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HomeMy WebLinkAbout23-6092City of Zlephyrhills 5335 Eighth Street v 1 y 1 ti�1� ,v`a�1�vvy vv Zephyrhills, FL 33542BNR-006092-2023 Phone: (313) 730-0020 Fax: (813) 730-0021 Issue gate: 0510212023 Perili ill 1 \ 1 \. � \l s'1\ }\ \ 1 •. 1 1\\ :.: 1. \. \. }1\ , i� t ).2' \... \ \ r �.}\\ :c 1 <.. 19"" d �;k• iA \ . � { J t . \} �,.,\va:�. A v�,y,t..vt� 04 26 210160 02000 0040 36523 Camp Fire Terrace \' (( 4 l' \ 1\ Ji .'S}11 \ \,S \ 1}\S\ l\ �Z'\ Ykj {\1: \�,\,,}kt \� \., .,y\., a 11 t\ \ 1 ;h i .�c,\ yl\ yr. .., ......,�...>.., ram: Name: LENNAR HOMES LLCPermit Type: Building New (Residential) Contractor: LENNAR HOMES LLC Class of Work: Townhome Address: 4301 W Boy Scout Blvd 600 Building Valuation: $232,680.00 TAMPA, FL 33607 Electrical Valuation: $34,902.00 t Phone: Mechanical Valuation: $16,287.60 Plumbing Valuation: $23,268.00 Total Valuation: $307,137.60 Total Fees: $14,217.05 ;J e Amount Paid: $14,217.05 Gate Paid: 51212d23 11:37:50AM \ \ \. '\ } Y„ \ CONSTRUCT TOWNHOME 1541 SCE FT 314 Water Meter Residential Connection Fee $794.92 Water Connection Residential Fee $1,140.00 Electrical Permit Fee $214.51 Park Impact Fee - Single Family/Townhome $769.56 Building Permit Fee $1,20140 Public Safety Impact Fee -Police $254.00 Address Fee $30,00 Transportation Impact Fee $3,445.20 Fire Wall/Smoke Wall Inspection $15.00 Driveway Fee $45.00 Transportation Impact Fee - City $34,80 Sewer Connection Residential Fee $2,400.00 Public Safety Impact Fee -Admin $26,35 Mechanical Plan Review Fee $0.00 SIF 1 percent Fee $33.53 Plumbing Valuation Fee $0.00 Electrical Plan Review Fee $0,00 Plumbing Permit Fee $156.34 School Impact Fee - Single Family $3,353.00 Mechanical Permit Fee $121.44 Building Plan Review Fee $180.00 REI SPECTION FEES: I With respect to Reinspection fees will comply with Florida Statute 53.80(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 reinsp etion. 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 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 '14 ayld. r1ll PE IT OFFICE THOUT APPROVED INSPECTION 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received Phonffontact or Parmittin 9Q8 77Q 7763—rrceivedOwner's Name CAL HEARTHSTONE LOT OPTION POP Own®r Phone Number 813.574.5700 Owner's Address 23975 ParkSorrenta, Ste. 220, Calabasas, CA 91302— Owner Phone Number �� Fee Simple Titleholder Name N/A Owner Phone Number Fee Simple Titleholder Address N/A JOB ADDRESS 36523 Camp Ire �erraCe LOT# 2Q�q SUBDIVISION Abbott Square PARCEL ID# 04-26 21-0 i 6Q Q2t�7Q-004© (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR ADDIALT SIGN DEMOLISH INSTALL REPAIR B PROPOSED USE SFR Q COMM OTHER TYPE OF CONSTRUCTION 0 BLOCK FRAME STEEL • ♦'Multi -family I Screen Enclosure / Fence ►' a •• . BUILDING $ 232680 VALUATION OF TOTAL CONSTRUCTION ' ELECTRICAL $ 34902 AMP SERVICE PROGRESS ENERGY W.R.E.C. PLUMBING $ 23268 (MECHANICAL $ I628% 6 VALUATION OF MECHANICAL INSTALLATION y t =GAS ROOFING = SPECIALTY = OTHER FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA BYES Do BUILDER COMPANY