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Home My WebLink About23-6089City e I \ 1 5335 Eighth Street Zephyrhills, FL 33542 Phone: (813) 780-0020 Fax: (813) 780-0021 Issue pate: 05/02/2023 v �2 V .v x:� .� i. 1 i V \A; 1 1 v A VA 11t St } s\ ye 1\ 1 t\ v y, j v Vv 1 t V A 11 \ v v � ,,. s77, ;. ,1'.. . S ll1 04 26 210160 02000 0010 36537 Camp Fire Terrace 7777 77 \ 1 v yy 1 1\ } 1 \ 1gs1 \ }py 1l Vv 1 \ 1ry v Name: LENNAR HOMES PLC Permit Type: Building New (Residential) Contractor: LENNAR HOMES LLC Class of Work: Townhome Address: 4301 W Boy Scout Blvd 600 Building Valuation: $232,680.00 r,.. TAMPA, Ft. 33607 Electrical Valuation: $34,902.00 Phone: Mechanical Valuation: $23,268.00 Plumbing Valuation: $16,287.60 Total Valuation: $307,137.60 'P`� a Total Fees: $14,217,05 Amount Paid: $0.00 Date Paid: 51212023 11:37:50AM CONSTRUCT TOWNHOME 1541 SQ FT Address Fee $30.00 Building Plan Review Fee $180.00 Electrical Permit Fee $214.51 Park Impact Fee - Single FamilytTownhome $769.56 Water Connection Residential Fee $1,140.00 Sewer Connection Residential Fee $2,400.00 Public Safety Impact Fee -Police $254.00 Mechanical Plan Review Fee $0.00 School Impact Fee - Single Family $3,353.00 SIF 1 percent Fee $33.53 Public Safety Impact Fee -Admin $26.35 Transportation Impact Fee - City $34.80 Plumbing Valuation Fee $0.00 Building Permit Fee $1,203.40 Mechanical Permit Fee $156.34 Electrical Plan Review Fee $0.00 Plumbing Permit Fee $121.44 Fire Wall/Smoke Wall Inspection $15.00 Driveway Fee $45.00 3t4 Water Meter Residential Connection Fee $794.92 Transportation Impact Fee $3,445.20 EI SPEC I FEES: (c) With respect to Reinspection fees will comply with Florida Statute 5 .80( )(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. CON CTOR SIGNATURE F E !T OFFICE 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 > Building Department Date Received Phone Contact for Perm (( 908 ) 770 _ 7763 ittin Owner's Name CAL HEARTHSTONE LOT OPTION POOL 03 L P Owner Phone Number 813.574.5700 Owner's Address 1 23975 Park Sorrento; Ste. 220, Calabasas, CA 91302 Owner Phone Number Fee Simple Titleholder Name I N/A Owner Phone Number Fee Simple Titleholder Address I NIA JOB ADDRESS 36537 Camp Fire Terrace LOT# 2001 SUBDIVISION Abbott Square PARCEL ID# 04-26-21-0160-02000-0010 (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADD/ALT SIGN DEMOLISH INSTALL REPAIR PROPOSED USE u v u SFR COMM OTHER TYPE OF CONSTRUCTION BLOCK Q FRAME C STEEL DESCRIPTION OF WORK Multi -family / Screen Enclosure / Fence BUILDING SIZE U/R IF 1939 SCI FOOTAGE 1541 HEIGHT 23' BUILDING $ 232680 VALUATION OF TOTAL CONSTRUCTION 0 ELECTRICAL $ 34902 AMP SERVICE PROGRESS ENERGY W.R. E.C. PLUMBING $ 23268� a MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION GAS � ROOFING SPECIALTY = OTHER —� �—y t ry l 7 FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA DYES 1 NO ..! ... BUILDER COMPANY Lermar Homes, LLC SIGNATURE REGISTERED Y/ N J FEE CURREN Y 1 N 4301 oy Scout Blvd Suite 600 Tampa, FL 33607 CGC1518166 Address License # _ ELECTRICIAN COMPANY EdrnonSOn Electric, Inc. SIGNATURE REGISTERED Y / N FEE CURREN Address License# I EC13005408 PLUMBER COMPANY bayonet