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Home My WebLink About23-60883 Issue Date: 05/02/2023 Pering S �t' � . . . . . . . . . . . . 01 '1# 04 26 21 0150 00600 0090 6213 Back Forty Loop ---- - ----- - - ---- ..... . i�tig . . 77 7 . . . ...... 7 tiv 77 " �, " 7777, g�E'I`N, Rlf"' "P"1. " A 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: $282,120.00 TAMPA, FL 33607 Electrical Valuation: $42,318.00 Phone: Mechanical Valuation: $19,748.40 Plumbing Valuation: $28,212.00 Total Valuation: $372,398,40 Total Fees: $20,500.02 Amount Paid: $20,500.02 I Date Paid: 5/2/2023 11:37:50AM CONSTRUCT SINGLE FAMILY 1870 SO FT 7 7 7, 7 7171� 7 7 777 77777777777 77717 777,777`7 7 " !7 '7` 77 Electrical Permit Fee $251 .59 Mechanical Plan Review Fee $0.00 Water Connection Residential Fee $1,140,00 3/4 Water Meter Fee (Calc) $794.92 Public Safety Impact Fee -Police $254,00 Address Fee $X00 Transportation Impact Fee - City $36.32 Park Impact Fee - Single Family/Townhome $769.56 Transportation Impact Fee $3,595.68 Plumbing Plan Review Fee $0.00 Building Plan Review Fee $180.00 SIF 1 percent Fee $83.28 Irrigation 3/4 Meter (Cale) $794.92 Driveway Fee $45.00 Plumbing Permit Fee $181.06 Mechanical Permit Fee $138.74 Building Permit Fee $1,450.60 Electrical Plan Review Fee WOO Public Safety Impact Fee -Admin $26.35 Sewer Connection Residential Fee $2,400.00 %. School Impact Fee - Single Family $8,328.00 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. "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 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 PE IT OFFICE 813-780-0020 City of Zephyrhilis Permit Application Building Department Date Received Phone Contact for Pormittin 908 770 Owner's Name CAL HEARTHSTONE LOT OPTION POOL 03 L Owner Phone Number Owner's Address 23975 Park Sorrento, Ste, 220, Calabasas, CA 91302 Owner Phone Number Fee Simple Titleholder Name N/A � Owner Phone Number 813.574,5700 Fax-813-780-0021 Fee Simple Titleholder Address NIA JOB ADDRESS 621 -Back Forty Loop LOT it 0609 SUBDIVISION JAbbott Square PARCEL ID# 04-26-21-0150-00600-0090 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH INSTALL REPAIR PROPOSED USE 0� SFR � COMM OTHER TYPE OF CONSTRUCTION d V It BLOCK FRAME STEEL DESCRIPTION OF WORK Single Family Residence (Foal 1 Screen Enclosure J Fence 1$7Q 28 BUILDING SIZE U!R SF 2351 SQ FOOTAGE HEIGHT 66 BUILDING $ 2$2120 VALUATION OF TOTAL CONSTRUCTION ELECTRICAL $ 42318 PROGRESS ENERGY W.R.E.C. AMP SERVICE 0 PLUMBING $ 28212 I �a8 (MECHANICAL $ ��dS 4 VALUATION OF MECHANICAL INSTALLATION GAS � ROOFING E:] SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS �—t FLOOD ZONE AREA YES i NO BUILDER COMPANY 1 Lennar ITomes, LLC SIGNATURE REGISTERED Y J N FEE CURRER Y_t N Address 4301 W Boy Scout Blvd Suite 600 Tampa, FL 33607 License # C(1C1518166 ELECTRICIAN 8 @p COMPANY Ed�/N n Electric, Inc. SIGNATURE 7 REGISTERED FEE CURREN Y / N Address I License# EG13005408 PLUMBER COMPANY Bay�Y/ et Plumbi�CUR.RE �Y/ C, Inc SIGNATURE REGISTERED N � FEE�� Address I License # GFG042998 I MECHANICAL COMPANY Bayonet �PlumbEing,RHeating & AC Inc SIGNATURE REGISTERED �Y / NUREN