HomeMy WebLinkAbout23-6185City of Zephyrhills
5335 Eighth Street
Zephyrhills, FL 33542
N R-QQ6185-2023"
Phone: (313) 730-0020
Fax: (313) 730-0021
Issue Date: 05to812023
r Building (Residential
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15 26 210230 00000 0100 38050 Falistone Way
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Name: LENNAR HOMES LLC Permit Type: Building New (Residential) Contractor: LFNNAR HOMES LLC
Class of Work: Townhome
Address: 4301 W Boy Scout Blvd 600 Building Valuation: $235,800.00
TAMPA, FL 33607
Electrical Valuation: $35,370.00
f\rPhone: Mechanical Valuation: $16,506.00"`�d
Plumbing Valuation: $23,580,00
Total Valuation: $311,256.00
Total Fees: $14,237.64
Amount Paid: $14,237.64
Crate Paid: 51812023 1:55:41 PM
CONSTRUCT TQWNHQME 1513 SQ FT
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Plumbing Valuation Fee $0.00 Building Plan Review Fees $180.00
Transportation Impact Fee $3,445.20 Public Safety Impact Fee -Police $254.00
Water Connection Residential Fee $1,140.00 Public Safety Impact Fee -Admin $26.35
Sewer Connection Residential Fee $2,400.00 Building Permit Fee $1,219.00
Driveway Fee $45.00 Fire Wall/Smoke Wall Inspection $15.00
Park Impact Fee - Single Family/Townhome $769.56 Plumbing Permit Fee $157.90
SIF 1 percent Fee $33.53 Mechanical Plan Review Fee $0,00
Address Fee $30.00 314 Water Meter Residential Connection Fee $794,92
School Impact Fee - Single Family $3,353.00 Electrical Permit Fee $216.85
Mechanical Permit Fee $122.53 Transportation Impact Fee - City $34.80
Electrioal Pian Review Fee $0.00
I SPECTl 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 tines 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 ether 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.
c TOR SIGNATURE
Fi—�M
ITHOUT APPROVED: INSPECTION
813-780-0020
a
Date Received {
City of Zephyrhills Permit Application
Building Department
Fax 81311780-0021
Owner's Name 1 Lennar Homes, LLC
Owner's Address
4301 W Boy Scout Blvd, Ste. 600, Tampa, FL 33607
Owner Phone Number
Fee Simple Titleholder Name
NIA
Owner Phone Number
Fee Simple Titleholder Address
I Toff
JOB ADDRESS
38050 Fallstone Way
LOT # 0010
SUBDIVISION Townes at Autumn Palm
PARCEL 1D#
15-26-21-0230-00000-0100
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED
New CONSTR
ADDIALT
SIGN DEMOLISH
INSTALL
REPAIR
PROPOSED USE SFR D
Comm
OTHER
TYPE OF CONSTRUCTION BLOCK
FRAME
STEEL
sMulti-family / Screen Enclosure / Fence
R �
O BUILDING $ 235800 _ VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL $ 35370 AMP SERVICE PROGRESS ENERGY W.R.E.C.
PLUMBING $ 23580
MECHANICAL $ 16506 VALUATION OF MECHANICAL INSTALLATION
=GAS t v r ROOFING E D SPECIALTY = OTHER r— �
FINISHED FLOOR ELEVATIONS I FLOOD ZONE AREA 'YES o
BUILDER � COMPANY
Lennar Ttcrrnes, Lief;
SIGNATURE REGISTERED LLLN J FEE CURREN Y/ N
Address 4301/W Boy Scaet W'5uite 600 Tampa, F1, 33607 License # I CGGI518166
ELECTRICIAN COMPANY Edmonson Electric Inc.
SIGNATURES REGISTERED Y 1 N FEE CURREN Y / N�
Address License # EC13005408
PLUMBER COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE ""'""` REGISTERED LY / N J FEE CURREN Y / N
Address � License #
CFC042598
MECHANICAL COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE Gs °' REGISTERED Y L N FEE CURREN Y / N
Address License# I CAC058062 m
OTHER COMPANY C Sterling Quality Roofing, Inc
SIGNATURE ,'I REGISTERED YIN FEE CURRE% Y / N
Address License # CCC057991�
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, Constriction 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. (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
I'amd I gve ty,71 isca 141:4 1 IVA I ai anu gn I A g 116-2 oxam-aaagumt,4 rM 1 02 IMMUR! I LIM Wai III UIUMM I Z•
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
1128/2021 -by Christopher Smith
who is/are personally known to me or4asAiav&-Fa1qdI_'G@d
as identification.