PlUmbing, Heating & AC, Inc SIGNATURE REGISTERED Y / N FEE CURREN L11N Address L License # CFC042998�� MECHANICAL COMPANY Bayonet Plumbing; Heating & AC, Inc SIGNATURE LREGISTERED L_11_N_j FEE CURREN Y 1 N Address License # CAC058062 OTHER COMPANY I C Sterling Quality Roofing, Inc SIGNATURE Y REGISTERED Y / N FEE CURREN Address License # CCC057991 —� aEtai��a�Ia'aato�c'li" alaQoaaallltalaoaa�Ilrala��ataa'aa�IIIIIaIIa,a 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 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 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, (AlC 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 THECOUNTERPERMITTING (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 N6TIC'E OF DEED " ♦NS: The undersigned understands that this permit may be subject to "deed" restrictions" which may be more • •responsibility applicable ._• UNLICENSED CONTRACTORS AND ! , r RESPONSIBILITIES: thecontractorowner has hired a 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 !violation advisedunder state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the intended work, they are to contact the PascoSection owner has hired a contractorcontractors,! Dritions of the "contractor Block" of this a lication for which the will be res onsibleIf IOU as the owner h i ♦ • �! i # • i •^ ! t ! ^i i ♦ i i # M i i # • i • • # M i i • i • l OWNER OR AGENT � - Subscribed and sworn d (or affirmed) before me this 1,28i202, by Christopher Smith Who is/are personally known to me or ve-predt�s®d as identification. r Notary Public Commission ��O 296057 Stephanie Farmer Name of Notary typed, printed or stamped 9ff:J �0�4tttt~ittz6:J Subscribed and sworn to (or affirmed) before me this arzanaza by Christopher Smith _ Who islareersonal mown to me or has/have produced as identification. Notary Public Commission No. 6 7 Stephanie Farmer Name of Notary typed, printed or stamped Iro 93 �Sir�sJun��Q2� �" F.Sa� edTP�u�'tcyF6�s 60Ue4@6.lgt� T VESCRIPTIONC LOT T-4, BLOCK 20, ABBOTT SQUARE PHASE 2, SITE PLAN ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK PAGES— OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA. (NOT A SURVEY) This SITE PLAN Prepared for and Certified To PROPOSED ELEVATIONS AND GRADING Lonnar Homes SHOWN HEREON ARE TAKEN FORM THE ENGINEERING PLANS OF 'ABBOTT SQUARE RESIDENTIAL', PREPARED BY 'WRA' PROVIDED BY CLIENT - -- ---- ALL ELEVATIONS REFERENCED TO NORTH AMERICAN VERTICAL DATUM OF 1988 (NAVD 88) TRACT"8-8" (CDD) OPEN SPACE N W4804 E PRI 92,68 IP�, SEC. 4, TWP. 26 S, RNG 21 E. PASCO COUNTY, FLORIDA fABBOTT SOUARE PHASE 2) Scale: 1 20' — — — — — — — — — — N. 2834 it) Jrt E, I ir 106_Ea E' �717.3 _�NAI O-LANA =NA IB0 173 18.0' ------ 22 4L z PROPOSED PROPOSED PROFOSED PROPOSED I STORY �Z STORYI �_TCKEVNLICCBE STORY I STORY Re TOWNEEOME =TOWNHOME A OWNHOME 1 PLAN 153 ? IC PLAN 7624 1� PLAN 1 621 PLAN 1532 ELEV'TH. c, ILI V'TH' ELLVIIII E ELEV 'Fril 1. GARAGE R GARAGE GARAGE A GARAGE I LOTS LOT 4 LOT 3 LOT 2 LOT I LOCK 20 6 BLOCK 20','1 6 BLOCK 20- BLOCK206 BLOCK 20 q 7TS 6.3' 130 TO ENTRY ENTRY ENTRY ENT ffl TRACT "84A" 100' (CDD) PARKING AREA wi TOO i6b -1, ILE) m6, 11,0 icro,- L�, i. fl2 2,31 28 3q IN (;), 