HomeMy WebLinkAbout23-6076City of Zephyrhills
535 Eighth Street
S t
Zephyrhills, FL 33542BNR-006076-2023
Rhone: (313) 730-0020
Fax: (313) 730-0021
Issue Date: 05l0l2d23
r ItBuilding (Residential
l
04 26 210150 00600 0110 6201 Back Forty Loop
7 7
., 777776IoV t
Name: LENNAR HOMES LLC Permit Type: wilding New (Residential) Contractor: LFNNAR HOMES LLC
Class of Work: SFR Construct
Address: 4301 W Boy Scout Blvd 600 Building Valuation: $320,640.00
TAMPA, FL 33607
Electrical Valuation: $48,096.00
Phone: Mechanical Valuation: $22,444.80...E'
Plumbing Valuation: $32,064.00
Total Valuation: $423,244.80
Total Fees: $20,754.25
Amount Paid: $20,754.25��
Date Paid: 5l212023 11:37:50AM
CONSTRUCT SINGLE FAMILY 2217 SQ FT
Public Safety Impact Fee -Police $264.00 Mechanical Plan Review Fee $0.00
Sewer Connection Residential Fee $2,400.00 Mechanical Permit Fee $152,22
Electrical Plan Review Fee $0.00 Public Safety Impact Fee -Admin $26.35
Driveway Fee $45.00 School Impact Fee - Single Family $8,328.00
SIF 1 percent Fee $83.28 Transportation Impact Fee - City $36.32
Electrical Permit Fee $280.48 Transportation Impact Fee $3,595.68
Plumbing Plan Review Fee $0.00 Building Plan Review Fee $180.00
Address Fee $30.00 Plumbing Permit Fee $200.32
3!4 Water Meter Fee (Cale) $794,92 Irrigation 3l4 Meter (Calc) $794.92
Water Connection Residential Fee $1,140.00 Building Permit Fee $1,643.20
Park Impact Fee - Single FamilylTownhome $769.56
REINSPECTION FEES: (c) With respect to Reinspection fees will comply with Florida Statute 553.80(2)(c) the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection, whichever is greater, for each subsequent relnspectiona
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result In your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
Complete Flans, Specifications acid fee Must Accompany Application, All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY EF R C.O.
NO OCCUPANCY BEFORE C.O.
ONTRACTOR SIGNAT E PE IT OFFICE
PERMIT EXPIRES IN fi MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION NOTICE
8131780-0020 City of Zephyrhills Permit Application
Building Department
Date Received - Phone Contact for Permitting908 Z7 A- - Z�
CAL HEARTHSTONE L= - - - �Owner Phone Number
Owner's Name LOT OPTION POOL 03 L �P
Owner's Address 23975 Park CA 91302 Owner Phone Number
Fee Simple Titleholder Name NIA Owner Phone Number
813.574,5700
Fax-813-780-0021
Fee Simple Titleholder Address [ N/A
JOB ADDRESS 6201 Back FOrtyLOT # 0611
SUBDIVISION EEiSCjuire PARCEL I D#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR 8 ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK E] FRAME STEEL
DESCRIPTION OF WORK Single Family Residence t Poo) t Screen Enclosure /Fence
BUILDING SIZE SCI FOOTAGE HEIGHT
—"BUILDING E2Q640 VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL 1$ 48096 AMP SERVICE [X] PROGRESS ENERGY W.R.E.C,
PLUMBING
32064
0 MECHANICAL VALUATION OF MECHANICAL INSTALLATION At 411", 1-'
=GAS ROOFING = SPECIALTY = OTHER tt
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES Do
Lcnnar Homes, LLC
BUILDER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
43 tR Boy Scout Blvd Suite 600 Tampa, FL 33607
Address License# F(7GC'518166
ELECTRICIAN COMPANY E!E�dm�onson Electric, Inc.