171
Notary Public
Commission 1'G 296057
Stephanie Farmer
Name of Notary typed, printed or stamped
Subscribed and sworn to (or affirmed) before me this
312822023 by - Christopher Smith
Who is/are personally known to me or has/have produced
as identification,
-Notary Public
Commission No. /ZOW
Stephanie Farmer
Name of Notary typed, printed or stamped
k 824
401-MI\ MOM #Mow
ox"MMOPMOOM
Lvinankm
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Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
38050 Fallstone Way
15 -26-21 -0230-00000-0 100
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, INC.
Private Provider: DEBRA ANNE KLAHR
Address: 747 5W 2N() AVE- SUITE 170,301,357,& 358, GAINESVILLE, FL 32601
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
review for fire, code, land use, environmental or other codes.
The following attalclanonts. are provided as iequire&
1. (qualification statements and/or resumes of the private provider and all duly authorized representatives.'
2,, Proof of insurance for professionaland comprehensive y inthe, liability amountof $1 million per
i
o ccurrenoD relating to all service's pierf-bimed as a private provider, including tailcoverage for, a mimm=
of 5 years subsequent to the performance of building code inspection services..
Individual
:(Signature)
print
Name:
address:
dress,
elf,phono
I�o .:
Pleagense appropriate notary block.
STATE of FLORIDA
COUNTY o*F HILLSBOROUGH
flaffmaml
Before. me, this day of
20— personally
appeared
who blevated the foregoing instrument,
and acknowledged before me that same
was executed for the purposes thoroin
exTrrssod.
Corporation
Print CorporstiouName
By:
I'lint
Name: Christ, or Smith
its: Authorized Aqgnt
Miard, FL 33172
Telephom•
No. 913-574-5700
'Corporation
136orrme, tis 22ND day of
MAY 202
persona* appeared,
of
Lennar Homes LLQ a
eorporiiion, 0 1 n
behalf of the state oorporation, who
executed the f6rDgoing kstrumant and
acicnowkd. god before me that same was
executed for the purposes th-.rein
Personally known odu or- X Prced idendtoation Type of idDritifloation produced
o du
Signat m of Notar�'
ASHLEE CA
LLAHAN
NotaiyPublio Stamp'. My COMMISSION # H
H 295930
PIRES:Novemb6`r30,2026
Commission Expire
Partnership
PrintPartnershipNainB
L%
I
Print
Name:
its,
Address:
Telephone
No.:
EMEM
pi afore me, dais day
pen6nally appeared
p ai tnor/agent an behalf of
a partnership, who exermtod the
foregoing instrument �nd
ad�nowlodg5d before me that same
was executodfor the purposes therein
expressed,
[—COMMERCIAL BUILDING SERVICES DIVISION R SIDEN'TIAL
BUILDING PERMIT DATA SHEET
TRACKING # FIRE MARSHAL #01 - ®ATE: 3/29/2023
FOLIO # 38050 F lls°toneWay__ EXAMINER: Debra Kl hr PX230E
Re uired Permits
Ij Building I JZ Plumbing I 1Z Mechanical I JZ Electrical —Amp
(._j 1ria vwturf Llruv 1rfJ C(:fl Vrf Vrff lro 4:6ff Urf Vrtf L_j lrla t (u Lb Vrf kmf
Rtaof [ 1 Gas ❑ Medical Gas Cl Fire Sprinklers
® On Site Piping ® Fire Line ® Irrigation ®.Fire Alarm
El Potable Rackilow .Assembly ® Fire Line Rackflow Preventer ® Irrigation Backflow Assembly Demolition
® Walk-in Cooler El Refrigeration ❑ Hood ® Ansul
El Fence/Wall ® Grease Trap [I Other D Other
Buildine Data
Type Construction: Vm8 Risk Category: Occupancy Load
0 myancy Classification: Assembly � ro"
usin®ss <Day Care/Educational
:Factory Hazardous stitutional [�Ivlercantile
n.