Y / N Address License # GAG058062 OTHER COMPANY I C Sterling Quality Roofing, Inc SIGNATURE REGISTERED Y / N FEE CURREN Y ! N Address License # GGG057991 IIOIt1iItAlllti[4III1�ItIN�IIItiRBIIIItFlItOaIIlIC18il0�91k�19�IIi1 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 dumpster; Site Work Permit for subdivisionstlarge 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 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 I - * 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 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 County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands th t Trans rt k n Im c F s n 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 com�glianc�- with all a licable laws, regulatirigmaisristruction, zlining and la devel 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 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, Wetland 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 11 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. It 141MI H K1 01 [AROMMIXIMM LIU M I I RAMIM am N*J 1 KIM NAMMUM LIS 1111 a LEI VAMMME N L4A7%R HIMMO-19MM I I LAS IMMIULymplasalnu ymymll on IMOV111101 It"s CWT1 IN a W :01TJ Ail 1:4 a k#m [CM01 Rita U *40lu =4 Ill I wilkip A I Maill IMMMA, FM I L111111,211010" 101 OWNER OR AGENT Subscribed and sworn a (or affirmed) before me this 312.M. by Christopher Smith Who is/are personally known to me or4a6id —as identification, —,Notary Public Commission —_ri�z G 296057 Stephanie Farmer Name of Notary typed, printed or stamped Subscribed and sworn to (or affirmed) before me this _L11_111111 _______bY_C_h_r1st_09b �Mlth Who is/are personally known to me or has/have produced as identification. Notary Public Commission No.. 60 7 Stephanie Farmer Name of Notary typed, printed or stamped NN 0"a THE NORTHEAST 1/4 OF I / THE SOUTHWEST 1/4 OF SECTION 4-26-21 0 PHASE 1A Structure Table BOOK 617 CS-5 TYPEVDBI % S1 71-75 1#(, k WITH SKIMMER (C213) EOP:94,40 RIM:94�40 24" RCP(NW)IE:90.00 CT "A" TRACT "A" CS-50 SILVERADO PHASE 1A TYPE'C'DBI PB 61, PG 71 EOP:90.42 RIM:90.42 24" RCPJSE)IE:87.40 OWNER: SD7-1 SILVERADO TYPE 9 CURB INLET ECP:95A4 FFFRk VALL'EStIi,'P-8'61 , PG 71 RIM:95.27 60" RCP(S)IE:78.20 - VELOPMENT 60" RCP(NW)IE:79.86 DISTRICT SD7-2 TYPE 9 CURB INLET EOP:95.82 RIM:95,65 60" RCP(SE)IE:80.26 60" RCP(N)IE:80.26 I9739---""—� PEW 985 T� . 7 0 .jpMFF. AD:9T90 97-67 -,,,J END -96 9 PE 'A F:98,57 PAD:97.90 o 96 12 96.19- 46.39- 5,09 r-TRACT 102 49'- 24" RCP @ 5.35%- PE40,17% F:7 1780 136'- 60" RCP @ 030% 96,19-97.020---96.48 96.2 0 96.00 96.72*961 PARCEL. 2 DESCRIPTION: LOT 9, BLOCK 6, ABBOTT SQUARE PHASE 18, 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 88) Lennar Homes his SITE FLAN Prepared for and Certified To: L01 = 5059 SQ.FT. LIVING AREA FT, PORCH = 38 SO. FT GARAGE =-AA3—SQ, FT. COVERED LANAI N/A SQ. FT. PATIO 18 50. FT POOL AREA FT CONC DRIVE FT. NC & CONIC PAD 12 SO. FT SIDEWALK FT LOT SOD FT. R/W SOD FT. LOT OCCUPIED AREA TO IRRIGATE (,7 070 SITE PLAN )NOT ASURVEY) LOT 8 BLOCKS S88'08'WE(P) 112,42' UA 499 __1_5X35 42.0 CIS -A/C PROPOSED 3. OX6 2 STORY RESIDENCE PATIO PLAN 1871 LOT 9 ELEV