SIGNATURE REGISTERED Y/ N FEE CURREN Y/
Address Lcense#
PLUMBER COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE REGISTERED Y/ N FEE CURRENY
V
Address EY— License #
MECHANICAL COMPANY Bayonet Plumbing, Heating & AC, Inc
N REGISTERED
�D Y/ N FEE CURREN Y/N
Address p License#
OTHER COMPANY �C Sterling Quality Roofing, Inc
SIGNATURE REGISTERED Y/ N FEE CURREN Y/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 ten (10) working days after submittal date. Required onsits, 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 Forms. R-O-W Permit for new construction.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stermwater Plans w/ 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)
Driveways -Not over Counter if on public roadways..needs ROW
REIM
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Trans ortation Im act Fees and Recourse Rec—e. Fees ma a I to the construction of new buildin s
my responsibi lity to i e tify what actions I must take to b in pliance. 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 Bayheads, Wetland Areas, Altering
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 f®r d f 'th to inform the owner of the ermitt* d't' ns set forth in
Subscribed and sworn o (or affirmed) before me this
_M_8=23by Christopher Smith
Who or-hee��
as identification.
----Notary Public
Stephanie Farmer
Name of Notary typed, printed or stamped
9mi
Subscribed and sworn to (or affirmed) before me this
XM2023 by Christopher Smith
�A��� or has/have produced
--as identification,
_Notary Public
Commission No. 7
Stephanie Farmer
Name of Notary typed, pdnted or stamped
of
., A0W
DESCRIPTION: LOT 11, BLOCK 6,ABB07T SQUARE PHASE I B,
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
(NAVO 8B)
hls SITE PLAN Prepared for and Certified To:
Lennar Names
197.601
Qus rA 1
7-
7
LOT FT.
LIVING AREA FT
PORCH FT
GARAGE =401_SO. FT.
COVERED LANAI =-WA—SO. FT,
PATIO -_L9--SOr FT
POOL AREA -_JS14A_SOr FT
CONC. DRIVE --335—SO. FT
A/C & CONC PAD =J2_S0. FT
SIDEWALK --&—SOL FT,
LOTSOD FT.
R/W SOD FT.
LOT OCCUPIED = %
AREA TO IRRIGATE ji
PROPOSED:
MINIMUM FLOOR ELEVATIONS:
LIVING AREA: 98.57'
GARAGE AREA:
ELEVATIONS REFERENCED TO
NORTH AMERICAN VERTICAL
DATUM OF1988
SURVEY ABBREV IONS
7) - AIC —IE161.
A/C - AIR CONDITIONER
(D) - DEED
DE -DRAIN GEE&SEMENT
AT - ALUMINUM FENCE
EL OR ELEV - ELEVATION
SHE - BASE FLOOD ELEVATION
BM -BENCHMARK MARK
E OP - EDGE OF PAVEMENT
E M I -EASEMENT
C C
F/C -FENCE CORNER
ICI - CALCULATED
GTo CONCRETE
CECENTERLINECLF
.=UN
MENT
- CHAIN LINK FENCE
CERP CoRRULIATF D METALPID
oC)NMPE
UNDIR
COF COLUMN
CONIC - CONCRETE
R - FFIP
O NO IRON ROD
FN&D - FOUND NAIL & DISK
CO - CONCR"E'LA`
CUP FOUND OPEN PIPE
CS I - CLEAR SIGHT TRIANGLE
LITE FOUND PINCHED PIPE
SITE PLAN SEC. 4, TWP. 26 S, RNG 21 E.
(NOT A SURVEY) PASCO COUNTY, FLORIDA
(ABBOTT SQUARE)
91.
el
C
<
0 1<1
U. Scale: 1 20'
0 V,
N`
P--------
•N88-08P 16 W(;;)Io
pq 1 A
LOT 10
BLOCK 6
1,77
0 0
�Cit V'
wp
GAR
LOT 11
BLOCK 6 li�5 -KC.