Residential R� me [s;Storage tility
Building Use: SINGLE FAMILY TOWNHOUSE / Alteration Level 2 Level 2 bevel 3
New Construction ® Interior Finish El Interior Remodel ® Exterior Remodel Addition ® Revision
Overall Size: Number of Stories: Total Sq. Ft.:
13w4 X 63 2 195
Living Area: 1513 Covered Area: 452 # of Bedrooms: 2
# of Baths: 2.5
Cost per square font: Estimated Value:
Roof T e: X Shin le Tile ❑ Built-u Ivletal ®Other Scares: 13
Zoning: Wi erne Debris: Energy Code:
'Inside ;Outside 40�2020
Flood Zone: X Rase Flood Elevation: Finish FIoor Elevation:
Hydrostatic Vents? ® Yes No S . Ft. Enclosed Space Below IIFE:
# of Vents: Size of Vents; 'Total Sq. In. Permanent Openings
Central A/C ® heat Pump E] Window A/C
Gas AIC ®Gas heat E] Electric Beat
Front Rear Left
2 As per Approved Site Plan
MM
V"R/\
VIRTUAL REVIEW ASSIST
Private Provider
Plan Compliance Affidavit
Private Provider Firm: Virtual Review Assist, Inc.
Private Provider: Debra Anne Klahr, BU 1967
Address: 747 Southwest 211 Avenue
Gainesville, FL 32601
Phone: 13-391-2959
Email: hi
1gy0avirnaalreviassit.o
Project: New SFR
iRogow, I I
holdsand
Name: Debra Anne Klahr
Plan Sheets 1,2, 3, 4,5,6, 7,8, 9,10,11,12,13,14,15,16,LI,SN,SN1, S3,S4,S5, S6,SS, ST,D1, WP,PAI.0,PA1.1,
PAI.2,PAL3,PA1:4, SHl.0,SHI.1,SH1.2,SHI.3,SHI.4,SI41.5
Florida License/Registration/Certification #(s) and description:
FS468 Certified Standard Plans Examiner
License #: PX2300t�
Signature of Reviewer:
SWORN AND SUBSCRIBED before"me by Debra Anne Klahr
being personally known to one or having produced as identification
and who being fully sworn and cautioned, state that the
to goi is true and correct to the best of his/her knowledge or belief,
igna e of Notary 16yt Name
Notary Public: NOTARY STAMP BELOW ley
commission expires:
g a.: "YCOMMIS$1010HH295980.
EXPIRE19,NOvembor30,2026
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DESCRIPTiOTL LOTIS) 9-16, TOWNES AT AUTUMN PALMS, ACCORDING
TO THE PLAT THEREOF, RECORDED IN PLAT BOOK
89, PAGE(S)1 13.1 14,
OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA.
-----------------
II NOTES: ________
�-- LOT GRADING' TYPE � N/A
PROPOSED PAD ELEVATION =- N/A
QJ
o
�
FRONT SET BACK -15
V SIDE SETBACK - 10"
Lej
10 0'
REAR SETBACK =20'
ALL WALKS 3.0' UNLESS NOTED
ALL A/C 3.2x 3.2'
(/E/U/D = INGRESS EGRESS/
UTILITY/ DRAINAGE ESM'T
LOT = 16957 SO, PT.
a.
LIVING AREA = 5336 FT.
__SO.
ENTRY 672 _SO, FT,
GARAGE 1848 SO, FT.
£.
COVERED LANAI 868 SO. FT.
LOT,..
PATIO = NA SO, FT.
17 ry.
POOL AREA = NA O. FT.
CONC. DRIVE = 2400 SO. FT..
A/C & CONC PAD = 80 SO. FT.
SIDEWALK= 324---__SO. FT.
.'...
SIDE YARD SWALE -- NA _ ---"----SO- FT.
CONSERVATION AREA = NA SO. FT,
SEC. 15, TWP, 26 S, RNG Z I E.