Len�/N ca LL.0 SIGNATURE A REGISTERED PEE OURREN Y IAddress 4301 } Scout Blvd Suite 600 Tainpa, FL 33607 License # CC C,1518166 ELECTRICIAN COMPANY Ednnonson Electric, Inc. SIGNATURE € REGISTERED Y 1 N FEECURREN YIN Address License# I EC13005408 � PLUMBER COMPANY Ba�NFEE �CURIRSN �Y/ AC, Inc SIGNATURE REGISTERED Address License# I CFC042998 MECHANICAL COMPANY Bayonet Plumbing, Heating cox AC, Inc SIGNATURE REGISTERED YIN FEE CURREN Y I N Address License # I CAC058062 OTHER COMPANY C Sterling Quality Roofing Inc SIGNATURE REGISTERED Y/ N FEE CURREN Y I N Address License# CCC057991 IIii6191tBOB.989IS9Ilt8I1lRIpRl6BBtItBIIBB&BBOIIBfi1Bl11BBtt&Btp61Bt 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 wl 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 & t 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 (PloUSurvey7Footage) Driveways -Not over Counter if on public roadways..needs ROW OWNER OR AGENT Subscribed and sworn o (or affirmed) before me this a�zeizoaa by (.hns opher Srrnth Who isfare personally knawn to me or�asitxa+��-,� as identification. "s Notary Public Commission G 296057 Stephanie Farmer Name of Notary typed, printed or stamped 9ff:3 Subscribed and sworn to (or affirmed) before me this srzerzoza by Christopher:Smith Who istare personally known to me or has/have produced as identification. Notary Public Commission No. 6 7 Stephanie Farmer Name of Notary typed, printed or stamped CM=IW0TI*HH ONO v F�TU'AL REVir"A ASSIST Notice to Building Official of Use of Private Provider Effective January 20, 2003 36523 Camp Fire Terrace 04-26-21-0160-02000-0040 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, I STEVE SMITH , 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 REVIEW ASSIST, IN I Private Provider: DEBPA 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/ SN4615) 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 I eview for fire codo, land use, envlro ental or other codes..' The following atta.chtnents. are provided as required; 1. Qualification statements and/or resumes of the private provider and all dulyy authorized xepreser tattives. 2.-Proof of insurance for professional and coropreh6nsive I al iliiy in:tho.am, unt.of 1 ii onp�' o ocurrence relating to all services perfofzned as a private provider; including tail coverage for amitiroura. of 5 years subsequent to the performance of building code inspection services; Individual Corporation Partnership . Print CozporationName Pr7ntP erslupNaie (signature). (signature) (sigtaaare) Print Print } print Name, Name, hr15d ! [fir CTil�l Nara�2e; A.ddms Its: Authorized Agent Its- Address'�00 NW1Ci7fh Avg. Address, Telephone Miarr i FL 33172 No. Telephone• Telephone No. 9137574-5700 No.: Pleaseuse appropriate notary hlock. STATE c)F FLORIDA COUNTY OF HILLSBOROUGH I dividual .'Corporalbn Partnership Beforeanf,-,t%is day of Beforeme,tbis 2 ND day of Beforeme,tlais By 20 ,personally MAY. 2o 2.2 of 2Q appeared' personally sppeared personaEy appeared who executed the foreg6i g instrument, of and acknowledged ;before roe that same I.. enn r H. ornes LLQ p erlagent onbehalf of 