5 CONC- WALK N 889* 'E fPJ qi 68`IRP 27,7 BASIS OF BEARING E Pt NOTES: CAMP FIRE TERRACE TRACT "A' LOT GRADING TYPE -A (CDD) RIGHT-OF-WAY PROPOSED PAD ELEVATION - 114,00 FRONT SET BACK = 20 LOT = 4083 SO, FT SIDE SET BACK- T5 LIVING VING AREA = Z682 SO. FT - ENTRY 280 SO. FT, SIDE SET BACK CORNER LOT) -10 GARAGE = 484 SO. FT REAR SETBACK = 15' NOTE: ENTRY WALKS ARE 3.0 CONC COVERED LANAI = 436 SCE FT C/S,A/C UNITS ARE 3.2 X3,2' PATIO NA SO. FT. 10.00 PUBLIC UTILITY EASEMENT POOL AREA =_hIA_SCL FT, PROPOSED: CONIC. MINIMUM FLOOR ELEVATIONS: A/C & DRIVE 800 —SO. FT. CO=_,4_OSCFF LIVING AREA: 114.67' LEGEND: SIDEWALKNIC PAD 186 —SCL FT. GARAGE AREA � PROPOSED DRAINAGE FLOW SIDE YARD SWALE = NA SO, FT ELEVATIONS REFERENCED TO (00,001 - PROPOSED GRADE CONSERVATION AREA =-NA—SO. FT NORTH AMERICAN VERTICAL E-00,00 = EXISTING GRADE LOT OCCUPIED = 60 % DATUM OF 1988 AREATO IRRIGATE = 40 % APPARENT FLOOD HAZARD ZONE: 'X"COMMUNITY NO. 120235 (MAP NUMBER 12 10 1 C-0452-F) EFFECTIVE DATE: 09/26/2014 SURVEY ABEIREVATIONS Ai • �PRC I ENGTH IN) - DEED INV INVER! PC - POIN f OF CURVE (M - RECOR�C LEGEND VINYLFoc, A/C AIRCEENuITONER DE- DRANAGE, EASEMFNI LB-LICENSF.DqUISNESS PC C - POINT Or COMPOUND CURVE RNG - RANGE A F - A I �U'1,1 1i60RI M-INNC ------- D ----- 0-- FE - 9 `�L 'TC I L P- DGEOFIRAVEMITEPI LEE- LOWEET I t COR ELEVATION O/E - POO' , t OUiPMEN7, RAN - RIGUT Or WAY 8 , 0�131 C"A-I.N 'L1-1L.VaFON I E - OmDSCAPF EASEMENT ECII - PERMANENT CONTROL POW RRS � RA1 ROAD SPSKE 'MSENC "MAR I R ESKET-EASEMEN! B - LICENSED SURVEYOR PC - PACE SEC - SECTION WOOD FENCE IM,U ' ATED F/C - FENCE CORNER (MI -MEASURED PI- PONT OF INTERSECTION SN&D-STTNAILANDUSK ASIFEALT ICI FCM - FOUND CONCRETE MET MITEsED END SECT TON PA -PARKER KALON LEEPI083CtMCHAIN UNIT FENCE RF CNXIN LINK DENCI MONUMENT Ei NO CORNER POUND I -PROPERTYUNE SIR -SO 112� WON ROD LB= —7-BRICK W, - CORRUGATED METAL Pill LP -FOUND IRON PIPE CIA - OVERALL PPOH - POINT OF BEGINNING TBM-7EMPORAPY FIC NC" F '0[ - C., am, DR - FO No IRON ROD OHW - OVERHEAD WIRED) 0 � POINT OF COMMENCEMENT TOB - TOP OF BANY ONC-CONCREIE N D - FOUND NNL & DISK O.R.-OFEWALRECORDS POI. - POINT ON LINE TWP - TOWNSH & UMNUM FENCE C UP - FOUND OPEN ISPL rl -Pt AT PRC = POidi Or REVERSE CURVE U E - UTP,17 Y PAS"PMENT -COVERED L" CONCRETE SLAB ;�PP -FOUND PINCHED I ME - FLAT BOOK IRM�PERMANNTREF��RENCFMONUM,'N-,IVF- NYLSENCE �Y, CLEAR SIGHT TRIANGLE J 12�2 JOB #6065 SURVEYOR'S NOTES: SURVEYOR'S CERTIFICATE 1708 Water Oak Drive 3— 1.) Current title information on the subject property had not been This cort'hes that skE ate of Site Plan., 1 1 -4-2,? fth hereon described Tarpon Springs, Florida e furnished to Initial Point Land Surveying, LLC, at the time of this property wad U perosion and Phone: 1727)-83T-1990 )WIGASTPHIBLI-CFEL2.0-SITE SITE PLAN Bar, th rAv Practice for FIondaPLS7I23C�gmaP1,cor 2.) This sketch was prepared without the benefit of title search, surveys Cut of I -and LBtf 8183 No instruments of record reflecting ownership, easements or S e I righB-of-way were furnished to the undersigned, unless otherwise a AZT: A C tied Drawn by: COS shown hemon u n t S c ion 472by, CPA rtley 3.) Roads, walks, and other similar items shown hereon were taken Stad*s�o 'hecked bjVJH — from engineering plans and are subject to survey. %�- I e.