S' BLOCK 6 GARAGE R ENTRY 4,3 S88`08'WEtT) 112,42'(P) LOT 10 BLOCKS * = 10,00 PUBLIC UTILITY EASEMENT SEC. 4, TWP. 26 S, RNG 21 E. PASCO COUNTY, FLORIDA [ABBOTT SQUARE) Scale: 1 20' 100 1 0 O rg LD NOTES: LEGEND: PROPOSED: LOT GRADING TYPE =A PROPOSED DRAINAGE FLOW MINIMUM FLOOR ELEVATIONS: PROPOSED PAD ELEVATION = 97,90 (00,00) - PROPOSED GRADE LIVING AREA: 98.57' FRONT SET BACK - 20 E-00,00 - EXISTING GRADE GARAGE AREA: SIDE SET BACK- Z5 ELEVATIONS REFERENCED TO PROPOSED ELEVATIONS AND GRADING NORTH AMERICAN VERTICAL SIDE SET BACK (CORNER LOT) = I OF SHOWN HEREON ARE TAKEN FORM THE ENGINEERING PLANS OF DATUM OF 1988 REAR SETBACK = 15 ABBOTT SQUARE RESIDENTIAL", PREPARED APPARENT FLOOD HAZARD ZONE:'X"COMMUNITY NO. 120235 BY'WRA'PROVIDED BY CLIENT (MAP NUMBER 12 IOTC-0289-F) EFFECTIVE DATE: 09/26/2014 L SURVEY ABBREVATIONS .__ PP - ARCLENGTH (0) - DEED NVERT PC -POINT OF CURVE (R! - RECORD LEGEND NC-AIRCONDMONCR I) E- DRAINAGE EASEMENT LB -LICENSED 8USNESS PCC - POINT OF COMPOUND CURVE ENO - RANGE VINYL FENCE Ar -ALUMINUM FENCE OR ELEV - ELEVATION LE-LANDSCAPTEASEMENT PER - PERMANENT CONTROL POINT M_CC`RC 8EE. 8 RRS - RA!L ROAD SPIKE ------ 8, � 8 ASK FLOOD CLIFFAcON EDP - EDGE OF PAVEMENT LIFE - LOWEST FLOOR ELEVATION P/E -POOL EQUIPMENT R/W - RIGHT OF WAY CNCH MARK E SEC - SECT ION LS - LICENSED SURVEYOR PC - PAGEI WOOD FENCE C. CURVE F/C - FENCE CORNER Pe - MEASURED Pi - PONT Or INTERSECTION SN&D - SET FINLAND DICK ASPHALT ICI -CALCULATED - CALCULATE FCM-FOUN CONCRETE MES - MITERED END SECTION PK -P�RKER "LON LB#8183 CEN11,11-Ral CHAIN LINK FENCE UNIF MONUMENT NCY - NO CORNER FOUND I PRODEVIYUNE SIR - SET 112- IRON ROD CM,CHAIN FENCE UP - FOUND IRON PIPE O/A - OVERALL POe - P T&M - TEMPORARY BENC L ' I RUGATEO METAL SET PONTOFSEGINNNG r '0' FIR - FOUND IRON ROD 01-M-OVERHEADWIRED) P C- OINTODCOMMENCTMENT TOB-TOPOFBANK CO -C.LU.N CO'C - CON< LIFTE FN&D - FOUND NAIL & DISK OR -OFFICIALRECORDS, POI, POINT ON LINE TSVP - TOWNSHIP ALUMINUM FENCE C/SN CON(AiH sii POP -FOUND OPEN PIPE (P) PLAT PRC POINT OF EVERIF CURVE E-I-flUEYEASEMINT =COVERED _ — CST- CLEAR YOT TRIANGLE OFF - FOUND PINCHED PIPE PB = PLAT BOOK FIRM - FERMAN T REFERENCE MONUMENT I VF - VINYL FENCE y JOB #iF908520609 SURVEYOR'S NOTES: SURVEVOITS CERTIFICATE 1708 Water Oak Drive D 1.) Current title information on the subject property had not been This certifies that ske h of the hereon described Tarpon Springs, Florida furnished to Initial Point Land Surveying, LLC, at the time of this Crty was SITE PLAN prop940% up—ision and Phone: (727)-831-1990 meets th CA I- Practice for FloridaPLBS 7123cwgriTail.c En 2.) This sketch was prepared without the benefit of a title search. su ey f rd of Land L8# 8183 No instruments of record reflecting ownership, easements or S -Ike h.Signed Fjle� rights -of -way were furnished to the undersigned, unless otherwise t or S shown hereon. pursuant Section 472 J t�artl y Drawn by: DJ8 3.) Roads, walks, and other similar items shown hereon were taken A 7 Checked by:JH from engineering plans and are subject to SO Date: q 3.01 a -0 4 .)This SITE PLAN does not reflect nor deter ie Re'll"ISIONS t 4'0( I