1� -e
D,
V,
Rl\
bb
LOT 12
BLOCK
,Elbpb� V,,"
CURVE DATA (P)
F—cuRvE TRADIUS __-ARC _LENGT_H_7_cTi`6_RD —LENGTH I-- CHORD —ARING 77151ELTA ANGI-E i
r _T _C5_47 _T 6 0 _00' 1 33,31 1 32,89' 1 _3F4_8 —48---]
1 CE�60AO
NOTES: 10.00 PUBLIC UTILITY EASEMENT
LOT GRADING TYPE -B
PROPOSED PAD ELEVATION = 97,90
LEGEND:
FRONT SET BACK - 20
SIDE SET BACK - T5
"�""- PROPOSED DRAINAGE FLOW
(00J00) = PROPOSED GRADE
SIDE SET BACK (CORNER
LOT) - 10
REAR SETBACK - 15
E-00,00 = EXISTING GRADE
APPARENT FLOOD HAZARD ZONE:'X COMMUNITY NO. 720235
MAP NUMBER 12 10 IC-0289-F) EFFECTIVE DATE: 09/26/2014
INV INVEST
PC -POINT OF CURVE
M) - RECORD
LB -LICENSED BURGESS
LF, - LANDSCAPE EASEMENT
CC - POINT OF COMPOUND CURVE
PCP - PERMANENT CONTROL POINT
RNG - RANGE
RRS - RAIL ROAD SPIKE
LFF -LOWEST FLOOR ELEVATION
PIE -POOL EQUIPMENT
R/W ARIGHT OF WAY
LS -LICENSED SURVEYOR
PC - PAGE
SEC - SECTION
(M) - MEASURED
PI- POINT OF INTERSECTION
SN&D - SET NAIL AND DISK
MEE - MITERED END SECTION
PR -PARKER "LON
_80183
NCF - NO CORNER FOUND
i -PR PERTYLINE
SIR -SET 112 IRON ROL) LEE 8183
COA - OVERALL
DOE POINT OF BEGINNING
IBM- TEMPORARY BENCH MARK
014W - OVERHEAD WIRE(Sl
POC POINT OF COMMENCTMENT
TOB-TOPOFBANK
O.R.-OFFICIALRECOqDS
SOL POINT ON LINE
TWP - TOWNSHIP
(P) -PLAT
P8 - PLAT BOOK
PRC - POINT OF REVERSE CURVE
PRM = PERMANENT REFERENCE MONUMENTI
IT E UTILITY EASEMENT
VF VINYL FENCE
I` Current title information on the subject property had not been.ThRioProfiesslook"llitmoil hereon des
Gate of Site Plat, 3-20-23 furnished to Initial Point Land Surveying, LLC. at the time of this
proper-ty'v_*', a u",
)WGAS-PHIBLII-8L6-SFEE SITE PLAN meets t )1
.ractice
)This sketch was prepared without the benefit of title search. 'Pi is rdol
7-- No instruments of record reflecting ownership, easements or Ise S Ep I ( ,
Ile:
rights-of way were furnished to the undersigned, unless otherwise I c1m Vt e, 9
shown hereon 0 on' I
Drawn by. COB Puniq a Section 1111.
— 3,� BEELER, walks, and other similar items shown hereon were taker . _
.necked by.JH from engineering plans and are subject to survey. at si ate: 121
RlVISIONS — 4,) This SITE PLAN does not reflect nor determine ownership, 02 04
5.) This SITE PLAN is subject to matters shown on the Plat of
'ABBOTT SQUARE PHASE I B41
6.) Dimensions shown hereon are in feet and decimal portions JLORIDJeff M 0 e
thereof 1P R AND
7.) Contractor arid —Net are to verify all setbacks, building MAPPER NO. I L 183
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
and
for
wd
PROPOSED ELEVATIONS AND GRADING
SHOWN HEREON ARE TAKEN FORM THE
ENGINEERING PLANS OF
ABBOTT SQUARE RESIDENTIAL, PREPARED
BY WRA'PROVIDED BY CLIENT
VINYL C FENE
CONC
ASPHALT —
WOOD FENCE
\ — \ —
RICK —
CHAIN LINK FENCE
—
.VFFC. _
C_
_AL1MNU FENCE
R,
1708 Water Oak Drive
Tarpon Springs, Florida
Phone: 1727)-831-1990
nww_)�5,
FloridaPIS 71239grinall, CRAC;_
LB# 8183
al'\M�
N C
Im
PI
Initial Point Land Surveying, LLC.
71-75
T "A"
TRACT "A"
SILVERADO PHASE IA
RE 61, PC 71
DWNER:
-VERADO
VACL'ES ,'P869, PG 71
ELOPMENT
)ISTRICT
11
TYPE''
PFF. 9, AD!
