HomeMy WebLinkAbout23-6190City of Zephyrhills
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5335 Eighth Street..
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Zephyrhills, FL 33542
NR-006190-2023
Phone: (813) 780-0020
Fax: (813) 780-0021
Issue toots: 05/08/2023
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15 26 21 0230 00000 01 50 38068 Fallstone Way T
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Name: LENNAR HOMES LLC Permit Type: Building New (Residential) Contractor: LENNAR HOMES LLG
Class of Work: Townhome
Address: 4301 W Boy Scout Blvd 600 Building Valuation: $235,800.00 ft
TAMPA, FL 33607 Electrical Valuation: $35,370.00 1M
Phone: Mechanical Valuation: $16,506.00 \rX
Plumbing Valuation: $23,580.00
Total Valuation: $311,256.00
Total Fees: $14,237.64
Amount Paid: $14,237,64 . Z
Uate Paid: 518/2023 1:55:41 PM
\ ., .\ i ".\ 1\.. Y. ...; �,.s�. \\ \ .; S. `zt.t,,, S. ~~,. 3. .< �; 1 \ s. � .�. \'. ..4 2 \1 \. 1....5•, "3 �;
.; ;:, \ \ c s, 1 .. e a},• :, , : L,\,.. ,. ,. -\:. .. \ \.. 4 » 1. .,., .,, � \ Y... CONSTRUCT TOWNHOME 1513 SQ FT
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Public Safety Impact Fee -Police $254.00 Electrical Permit Fee $216.85
$IF 1 percent Fee $33.53 Plumbing Permit Fee $157.90
Water Connection Residential Fee $1,140.00 Plumbing Valuation Fee $0.00
Fire Wall/Smoke Wall Inspection $15.00 Address Fee $30.00
Driveway Fee $45.00 Building Permit Fee $1,219.00
Mechanical Plan Review Fee $0.00 Public Safety Impact Fee -Admin $26.35
3/4 Water Meter Residential Connection Fee $794.92 Mechanical Permit Fee $122.53
Transportation Impact Fee - City $34.80 Electrical Plan Review Fee $0.00
Park Impact Fee - Single Family/Townhome $769.56 School Impact Fee - Single Family $3,353.00
Sewer Connection Residential Fee $2,400,00 Transportation Impact Fee $3,445.20
Building Plan Review Fee $180,00
EI SP CTI ES: (c) With respect to Reinspection fees will comply with Florida Statute 553,80(2)(c) the
local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection, whichever is greater, for each subsequent reinspection.
Notice: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permit required from other governmental
entities such as water management, state agencies or federal agencies.
"Warning to owner: Your failure to record a notice of commencement may result in your paying ice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
Complete Plans, Specifications add fee Must Accompany Application. All work shall be performed in
accordance with City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
� t }{
PE IT OFFICE
NOTICEPERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR
780-0020 City of Zephyrhills PermitiApplication Fay -sus -Sao -oozy
Building Department
INTIVIII204=
908 t 770
Owner's Name
Lenner Homes, LLC
Owner Phone Number
911574,5700
Owner's Address
4301 W Boy Scout Blvd, Ste. 600, Tampa, FL 33607
Owner Phone Number
Fee Simple Titleholder Name
Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS
500� FaIlStone way
GOT # 0015
SUBDIVISION TOWI1e$ at Autumn Palm
PARCEL ID#
5-25-2 j-0230-00000-0150
(.STAINED FROM PROPERTY TAX NbTICE)
WORK PROPOSED
NEW CONSTR
ADDIALT
SIGN DEMOLISH
INSTALL
REPAIR
PROPOSED USE SFR Itw.i
COMM
OTHER
�._.