ownership, '61 1jeE 1108 'IN 6,This SITE PLAN is subject to matters shown on the Plat of IT, kZ=,V 'ABBOTT SQUARE PHASE I B' 6.) Di Jeff M. Dimensions shown hereon are in feet and decimal portions I theremof FLORID, 1V�sw�s. MA R AND 7,) Contractor and owner are to verify all setbacks, building MAPPER N t — 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 Surveying, LLC. at users sole risk. AC., C, ElevationPlan Model Garagez t New Development Check List Parcel #; Ov — _ ) --0 ' C ) e V Address "C Setbacks: From Rear Sldes Elevation. Garage: Roof Shingle Dimension/Architectural; ) � VR/\ VIRTUAL REVIEW ASSIST Private Provider Plan ® la ce Affidavit Private Provider Firm: Virtual Review Assist, Inc. Private Provider: Debra Anne Klahr, BU1967 Address: 747 Southwest 2" Avenue Gainesville, FL 32601 Phone: 813-391-2959 Email: lgc virtualreviewassist,co n Project: New SFR • 6213 BACK FORTY • «'DfLa and holds the appropriate license or certificate: =FAMIRIORM Plan Sheets A 1 t 1 I Florida License/Registration/Certification #(s) and description: FS468 Certified Standard Plans Examiner. License #: PX2300 E st` Signature of Reviewer: t3 SWORN AND SUBSCRIBED b ore me by Debra Anne Rlahr being personally known to meor having produced as identification and who being fully sworn and cautioned, state that the 1�9�0 i is true and o ct tot e best of his/her knowledge or lie Signature of Notary Print Name Notary Public: NOTARY STAMP BELOW My commission expires: AT ASHLEE CALLAHAN *i MY COMMISSION # HH 296980 r p� EXPIRES., November 30, 2026 Parcel Tax ID: Services to be provided Notice to Building Official of Use of Private Provider Effective January 20, 2003 6213 Back Forty Loop 04-26-21-0150-00600-0090 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. MMM 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 Aidress: 747 SW 2N[) AVE- SUITE 170,301,357,& 358, GAINESVILLE, FL 32601 Telephone: 813-376-3088 Fax: N/A 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 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 w The following .g attar eats are provided as tpquired, 1. Qualification statements and/orresumes of the private provider and all duly: authorized representatives, 2... Proof of insurance for professidnal.and coxn#ehensive liability in,the a aunt .of 1 million per occurxencerelating to ail'service'sperformed as aprivate provid r; including taffcoverage for amirlimum of 5 years subsequent to the performance ofbuilding code inspection servloees> Individual :(signature). Print Name; A,ddxesse Telephone No. , I'leaseuse appropriate notary bl'ockZ STATE OF FLORIDA . COUNTY OF HILL BOROil H B efore Me-, this day of 2Q,____,personally appeared - who executed the foregoing instrument, an'd acknowledged before one that sawne "wag executed for the purposes therein capressedm Corp oration LENNAR HOMES L I Print CoaporationNauae By; (signature) Prim Names lirist her Smith it: Authorized Agent .Address 700 NW 107th AVQ iami FL 3317 Telephone, No, 913-774-- 70 Corp oratgon Before e,this 22ND day of MAY . 