereof,
FLORI 6V RAND
74 Contractor and owner are to verify all setbacks, building
_MAPPERN 1 1—
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
Initial Point Land Surveing, LLC. y
C t r,
Plan Model Elevation
Garage Lot Size Block Lot
New Development Check List
Parcel M
Address:
Setbacks: Front__2 2_--,S7 Rear 37. Sides
Elevation: Garage:
Roof Shingle Dime nsion/Architectural:
VR/\
VIRTUAL REVIEW ASSIST
Private Provider
r
Plan o liars Affidavit
Private Provider Firth: Virtual Review Assist, Inc.
Private Provider: Debra Anne Klahr,1BU1967
Address: 747 Southwest 211 Avenue
Gainesville, FL 32601
Phone: 13.391-2959
Email: Ilxc corn
Project: New SFR
Address(s): 6219 BACK FORTY 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 wilding Code by the
following affiant, who is duly authorized to perform plans review pursuant to Section 5531391, Florida Statute
and holds the appropriate license or certificate:
Name: Debra Anne Klahr
Plan Sheets CS,AI,A2,A3,A4,A5,A6.1,A6.2, SNO, SNI, S3,S4,S5,S6, ST, SS, 511, 512,
1, 2, 2.IPAl.0,PAl.I, PAI.2,PAI.3,PAI.4, SHI.0,SHI.I,SII1.2;SHI.3,SHI.4,SIII.5
Florida License/Registration/Certification #(s) and description:
FS46" Certified Standard Plans Examiner
License #: PX2300
Signature of Reviewer: Ilen
SWORN AND SUBSCRIBED before me by Debra Anne Klahr
being personally known to me or having produced as identification x
and who being fully sworn and cautioned, state that the
fore in s itrue and correct to i`ne best f his/her knowledge or belief
Signa e of Notary Print Name
Notary Public: NOTARY STAMP BELOW My
commission expires:
ASHIEE CALLAHAN
*= My COMMISSION # HH 295980
�� EXPIRES: November 30, 2026
Services to be provided:
\/R/\
v R T U A L R E V E., 01 A S 5 1 S
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
6219 Back Forty Loop
04-26-21-0150-00600-0080
Plans Review X
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,
pfflv��
owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
VIPTUAL PEVIEW A55I5T, ME
Private Provider Firm:
Private Provider: r)EBPA ANNE KLAHP
Address: 747 SW 2ND AVE- SUITE 170,301,357,4 358, GAINESVILLE, FL 32601
Telephone: 813-376-3088 Fax: N/A
Email Address (Optional): deb@virtualreviewassist,com
#
Florida License, Registration or Certificate #, (LTA SU1967/ PX2300/ BN4615)
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 harmless the
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
review for fire code, land use; envirommental or other codes.
The following attar eats are provided as required:
1. Qualification statements and/or resumes of the private provider and all duly authorized TepTeStlltativeS.
2, Proof ofinsuranca forprofessional and co#rehensive liability in,the,smount -of $1 raillion per
o courKe=e relating to all services s p orfoimod as a private provider, including tail coverage for a minimum
of 5 years subsequent to the perfbriu ' code inspection se ices,
an c(-, of building
Individual Corporation Partnership
Print Coiporation.Nkuio PrbutFartnershipNmne
By:By —
;(-igmtore) (signature) (signature)
Print P.Tint Flint
Name _.Ch�rlsto Christopher S�ry�ith Name -
its: Authorized AggLnt Its.
Address;
Telephone Miami FL 33172
TelehTolTelephoneNo, 91on53-574-5700
'Pleak,,IlSe oppropriate notary blbck
s TATF, op FLORIDA
COUNTY bF ALLSBOROUGH
IndWaal
B D. fOTD Me, this day of
20.pelsonally
appealed '
who executed the forego'ing imtru rent,
and acknowledged before me, that samf,
vas executed for the purposes therein
UEEME1.1
B efore one, this day
of
peta6nally appomd
p artnex/agent on b ehalf of
apartnersblp,`who executed the
fore;goin.9 instument and.