'was executed for the purposes therein sarpnrafi on, O' expressede behalf afth6 state corporation, who a partnership, who executed the executed the f'aregoing instr=eat and foregoing instrument kncl aclai ovaledged before me thst s e `was` acknowledged before zxae that same executed for the pu*pses tb,.erein was executod.for the purpqm therein expressed, expressed, Personally known X or Pro ducedidarl#oation Type, ofidentifioationproduoed Signatzre ofNotar ?TintNamo ASHL.EECALLAHAN NotaryPublic Stamp; ;tiv Y .q ; ASHLEE CALLAHAtd Coxnmissioxal-xpires; YCCt�h11SSION#N 295960 =� EXPIRES: Nova09 s0, 2026 ^o p Vy a VR/\ VIRTUAL REVIEW ASSIST Private Provider Plan Compliance Affidavit Private Provider Firth: Virtual Review Assist, Inc. Private Provider: Debra Anne Klahr, BU 1967 Address: 747 Southwest 2,d Avenue Gainesville, FL 32601 Phone: 813-391-2959 Email: luc virtualreviewassistcoin Project: New SET Address(s): 36523 CAMPFIRE TERRACE 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 d holds the appropriate license or certificate: Name: Debra Anne Klahr Plan Sheets 1,2,3,4,5,6,7,8,9,10,11,12,13,14,15,16, Ll, SN; SN1, S3;S4,S5,S6, ST, SS, D1, 1, 2, 2.1, PA1.0,PAL1, PA1.2,PA1.3,PA1.4, SHl.0,SHI.I,SHI.2,SHI.3,SHL4,SHl.5 Florida License/Registration/Certification #(s) and description: FS468 Certified Standard Plans Examiner License #: PX2300 Signature of Reviewers SWORN AND SUBSCRIBED, ,Pe6e 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 foregoing is true andleorrect to the best of his/her knowledge or belief. �� .ate -J lgna e of Notary tnt N e Not Public: NOTARY STAMP BELOW My [—COMMERCIAL BUILDING SERVICES DIVISION RESIDENTIAL BUILDING PERMIT DATA SHEET TRACKING FIRE MARSHAL # I ® DATE: 4/09/2023 FOLIO # 36523 CAMP FIRE TER EXAMINER: ebrb Klahr PX230C Re uired Permits Building Plumbing Mechanical Electrical Amp [l Ins ection 0n1v D Ins ection On 0 Ins ection On ❑ Ins ection Onl Roof 0-1 [j Gas El Medical Gas ❑ Fire Sprinklers On Site Piping [l File Line [] Irrigation ❑ Fire Alarm El Potable Backflow Assembly El Fire Line Backflow P'reventer ® Irrigation Rackflow Assembly E Demolition [l Walk-in Cooler ❑ Refrigeration [l Hood E Ansul Fence all El Grease Trap ❑ Other [l Other T e Construction: V-Q I Risk Category: Occupancy Load 0 an cy Classitiction: Assembly usiness Day Care/Educational Factory Hazardous _ nst�tuiianal Mercantile Residential R-" Storage �� „� [�Utility Building Use: SINGLE FAMILY TOWNHOUSE / Alteration ❑ Level I Level 2 0-Level 3 New Construction 0 Interior Finish ® Interior Remodel 0 Exterior Remodel 0 Addition ® Revision Overall Size: Number of Stories: Total Sq. Ft,: 15-4 X 63 2 1939 Living Area: 1541 Covered Area: 398 # of Bedrooms: 2 # of Baths: 2.5 Cost per square foot: Estimated Value: Roof I e: Shinele B uiltmu Fetal Other S uares: 23 Zoning: Wi' o e Debris: Energy Code: 20 Inside Outside 40420 Flood Zone: X Base Flood Elevation: Finish Floor Elevation Hydrostatic Vents? ®,Yes No Sq. Ft. Enclosed Space Below OFF: # of Vents: Size of Vents: Total Sqa In, I�er tanetlt t pezlings Central AIC X Il�at I$urtcp [� Wizidow A1C [� Gas ri1 � Gad Beat [� Flectt°ic Beat On Site lei Can Sanitary Sewer Storm Sewer Catch Basins Potable Water Underground Fire Line Setbacks Front Rear Left Right As per Approved Site Flame Comments: DESCRIPTIOM LOT 1-4, BLOCK 20, ABBOTT SQUARE PHASE 2, ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK SITE PLAN SEC. 4, TWP, 26 S, RING 21 E. PAGES— OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA, (NOT A SURVEY) PASCO COUNTY, FLORIDA I,---- - --I This SITE PLAN Prepared for and Certified To: (ABBOTT SOUARE PHASE 2) PROPOSED ELEVATIONS AND GRADING Lenrar 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 Scale: 1 20' VERTICAL DATUM OF 1988 (NAVD 88) TRACT "18-8" (CDD) OPEN SPACE N R9-4804- E tPJ q2 68'rIP 7— 28734 (P) !800'1Pi 1; 8 10 0 1 P) �1� 28 31 IT) C, 1'� RIn 1 0 NA ANAICANA NA lRo 17.3 173 18,0 PROPOSED I S-ORI, PROPOSED Ys PR1 STORY OPOSED IKO OS111 H RY -7STO RY rn W TOWZME "T0WNHOME �ICLWNHOGJK WNHOME624 I PLAN I S32 TON 1624 0 PLAN 1532 ELEV Thi 'I PLAN I PLA GARAGE R B FLEV ­Uq' ELEV7H, �E ELEV Trr 5 GARAGE I -�Z GARAGE R GARAGE LOTS 0 % �; 13 3 LOT 2 LOT I BLOCK 20 B LOTIT OIT LOT 20�� LOCK 2 BLOCK BLOCK20-0 8 BLOCK 20 TO 63 130 To ENTRY ENTRY F.ENTRY ENTRY I Cror TRACT "84A" z (CDD) PARKING AREA FE, Il'o 11,C) W�ro,o. I Erb 100 W o\ 0— 0 41 t w1 I R.V, N 89NIE(EVE (PI 28 34 P) I Is, 06 IF) 2834tll) 5 {ONCE WALK NBE 27,7, BASIS OF BEARING N W48'04- E Rst NOTES: CAMP FIRE TERRACE LOT GRADING TYPE -A TRACT "A" (Coo) RIGHT-OF-WAY PROPOSED PAD ELEVATION - 114,00' FRONT SET BACK - 20 LOT = 4083 SO, FT. SIDE SET BACK = T5 LIVING AREA = 2682. SO, FT. ENTRY = 280 SO, FT, SIDE SET BACK (CORNER LOT) 10 GARAGE -St84 SO, FT, REAR SETBACK - 15 NOTE: ENTRY WALKS ARE 3.0'CONC COVERED LANAI $O. FT, C/S-A'C UNITS ARE 3,2 X3Z' PATIO _ NA -So, FT, PROPOSED: 10.00 PUBLIC UTILITY EASEMENT POOL AREA = NA SCL FT, CONC, DRIVE SO, FT, MINIMUM FLOOR ELEVATIONS: LIVING AREA: A/C & CONC PAD FT, 114.67' LEGEND: SIDEWALK FT. GARAGE AREA: __,� = PROPOSED DRAINAGE FLOW SIDE YARD SWALE = NAB _SC_ FT. ELEVATIONS REFERENCED TO (00,00) PROPOSED GRADE CONSERVATION AREA =_.NA_SQ. FT, NORTH AMERICAN VERTICAL E 00 00 = EXISTING GRADE LOT OCCUPIED 60 % DATUM OF 1988 AREA TO IRRIGATE SF APPARENT FLOOD HAZARD ZONE: X COMMUNITY NO. 120235 SURVEY ABB REV:A::T:1:0=NS (MAP NUMBER 12101 C-0452-P) EFFECTIVE DATE: 09/26/2074 -71 —APC-ENGTH 0! - DEED INV - NVVRI PC - POLN'OF CURVE is) -RECORD LEGEND A/C- AIR CONDITIONER D E- DRAINAGE EASEMENT N -LICENSED BUISEGSE PCC-PCs TOICOMPOUNDCURVz RNG - RANGF VINYL FENCE AT -ALUMINUM PENCE E, OR FLEV - ELEVATION LE- LANDSCAPE EASEMENT PCP PERMANENT CONIROL POIN i RRS - RAJ. ROADY'Af CoNC ------- 0— EFF _ BASE F ELEVATION POP - EDGE OF PAVEMENT LFL- LOWEST FLOOR ELEVATION TT POO, FOUPRAORT R--RIGHT OF WAY Bhr- BENCHMARK ESM T - EASEMENT ,,S - LICENSED SURVEYOR OF - PAGEWOOD FENCE C - CURVE MARK F/C - FENCE CORNEA IMP -Mt ASURED IF- POINT OF INIERSECTION S-SECTION ANI)IRS, PC I - C)ELCULATI SN&D - SE! NAT, CLIETERLINE D CCU - FOUND CONCRETE MES - MILLIKED END SECTION PC -PARKER KALON U30183 CHAIN LINK FENCE MONUMENT NVF - NO (ORKIN FOUND