20 2 personally appeared ' Of Lerner Homes LL a carporaii.on, on hell f ofthe state corporation, who executed the foregoing instrument and acknow;ledgeabeforeMethat same wass executed for the p oses-thorcin expressed. By: (Signa%e) Prat Name, Its: .Address: Telephone No,: B efore rne, this day of 2Q , personally' appeared ------------- P er/a.gentonbohalfof a. partnership, who exa.cuted the - foregoing instrument ' .d acknowledged before me that same -was execi6dforthop-orposestherelu exprgssed.. ' Porsonallyknown X 4-Procedidex�tication Type ofidentiffoationproduced signatarf� ofNotan PrintNome ASHLEE CALLAHAN NotatyPublic 5tmp; Commission Expires; � �*r ASNI N# H 2 Y GC�lSS€�N NN 95980 �, xPIR S; Novemb r 3b, 2026 -COMMERCIAL BUILDING SERVICES DIVISION RESIDENTIAL BUILDING PERMIT DATA SHEET TRACKING # FIRE MARSHAL #01 - DATE: 4/0 /2023 FOLIO # 6213 BACK FORTY LP XA IN :zebra Klahr PX230C Re uiredPermits Building Plumbing Mechanical Electrical Amp D Inspection Oiniv ❑ Ins ection tint �] Ins ection On M Ins ection Onl li;oof [1 Gas El Medical Gas [] Fire Sprinklers [:1 On Site Piping [l Fire Lire D Irrigation [] Fire Alarm El Potable Backflow Assembly ® Fire Line Baekilow.Preventer ® Irrigation Backfiow Assembly E] Demolition (� Walk-in Cooler [l Refrigeration Hood El Ansul E] Fence all ❑ Crease Trap [l Other D Other T e Construction: " Risk Category: Occupancy Load O aney Classification: Assembly � � - bay Care/Educational FactoryHazardous Institatianal Mercantile Residential ® Storage Rbusmoss Utility Building Use: SINGLE FAMILY kESIDENCE J Alteration Level 1 'Level 2 'Level 3 New Construction ® Interior Finish ❑ Interior Remodel Exterior Remodel ® Addition ❑ Revision Overall Size: Number of Stories: Total Sq. Ft.: 30 X 42 2 231 Living Area 1870 Covered .area: 481 # of Bedrooms: 4 # of Baths: 2, Cost per square foot: Estimated Value: hoof e: C Shin le ]Tile Built-U ❑ 1�Ietal Other scares: 16 Zoning: Wi o e Debris: Energy Code: ;Inside Outside 405-2020 Flood Zone: X Base Flood Elevation: Finish Floor Elevation: Hydrostatic Vents ®;des to Sq. Ft. Enclosed Space below TIFF: # of Vents: Size of Vents: Total > Ina T rrrran art C perrings Central A/C X Heat Iaurnp Window -A/C Cas AIC [� Cas Beat [ llectric Beat On Site Sanitary Sever Storm Sewer Catch Basins Notable Water Under round Fire Line Setbacks Front hear Left Might 21 As per Approved Site Man Comments: �t� ft- Permit No. O Date Permitted L v 2 Builder Name/Owner Nana ' !' Control # County Parcel No. t C Z SubDiY. r' AddressfE.oeation - _ �� - � �k3 /t11) Classification/Type of Use "' e TRANSPORTATION IMPACT FEE Rate: Sq, Ft unit, Exempt 0 yes No How Determined Impact Fee Amount 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 Haag Determined_ PARKS AND RECREATION FEE Land Account Land Credit Land Total Recreation Account RecreationCredit Recreation Total Zone Total Amount $ Exempt =Yes No How Determined LIBRARY FEE Land Account Land Credit Land Total Facility Account Facility Credit Facility Total ExemptEl yes No How Determined Total Amount RESOURCE FEE ERU Total Amount Prepared By r Checked By NO CERTI LATE OF OCCUPANY WILL BE 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. NM R"7�4I�i7{�jll+l RECEIPT NO DATE BY