BLO TYPE OF CONSTRUCTION tiJ CK -_t
i_.-
FRAME
STEEL
BUILDING $ 235800 VALUATION OF TOTAL CONSTRUCTION
ELECTRICAL PROGRESS ENERGY W.R.E.C. $
35370 AMP SERVICE
0 PLUMBING $ 23580��
MECHANICAL $ 16506 VALUATION OF MECHANICAL INSTALLATION gyp. F
=GAS ROOFING SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA YES Do
BUILDER COMPANY Le�Y/
loxnes, LLC
SIGNATURE REGISTERED N I FEECURREN YIN
430 Boy Scow lvd 11 Suite 600 i am(ta, FZ 336Q7 CCC] 518166
Address License
ELECTRICIAN o COMPANY dmonson Electric Inc.Y1 N FEY!NSIGNATURE REGISTERED �
;=
Address License# EC130054Q8
Bayonet Plum
bing, Heating
PLUMBER COMPANY y
SIGNATURE REGISTERED Y 1 N
Address License #
CFC042998 €
MECHANICAL COMPANY Bayonet Plumbing, Heating & AC, Inc
SIGNATURE / REGISTERED Y J N FEE euRREN Y I N
Address License # CAC058062�
OTHER? COMPANY C Sterling Quality Roofing, Inc
SIGNATURE REGISTERED Y ! N FEE CURREN Y ! N
Address License # CCC057991
@ili8l�4I�IElIt�tlMEtttilS�Fi6il�&IIt@S[EOE�FE���9B�lEEElF�[��19Ett
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Farms; 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 wt 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
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictio
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with a
applicable deed restrictions,
UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor
contractors to undertake work, they may be required to be licensed in accordance with state and local regulations If I
aftNEW, =0XV1010, I I
MINOR MINN I 1 -1111 M-W
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understan
111 161
myresponsi ifi 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 Sensiti
Lands, Water/Wastewater Treatment,
Southwest Florida Water Management District -Wells, Cypress Bayheads, Wetland Areas, Alteri
Watercourses,
Army Corps of Engineers -Seawalls, Docks, Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit -Wells, Wastewater Treatme
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
11 compensating volume" will be submitted at time of permitting which is prepared by a professional engine
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
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 adja
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violatir
the conditions of the building permit issued under the attached permit application, for lots less than one
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I Dromise in deed faith to inform the owner of the oermiftina conditions set forth
requiring a correction of errors in plans, construction or violations of any codes, Every permit issued shall become inval
unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized
n.
1, 6116 6M. R."4 " 111 * W."
lam [it Its ITATI 1101121 191VI I ky, I %I mITA 4L 14,13 "IKMOJ; I -�JJ1k01W4 im ftht
OWNER OR AGENT
Subscribed and sworn to (or affirmed) before me this
as identification.
Notary Public
Commission G296057
Stephanie Farmer
Name of Notary typed, printed or stamped
9ffJ
Subscribed and sworn to (or affirmed) before me this
1111,2111 --by
Who istare persona(I known to me or has/have produced
as identification.
----Notary Public
Commission No. 7
Stephanie Farmer
Name of Notary typed, printed or stamped
a n� w
l
I PAD
85
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83.66
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e
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1�4.33
84.10
RREL
1101
DESCRIPTION: LOTIS) 9-76, TOWNES AT AUTUMN PALMS, ACCORDING
TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 69, PAGN-,) 113,114,
OF THE PUBUC RECORDS OF PASCO COUNTY, FLORIDA,
-----------------
b
EN 666
it NOTES: -------- T,
LOT GRADING TYPE = N/A
PROPOSED PAD ELEVATION N/A b
R5
FRONT SETBACK - 15
U SIDE SETBACK'- 10
V1 INN
REAR SETBACK = 20
ALL WALKS 3,0'UNLESS NOTED
ALL A/C 3.2x3.2
VE/U/D � INGRESS EGRESS/
UTILITY/ DRAINAGE ESM I
LOT
= 16957SCE FT
LIVING AREA
= 5336
SO, FT
ENTRY
= 672
SO. FT
GARAGE
= 1848
SO- FT
COVERED LANAI
868
SO. FT
PATIO
= NA
-50. FT,
POOL AREA
= NA --SC.
FT.