T -97
95.09
TRA
D�7
19" RCP @ 0.17%
Fo 1p,,
136'- 60" RCP @ 0-305/1
96.19-97
c
96.00- p ARCEL
//, V
96.84
T
49'- 24" RCP :@ 535%.A
-96 111196.24
SM
48" F
NV: 83.
77
)!7
.97 IG
2*-96A4
-
65'Zg
-11tx \ COMPANY
4 WOOD AIL rENU
-OLONY C
K 1, PAGE 55
k191' - 60" RCP @ 014%
F. POND 5
TOB:95.00
w
) zoo
Plan Model Elevation
rc) 08-- 5), (-'. 1
Garage Lot Size Block Lot
9
New Development Check List
') �
Parcel#: 21 — L:i
11 ) — 0/ 0
Address: C)
6,
Setbacks: Front AO, Rear (40 Sides 1
-a2-9 d- I I
K '?
Elevation: Garage:
I
Roof Shingle Dimension/Architectural: ) MAU 5
VIRTUAL REVIEW ASSIST
Private Provider
Plan o fiance Affidavit
Private Provider Firm..: Virtual Review Assist, Inc.
Private Provider: Debra Anne`Klahr, HU1967
Address: 747 Southwest 2" d Avenue
Gainesville, FL 32601
Phone: 813-391-2959
Email: 1Li y_@yjAu 1rqyiewassist.ggin
6201 BACKFORTY
hereby
Floridacompliance with the
and holds the appropriate license
Name: Debra Anne"Klahr
Plan Sheets CS,A1,A2,A3,A4,A5,A6,A6.1; SNO, SN1,.S3,S4,SS,S6, ST,SS,SII,SI2, I,PAI.0,PA1.1,
PAI.2,PAI.3,PAI.4, SHI.0,SHI.I,SHI.2,SHI.3,SHI.4,SHI.5
Florida License/Registration/Certification #(s) and description:
FS468 Certified Standard Plans Examiner
License #k: PX2300
Signature of Reviewer: w
SWORN AND SUBSCRIBED re me by Debra Anne Klahr
being personally known to me or having, produced as identification
and who being fully sworn and cautioned, state that the
Wreggue and c ect to the best of IrWher knowledge or belief.otary Print Name
commission expires:
<„ APdLEOAGl.AAN
Y COMMISSION # t#N 295980
mb� 3Q; 206
EXPIRES: Nove
Services to be provided:
v 1 R F L) A L R E-, V E: "v`1 A S S ES 1'
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
6201 Back Forty Loop
04-26-21-0150-00600-0110
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.
Mt=
owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the services
indicated above.
Private Provider Finn: VIRTUAL REVIEW ASSIST, INC.
Private Provider: DEBRA ANNE KLAHR
Address: 747 SW 2N[) AVE- SUITE 170,301,357,4 358, GAINESVILLE, FL 32601
Telephone: 813-376-3088 Fax: NIA
Email Address (Optional): deb@virtualreviewassist.com
Florida License, Registration or Certificate #: (LIC # BU1967/ 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 any 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 perfortri 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; envirot.mental or other codes..
The following . atta.chments. are provided as xequired,
1. Qualification statements and/or xesu=s of the pxxvate provider and all duly: authorized representatives,
2.:Proof of insurance for professional and coin�reh6ns ve liability in tho. aluount .of i million per
occurxencerelatzng to all services performed as a private provider, including tail coverage for. a rniiiimum
of 5 years subsequent to the pexforinance of building code inspection services,
Individual Corporation Partnership .
Print CoaporatzonNalne PrintPartnershipNa e
By: By:
(signature) (signature} (signature)
Print Print Print
I��ame; I�an�e, �1TIS r $rrli' Nam
Address: - its; Authorized A ent jtso
Address: 0 NY 107t% AV- -_ Address:
Telephone Mlaffi FL 3 172
No.: -
Telephone, Telephone
No. 311,574-5700 NO.-
PTeaseuse appropr�atenotarybl�o.I�. -
S'TA.TE OF FLORIDA .