- ATE Date: 111.28 re R 4.)This SITE LAN does not reflect nor determine ownership IEVISIONS 5,This SITE PLAN is subject to matters shown on the Plat of Ht y00:01' P500' PST .. . ) "ABBOT? SQUARE PHASE 2' LOR D 6.) Dimensions shown hereon are in feet and decimal portions FLORIDA' R RAND 10 thereof. 7.) Contractor and owner are to verify all setbacks, building MAP PER P, dimensions, and layout shown Doreen 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 1-1 deviation from information shown heredr. Failure to do 50 will be LICENSED SURVEYOR AND MAPPER Initial Point Land Surveying, LLC. at users sole risk. I 11230 { t 4 114.43 ---- �i i � 7 i i 115.22 115.04 4 1AA8 V:: R 'U A L R E V E "A" A S S S Notice to Building Official of Use of Private Provider Effective January 20, 2003 36537 Camp Fire Terrace 04-26-21-0160- 02000-00 10 Services to be provided 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. 11 STEVE SMITH owner, affirm I have entered into a contract with the Private Provider indicated below to conduct the set vices indicated above. Private Provider Firm: VIRTUAL REVIEW ASSIST, INC. Private Provider: DESPA ANNE KLAHR Address: 747 SW 2ND 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 f6iin, 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- enviTommental or other codes. The following attar exits are provided as required- 1. (qualification statements and/or resumes of the private provider and all duly authorized representatives. 2.Tioof ofinsurance for professionaland comprehensive liability in.,the,ainount of $1 million per o courrence relating to all services pi rf imed as a private provider, including tail coverage for a miriinium, of 5 years subsequent to the performanc e building code inspection services., Individual C�Orporation Partnership Print CoiyoTationName PrintPartnership Name By, By, (Signature) (signature) . Print Print Print NTamo:_h �Isto �her S�rnth Name: its: Authorized Arlpnf xtse Address:_ZQQMW 107ih v. Address; Telephone Miarn FL 33172 Telephone, Telephone No, 913-574-5700 No.: Pleasenseappropriate'notarybl'ock. STATE OF FLORIDA COUNTY OF HILLSBOROUGH Individual Corporation Partnership B dore. me-, his day of Bdcre1n,,tjjb 22ND day of 13�foromo,tbis day 20.porsonally MAY. zo 2_2 of . . . . � 20__, appeared personally appeared, pms&ally appeared. who =outed the foregoing instrument, Of and a6knowledged before me that spnc Lennar Hamer ,.LLQ, a p axt=/agent on b 6half of was executed for the purposes therein r-orp orkion, 6n expressed.'behalf of the state corporation, who a partnership, who executed the executed the f6regoing instrument and foregoing instrument and aclo�owledged before me that same was acknowledged before me that same executed for the p-phorein -was ommuted-for the pmposes therein in pse -1s expressed. oxprqssed'. ForsoDallY knowA _)(4or Pro duced identification. Type of'identifloation produced Sipat rq of Notan, Pri ntN=P- ASHLEE CALLAHAN NotaiyPublic Stamp.: ASHLEE CALLAHAN coundsSion Expirm $SION # HH 296980 WCOMMI EXPIRE$: NoVeMbSt 30, 2026 P