CONC. DRIVE
= 2400
FT,
A/C & CONIC PAD
= 80
-So,
SO. FT,
WALK S D ;E
---324
SCL FT,
SIDE YARD SWALE
= NA
SO, FT,
CONSERVATION AREA
= NA
SO, FT,
LOT OCCUPIED
= 68
IS,
AREA TO IRRIGATE
= 32
%
SEC, 15, TWP, 26 S, RNG 21 E.
------------------------------------------------------------------------------------
PASCO COUNTY, FLORIDA
(TOWNES AT AUTUMN PALMS)
SITE PLAN
(NOT A SURVEY)
1708 Water Oak Drive
Tarpon Springs, Florida
Phone: (727)-831-1990
TRACT "H"
Z", T;E
Flo ridaPLS712 3@Dgmail. com
LANDSCABUFFER
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78-31 180 18,0,
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LLC
UNIT -A UNIT B
UNIT{
1,
1532
1516
1624
EZ
LOT
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UNIT{ UNIT{ UNIT{ UNIT-B
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LOT LOT LOT
13 12 11
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FT 1) 18,0 18, 0 IF)
-------- /L ---------- -4 -1 froo 0' (PI Ll L4101
# t89R56'08"E1p)
JOB
15969520009
15969520010
T-
159695206II
15969520012
F
'F;
'FALLSTONE WAY
15969520013
SST56'08'ER) 326,99 (P)
15969520014
BASIS -0—FBEARFN-G-
159695200151
ZEPHYRHILLS
PROPOSED*
LOWEST FLOOR ELEVATIMCITYOF
"' 11EMENT
LIVING ARE&84.83'
NOTE CONSTRUCTION PROPOSED ELEVATIONS AND TYPE
GARAGE AREA: ALL ELEVATIONS REFERENCED
GRADING PLANS GRADING SHOWN HEREON ARE TAKEN
ELEVATIONS REFERENCED TO TO NORTH AMERICAN
HAVEHA' MINIMAL FORM THE ENGINEERING PLANS OF MASER
NORTH AMERICAN VERTICAL DATUM OF VERTICAL DATUM OF 1988
GRADING/ELEVATION CONSULTING P.A,', PROVIDED BY CLIENT
INAVO 88)
1988
INFORMATION
10,85- NATIONAL GEODETIC VERTICAL
SURVEY ABBREVAT10iiIIii]
DATUM OF 1929
AfC INV - —INVO-1
* cstaf Party
AF-AWAINLARFENCE DE- DRAIPOOk fASUEFW ES-LICENSEDSLISNEC,
SIT-RAIII-MELF-TION EL OR ELEV - E U VALE ION Iff -IORASTPLOGRHWANON
ROP - PERWNFN-1 COWENA PEGGT RNG - RANGE
F/E - DOOE rQUIPMEFFIT PRS-AE?LRO/AEe`OF Checked �Y, JH J_
EM - 3,NCH WRR EOM-EDGEOFLOVEEAFFif LS-CENSEDSURWYOR
C - CUR',R ESM I - EASEMENT (MI - NI
PG - NEN' R/W � RIGHT OF WAY File;
PI -POINT OF INTF RSECI ON OC-SFCP0N
I(-FAICULAT'D I /C, I ENCE LARDER ME S - MITERED END SECTION fON
PK-PARKERKALON ENID - SET NAIL AND DISK MOP I In Date of Site Plarr()6-08-2 2
k2C[NTERLINF FCM - FOUND C ONCREI F MONUMENT Or F NO CORNER I N"ND
C f - I I AIN I INK FE, NCT, FIP - I O.ND IRON PIPE 01A OVERALL
(VP - CORRUGATED ME Al VIPF FIR - f OUNO RON ROD .11—CE—A—IRFOI
POP- POINT OF EDGINNING OR-SFT 1/Z IRON ROD ISSN 818�
IIOC - POINT OF COMMFN(EMENT rIEM-TFMPDRAG`8LNCI-4MARR rWG:T9-J6TVAPSITFJS1
POI- POINT ON I I.E 108-TOPOFFANK
<, I -COLUMN FN&D - FOUND NN1 & DIAT OR -OFFICAIRIFFORM Of POINT Of REVERSE CURVE Tve - IOWNSHP This SITE Plan Prepared for and
C ONC - CONCRE TE�Eri 1OP-EOLINDOOFNIPIPF (IT -,-I PRM PERPATNEWOORFNCEPTOET)WOT UF-UTITF!YEAN`MLNT Lerida, Homes
c/� - coNcRETE 9, nPP - FOUND PINCHED PIPE e-NATROOK F U E - PUIAX UTEH 7Y EPONANT
o
LEGEND
UNIT -A
1532
SURFACE TYPE FENCES
ALUMINLERA FENCE
IN
in Ea -FENCE
LOT 00
LOT
9
8 P121CK WOOD FENCE
TO
RJ
SANDPDIRT
-x—
54 rely
OV, 1111"0"1"
--CE-GEND-
11.3