I -PROPER'IYUNE SIR - SET 112 IRON ROD LEIS 8183 CL' CHANLNK"'C' IR � Oi`%D) IRON ROD Of AE - OVGRK LEAD WIREFS) LIO� - POINT OF COMMENCIMENT FOR - TOP OF BANK =_`dICR c—CORRUnATEENIIIAIIIII ril-DO N �R NPIPL CIA - OVERALI, POS - POINT OF EGGINNING TRY- TEMPORARY RENCH MARK rN6D -MAD NAIL & DISK U.R.Of HCIAI RECORDS PO-PONTONLINIF TSEV - TOWNY 4111 [2�2 ALUMINU PENCE C& CCLUMN E EN PIPE (PI - NXI CM I -C. CRETE 01, � r F_ CAVER'p C/s - CONCRETE SLAY OUND OFF, PAC - POINT OF RGsERSF (URGE U E - UTILITY EASEMENT CG CLEAR SIGHT TITANGLE FPP-COUNDPLN EDDPL PIE - PLAI BOOK PRIM - PERMANENT REFERENCE MONUMENT, VF - VINe PENCE JOB #6065 SURVEYORS NOTES: SURVEYOR'S CERTIFICATE 1708 Water Oak Drive Date ofSjte Plant 1- 1.) Current title information on the subject property had not been This ertf thatskcgtQ ftho hereon described Tarpon Springs, Florida P, 4-22 furnished to Initial Point Land Surveying, LLC. at the time of this propc,�Rtyftte;., upervision and Phone: (727)-831-1990 2.) This sketch was prepared without the benefit of a title search, meets 1, e Practice for FlondaFILS7723,egmaix in DPASAVIFY I A L l4oL20 SITE PLAN e surveys rd of Land LB# 8183 No instruments of record reflecting ownership, easements or S we I J_ -ise: rights-carway were furnished to the undersigned, unless otherwise ned AZ , ist shown hereon, iiirrran 47 2, t))ie (tley Drawn by, DJB 3,) Roads, walks, and other similar items shown hereon were take Stat S-0 from engineering plans and are subject to -'e; -hecked byJH Date: (P 11.28 IEVISIONS 4.I This SITE PLAN does not reflect nor detormineey ownership. HH I eyT. W.1. 5100' WIT 6.) This SITE PLAN is subject to matters shown on the Plat of f LORI 'ABBOTT SQUARE PHASE 2 6.) Dimensions shown hereon are in feet and decimal portions Jeff lvl� thereof, FLORIDA R RAND 10 7.) Contractor and owner are to verity all setbacks, building MAPPER NO, dimensions, and layout shown hereon prior to any construction, NOT VALID WITHOUT THE ORIGINAL and.immediately advise Initial Point Lind Surveying, LEE. of any SIGNATURE AND SEAL OF A FLORIDA a1 deviation from information shown hereon. Failure to do so will be LICENSED SURVEYOR AND MAPPER Initial Point Land Surveying, LLC. at users safe risk, Permit No. 612- )1041 Date Permitted A 0 Builder Name/Owner Name 6ivy- Control # County Parcel No, 0 1_4 L2- SubDiv: j�� Address/Location — — ?3 LY W V Classification/Type of Use TRANSPORTATION IMPACT FEE Rate: Sq. Ft Unit: Exempt 0 Yes 0 No How Determined Impact Fee Amount _1_3j_L0_ Zone No. TAZ:— SCHOOL IMPACT FEE Account (056) Single -Family Detached House Amount (057) Mobile Home (058) Other Residential (123) Collection Fee Exempt CDYes = No How Determined_ PARKSAND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zone Total Amount $_Z64.�2_ Exempt =Yes = No How Determined 1�1 Land Account Land Credit Land Total Facility Account Facility Credit Facility Total Exempt 0 Yes No How Determined — Total Amount RESOURCE FEE ERU Total Amount Prepared By Checked By NO ICEIVICATEIF 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. DATE RECEIVED BY RECEIPT NO DATE BY