VRA VIRTUAL REVIEW ASSIST" Private Provider Plan ® lia c Affidavit Provider -Private Provider Firm- Virtual Review Assist, Inc. Private Address: 747 Southwest 2nd Avenue Phone., 813-391-2959 Email: jAcyfq) Project: New SFT •dCAMP FIRE TERRACE I hereby certify that to the best of my knowledge and belief the plans submitted were reviewed for and are in Floridacompliance with the 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: Florida License/Registration/Certification # J and description: FS468 Certified Standard Flans Examiner License #: PX2300 � A Q, w Signature of Reviewer: r y SWORN AND SUBSCRJBEDbcore me by )zebra Anne Klahr being personally known to net. or having produced as identification and who being fully sworn and cautioned, state that the oregoing is true an correct to the best of his/her knowledge or belief. Signs e of Notary Print Name commission expires: [� [—COMMERCIAL BUILDING SERVICES DIVISION 12I1+ SIDENTIAL BUILDING PERMIT DATA SHEET TRACKING # FIRE MARSHAL#01- DATE:_4/09/2023 F° LIO # 36537 CAMPFIRE TER EXAMINER: Debra Mohr PX230C Re hired Permits Building Plumbing Mechanical Electrical Amp Ins ection Ont � Ins' ection Onl 0 Ins ectaon Cent [] Ins ection Onl Roof � Gas ED Medical Gas � `ire Sprinklers ® On Site Piping Fire Line ❑ Irrigation Fire Alarm Potable Baekflow Assembly [] Fire bins Backiiow Preventer El Irrigation Rackflow Assembly El Demolition ®Walk-in Cooler Refrigeration El Hood E] Ansadl El Fence all El Crease Trap D Other EJ Other Building Data T e Construction: Risk Category: Occupancy Load axso Classification: Assembly Y3usness Day Care/Educational .. , FactoryIIazardous nstitutic�nal ®Mercantile Residential �m J'Storage ,Utility Building Use: INN FAMILY it'�V{/1�9PIQU E / Alteration Level l Level 2 Q Leve13 lw�New Construction [ Interior Finish 0 Interior Remodel ❑ Exterior Remodel E3 Addition ❑ Revision Overall Size: Number of Stories: "Total Sq. Ft.: 18-4 X 63 2 1939 Living Area: 1541 Covered area: 39 # of Bedrooms: 2 # of laths: 2,5 Cost per square foot: Estimated Value: Roof i e: n RJ1e 'Tile E] Built-u Metal Other Scares: 13 Zoning: Wl o e Debris: Energy Code El Inside Outside 405-2020 Flood Zone: X Base Flood Elevation: Finish Floor Elevation: Hydrostatic Vents" P Yes „ No ' Sq. Ft. Enclosed Space Below BF : of Vents: Size of Vents. Total Sq. Ine ertnnent Oeniilgs Central A/C � heat Pump window A/C D Gas A/C El Gas Meat Electric Feat Setbacks Front Rear Left Right As per Approved Site Ilan Comments: IN xp �i ,;;n't\e,��. Permit No. Date Permitted ` o2- Builder NamelOwner Name Control # County Parcel No. 2 -' . `« >�ubDiv: Address/Location ' 53 Classification/Type of Use TRANSPORTATION IMPACT FEE Rate: Sq. Ft Unit: Exempt Yes No Flog Determined Impact Fee Amount L� Zone No. TAZ: SCHOOL IMPACT FEE Account (056) Single -Family Detached House Amount $ d (057) Mobile Home (058) Other Residential (123) Collection Fee Exempt =Yes = No How Determined_ PARKS AND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zone Total Amount $ 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 c Checked By N CERTIFI OF OCCUPANY WILL RE ISSUED DR 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