COUNTY OF HILLSBORO GH
L
this� day of
Corporation
Bef,,reme,thb 22 D day of
MAY . 20
personally appeared '
of
Lana r Homes, LLB a
corporation) tttk
behalf ofthestate corporation, who
executed the foregoing instrument and
aclonowledged before me that same was
executed for tine p o s.es therein
expressed.
Partnership
B efore me, this day
of 2.d
personally appeared
p erlagent onbehalf of
apartnership, whoexecutedtbe
foregoing instoment and
aoknowledged before e that same
was executed.foriliepurposesihmem
expressed.
Fersonallylnnwn X orq Pxoduoedlden#goation Type ofidentification Produced
Sigua re ofNotary PrintName ASHLEE CALLAHAN
NotaxyPublic Stamp;
��a ASHLEE CALLAHAN
commission Expires: � �_ � CM ►$SION HH 296980
- ��°°�" EXPIRES. November 80, 2026
[—COMMERCIAL BUILDING SERVICES DIVISION RESIDENTIAL
BUILDING PERMIT DATA SHEET
TRACKING # FIRE MARSHAL #01 - DATE: /2023
FOLIO # 6201 BACK FOR LP EXAMINER: Debra Klahr PX230(
Re uired Permits
F!u:i1:dEg Plumbing Mechanical Electrical Amp
:Ins Ins action Ins ection On El Ins ection OnI M Ins action l —
0Roof ❑ Gas Medical Gas Fire Sprinklers
El On Site Piping El Fire Line E] Irrigation El Fire Alarm
El Potable Backilow Assembly El Fire Line Backflow Preventer E-] Irrigation Backflow Assembly EJ Demolition
E]Walk-in Cooler El Refrigeration El Hood El Ansul
El Fence all [] Grease Trap El Other D Other
MWTW�
T De Construction: V-8 Risk Category: ......... Occupancy Load
Oan
cC' a'ification: l'Assembl
y Day Care/EducationalVact0ry Hazardous institutional EMercantileZside Residential ®;Storage
Building Use: SINGLE FAMILY RESIDENCE 1 Alteration r Level I Level 2 FE1,Level 3 I P
1,6New Construction Interior Finish El Interior Remodel Exterior Remodel El Addition EJ Revision
Overall Size: Number of Stories: Total Sq. Ft.:
30 X 46 2 2672
Living Area: 2217 Covered Area: 455 # of Bedrooms: 6
# of Baths: 2.5
Cost per square foot: =Es;fim=atedVa1ue: —
i , p M
RoRLTjkL,N Shin le []Tile El Built-up MetalI
Other Squares: 17
Zoning: Wi orn;Debrh,, Energy Code: 405-2020�Jnside utside
Flood Zone: X Base Flood Elevation: Finish Floor Elevation:
Hydrostatic Vents? M"des
Sq. Ft. Enclosed Space Below BFE:
# of Vents: Size of Vents:
Efl — Central A/C Heat Pump Window A/C
El Gas A/C 0 Gas Heat Electric Heat
Front Rear
Comments:
Left
As per Approved Site Plan
mm
Permit No._Loln�_
Date Permitted j-32_:2_3
Builder Name/Owner Name Control #_
County Parcel No.01, f26,z-1(0 1" V4
SubDiv:_A!/J 0_
19
Address/Location 2t
Classification/Type of Use
TRANSPORTATION IMPACT FEE Rate: Sq. R Unit:
Exempt 0 Yes 0 No How Determined
Impact Fee Amount :i , - �3�32� Zone No. TAZ:_
SCHOOL IMPACT FEE
Account (056) Single -Family Detached House Amount $
(057) Mobile Home
(058) Other Residential
(123) Collection Fee
Exempt =Yes = No How Determined_
PARKSAND RECREATION FEE
Land Account Land Credit Land Total
Zone
Exempt =Yes = No How Determined
LIBRARY FEE
Land Account Land Credit
Facility Account Facility Credit
Exempt El Yes No How Determined
Recreation Total
Total Amount $_24L
Facility Total
Total Amount I& ---
RESOURCE FEE ERU
C Chec�kedBy hecked By
NO CERTIFI
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.
RM
M51119WIXI
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