acicnowled&od bdOTO Ine that same
was exeDuted-fortht-,PDrpqsbsthDrehi
-PersoliallyknwNn X or- ProducDdid5nti-goation Type of idcntiflcationproducod
Signature ofNotar� Pxiat1\1a= ASHLEE CALLAHAN
Notaxy Public Stamp:
EE
FR ASHL
Commission Expires; W COMMISSION #HCALLAHAN
H 295980
' November 00 2026
CorpDrati6n
Before mr,this 22ND day of
MAY 20 2-2
personally appeared.
of
Lennar Homes LLC
behalf of th6state rorporation, who
executed the f6rego, instrumentand
foregoing
acl6iow Wged bof= me that same was'
exDcutod for the purposes ,thrTDba
, C(31V ME CIAL BUILDING SERVICES DIVISION SIDEN IAL
BUILDING PERMIT DATA SHEET
TRACKING # FIRE MARSHAL #01 m DATE: 4✓10/2023
FOLIO # 6219 BACK FORTY LP EXAMINER: MINE:Re bebra Klahr PX 30C
Re uired Permits
Building IV Plumbing Mechanical Electrical Amp
Dins ection OnLy I Ins ection onl [I Ins ection Only[� Ins action �?nl
Roof �]G asMedical has [] Eire Sprinklers
E On Site Piping El Fire Line ❑ Irrigation El Fire Alarm
Ej Potable Backtlow Assembly ® Fire Thane Backtiow Preventer El Irrigation Tlacktlow Assembly Demolition
El Walk-in Cooler ❑ Refrigeration ®Hood El Ansul
El Fence/Wall ® Crease Trap ® Other tither
Buildine Data
Type Construction: v--s Risk Category: Occupancy Load
ancy Class
ifieatioa: Assembly aJ3�asiness ay Care/Educational
w
Factory `Hazardous Institutional ®Ivlercantile
Residential R� (Storage �] Utility
Building Use: SINGLE FAMILY RESIDENCE ! Alteration ,Level 1 bevel 2 ® bevel 3
lw�New Construction E Interior Finish EJ Interior Remodel El Exterior Remodel Addition ® Revision
Overall Size: Number of Stories: 'Total Sq. Ft.:
30 X 52-8 2 3016
Living Area: 2530 Covered Area: 436 # of Bedrooms: 6
# of Baths:
Cost per squi°e foot: Estimated Value:
Roof T e: Shin le ❑Tile 1111t-up ❑ Metal Other S uares: 20
Zoning: Wi orne Debris: EnergyCode:
ElInside Outside �05�2020
Flood Zone: X Rase Flood Elevation: Finish Floor Elevation:
Elydrost tic Vents � ®Yes �No Sq. Ft. Enclosed Space >3elow T{ l :
v,.,.,a ...s.A
# of Vent
s: Side of dents: Total Sq. In. Pern►aneut Openings
]'CentralA/C Beat Furnp Window AlC
El Gas A/C M Gas Heat ® Electric heat
Setbacks
Front Rear Left Right
0 As per Approved Site Plan
Comments:
Permit No. dk
Date Permitt d i%
Builder Name/Owner Name _ �� � Controllj#
County Parcel No. SubDiv: �''�
Address/Location
Classification/Type of Use 1�
TRANSPORTATION IMPACT FEE Rate: 5q. Ft unite��
Exempt 0 Yes No How Determined
Impact Fee Amount Zone No. TAZa
SCHOOL IMPACT FEE
Account (056) Single -Family Detached House Amount $ ,
(057) Mobile Home
(058) Other Residential
(123) Collection Fee
Exempt =Yes = No Hove Determined_
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zone Total Amount $ W` Z
Exempt =Yes =No How Determined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credit Facility Total
Exempt Yes No How Determined Total Amount
RESOURCE FEE ERU
Total Amount
Prepared By eRTIFICATfOF
ICChecked By
NO OCCUPANY WILL RE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
ACKNOWLEDGEMENT BELOW DOES NOT IMPLY ACCEPTANCE OF CONCURRENCE, BUT SIMPLY REECEIPT OF A COPY OF THIS
FORM, PLACING THE BUILDING OWNER ON NOTICE OF THIS ASSESSMENT AND THE CONDITIONS OF PAYMENT FOR SAME.
DATE RECEIVED BY
RECEIPT NO DATE BY