PASCO COUNTY, FLORIDA
(TOWNES AT AUTUMN PALMS)
rt _______ mT
TRACT 'H'
LANDSCAPE BUFFER
S 84'56'08' P
Itrurr (7 18,00, (P) 00" {P 1I a To" (P lao0 ( f
i 1 1 i I
2
AT
RES
UNIT -A UNIT-B
UNIT-C
UNIT-C
w 1532 1516
�
1624
w 1624
o
144'LEI'
0
0�
LOT LOT
LOT
LOT
16 IS
14
13
TO 6.7'
6,17
6.7'
2
m
LOT OCCUPIED = 6S 1% (81�,661- I 113 113
AREA TO IRRIGATE - 32 TA I
'1
M
o }
i a
5 B9'36'08 k (P) 1.8 (PI 28,30{�UTi8,0077
71-777
'
SITE PLAN
(NOT A SURVEY)
----
i
n:
n i �
if
8
0
UNIT{ UNIT-C
UNIT-B
UNIT
1624 w 1624
1516
1532
?.
o
w
�
a
LOT LOT
LOT
LOT
LOT
12 11
10
9
8
z 6.7' 6,7'
,Cq z
Z 7.0"
< <
1ITO'
t f.3 1; i 113 0-0 [ ,Ti j. It3 1I3 1t3 :!
} 100 1 f0o �^i{ Ib } Tit_t00 1 E IOO �Ix `,�
( µµry,t
iD
f f r �, / f �� jl •; i Io
S. N
^t18.00 P i 1800 P I tfi Qb`+ i 38. 0 P i 18 0 P }", If 28.33' (P)
' ` S 69`56,08`.E iP) ' 5 0
FA LLSTONE WAY
)59536 3 itOADWAiYTRACT-C S89`56'OfL£(P) 32899-R)
259695zggTs PROPOSED: CIg�TgY/ OF ZEP6v MILLS
)596962Q016 LOWEST FLOOR ELEVATIQF U/DEASEPfiEtdT
LIVING ARE&0483` _.
NOTE: CONSTRUCTION PROPOSED ELEVATIONS AND TYPE GARAGE AREA. 1 ALL ELEVATIONS REFERENCED-..i
GRADING PLANS GRADING SHOWN HEREON ARE TAKEN I ELEVATIONS REFERENCED fii3 TO NORTH AMERICAN i
HAVE MINIMAL % FORM THE ENGINEERING PLANS OF "MASER NORTH AMERICAN VERTICAL DATUM OF VERTICAL DATUM OF 1988
GRADING ELEVATION CONSULTING PA. PROVIDED BYCLIENT � iNAVD86) j
INFORMATION`.e..-' ,,.,.-. .. """"" _.-'_`n „"'1 7B8@
"0,85— NATIONAL G£QI?£'i'fG VERTICAL.
DATUM OF 1929
a/-aazroru�rsIONOR lD) DFEr, Pray nnitrsr tic oNT OF cuRVE IRP .. eccoeD Drawn filF CWC Party Chief:JH
AF At U!'NUMEENCE IS DRANACF EASEMENT -B^LICENSED RUISNFM PCP- PERMANENT.ONTROL POINT RNG RANGE
8EE-BASE ELOODELEVAPON ELOREL.V=ELEVATION LFL OSYEW FLOOR ELEVATION P/F -POOI F.OUIPMENT RAS - RAIL ROhD SvfKE �hr'=ke=l +Y -
BM - BENCIT MARK FOP EDGE OF PAVEMEN'i I , LICENSED SURVEYOR PG - PAGE R/W-Rt6F{r OF WAY File
C -CURVE ESMT FAWMENT IMP MEASURED PI- POINT OF INTERSECTION SEC - SECTION _
rj-CALCULATED F/C= FENCE ICOQNCRETE MONUMENT NCF-NO CORNER END
NON PKO-PARKER KALON SN&D- SET NAIL AND DISK I-Ral183 Date of Site Plan06,08.222 CWC
4-CFNTFRiJNE ECM-FOUN' - POINT OF BEGINNING SIR •-SET 1/2-PON ROD LBN 8183
CLE- c FAIN LINK IFEE .E OF -FOUND MON PIPE O/A- OVERALE POC- POINT OF COMMEWTERNT TBM- TEMPORARY BEN{H MARK Di,YjG:Ly 16-TRI?AP. SITE. DINO
CMP- CORRUGAI ED METAL MIT FiR-FOUND IRON ROD OFTW ^ OVC4HEAO WIREID PO POINrONLNE FOR - FOR OF BANK
CO, C-UMN FNM3- FOUND NAPL&DISK OR OFFIUAI.RECORDS PRC POINT OF REVERSE CURVE. I&P^TOWNSHIP This SITE Plan Prepared for and Certified
LONG^CONCRETE FOF-FOUNOOPFNPIPL (P! PUT Pi66 - PDRSIANENT REFERENCE MONUMENT' U.F• Ji1UFY FASF,MENT Lennar Hor B
CIS - CONCRETE SL48 DPP^FOUNDPPVI4'A3 PPE PP=PViTE00K PU.E � PUBIIC UTILRYf ASEMENT
1708 Water Oak Drive
Tarpon Springs, Florida
Phone: 1727I-831-1990
FJoDdaPLS7123@lgmaiJ.com
L8# 8183
i471ZZ
'.:..'fin �`.,.`
Scale: 1" = 20'
Initial Point Land Surveying, LLC.
LEGEND
SURFACE TYPE m FENCES
p jFl CONC AWMINUMFFNIF
/ ASP IAET VINYI FEPO (
=PRIOR WOOD11NCG
=SAND/LJIRT CHAIN LINK FENCE
-C4VERE0 OVERHEAD VOWER
PROPOSED DRAINAGE FLOW
100,00) - PROPOSED GRADE
E 00,00 - EXISTING GRADE " 2' OAK
11 E 0 INGRESS ELiRE55/U E & FEE
APPARENT FLOOD HAZARD ZONE "'COMMUNITY NOF 12W3a -
(MAP NUMBER 3Z101 C�0452-PJ EF6ECTA lE DATE 09,1�6/2014
surzvEra�s €�ccT�s:
1.) Current title information can the subject property had net been
fumished to Initial Point Land Surveying, LLC at the uTne of felt seta than
2.) Thls sketch was propared without the benefit of a title scarce, No
instruments of record reflecting ownership, easemeneR or righoi-of-way - -- -
were Furnished to the undersigned un7r4s otherione shown hereon. _.-.
3.) Reads walks, and other similar items shown hereon were taken from
entilmeoring plans and are subject to survey.
4.) This site plan ones cot mfEect nor detarmsne cnvnershLp.
5.) This site plan Is subject to matter€ shoran on the Plat cif 'TOWNS c-
AUTUMN PALM"
6.) Dimtrivons shown hereon are in feet and declmai portions there -of.
7.) Contractor and owner are to Verify all setbacks,. building dimensronm,
and layout shown hereon prior to any construction, and imnsediaeedy
advice Initial Point €.arid Surveying, hLC of any deviation from
Information shown, hereon. Failure to do sea will be at user s mete nsi .
SS1 Te
This certiffes that ski Fir pony as made
undermys pl < Yraetfeetar
surveys as sin Chapter
WETTEST to S,f, t; ..4-, 3, F;�I', min 1FRIPulaM to
Sectfon47 j Stamm Ittit ,(}3,
wool
)A PROFESS' VR%9ffAND ' FF,R#,5#?123.t,6�81A3
NOT VALID NATURE AND SEAL
OF A FLOR �U , . OR AND MAPPER
i
Builder Name/Owner Name
County Parcel No,pCGCe
Address/Location �LC63A5
Permit No.t
t i
Date Permitted"
Control #
Classification/Type of Use
TRANSPORTATION IMPACT FEE Rate: Sq. Ft Unit:f
Exempt Yes No How Determined
Impact Fee Amount (90 Zone No. TAZ:
SCHOOL IMPACT FEE
Account (056)
Single -Family Detached House
(057)
Mobile Home
(058)
Other Residential
(123)
Collection Fee
Exempt Yes
= NO Hove Determined_
Amount $
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreation Total
Zone Total Amount $
Exempt =Yes =No How Determined
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 6V`14_ � Checked 6y
NO CERTIFICATE OF OCCUPANY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND RECEIPTER 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 RECEDED BY
RECEIPT NO DATE BY