IR
.yi
taRcItij PROPOSED DRAINAGE FLOW
.'„�
(00.001 - PROPOSED GRADE
2'OAK
E-00-00 - EXISTING GRADE
O
X LOF INGRESS EGRESS/LFE & D,E
(P)
APPARENT FLOOD HAZARD ZONE:'X' COMMUNITY NO, 120235
(MAP NUMBER 1210IC-0452-F) EFFECTIVE DATE: 09/26/2014
SURVEYOR'S NOTES:
-A-
I Current title inforinabor, on the subject property had not been
furnished to Initial Point Land Surseying, LLC. at the time of this site plan
2 This sketch was prepared without the benefit of a title search. No
instruments of record reflecting ownership, easements or rightsol-vvay
1
cr were furnished to the undersigned, unless otherwise shown hereon,
F
3.) Roads, walks, and other similar items shown hereon were taken from
engineering plans and are subject to survey,
4.) This site plan does not reflect nor determine ownership.
54 This site plan is subject to matters shown on the Plat of"TOWNS @
AUTUMN PALM
6 ') Dimensions shown hereon are in feet and decimal portions thereof..
7.1 Contractor and owner are to verily all ser sacks, building derensiorm
and layout shown hereon prior to any construction, and vrinnediate ji
advise Initial Point Land Surveying, LOC. of any deviation from
information shown hereon. Failure to do so will be at users sole risk.
Ir
Hartley 12" - \ ol .1 Date
%Uvp� NQ - LS#7123 L8#8183 )A PROFESS 4WA,
V6 ORANOMAPPER
NOT VALID 'a NATURE AND Sfi�
OFAFLOR% ft9
Services vices to be provided:
\/R/\
U A L R El V A SS I S T
v 1 F1 W
Notice to Building Official of
Use of Private Provider
Effective January 20, 2003
38068 Fallstone Way
15-26-21-0230-00000-0150
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.
I SIEVE 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 SW 2N[) AVE- SUITE 170,301,357,& 358, GAINESVILLE, FL 32601
Telephone: 813-376-3088 Fax: N/A
1
murni, It
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 Goode, laud use; enviiommental or other codes.
The following attar eats are provided as required:
1. Qualification statements and/or resumes of the private provider and all duly authorized representatives,
I. Pro of of insurance for professidnaland couaprehensive liability in,the: ount .of 1 million per
occurrence- relating to all "services performed as a private provider, including tail coverage for a mmunum
of 5 years subs equentto th perforzxaance of building code inspection services.
Individual corporation Partnership .
Print CorpomtionNanae PrintP ershipNmna
By;
:(signature) (signature) (signature)
Print Print Print
Name. Name• Christ. her Smith Na=
Address its: Authorized Agent Its.
Address: QQ hiini"10 �_ Address, -
Telephone Miaifi FL 33172
Telephone, Telephone
No, 313T574-5700 No.:
Please use appropriate notary b1bek.
TATF' OF FLORIDA .
Individual Corporation Partnership
Peforeme, this day of l3ef6te e, 22ND day of Beforeme,this day
20. personally MAY 20 2 of 20
appeared personally appeared personally appeared
who executed the foregoing instrument, of
and acknowledged before mD that same Lenn r HomesLLC a p or/agent on behalf o
was exeouted for the purposes therein corporation, on
e5cprrssod. behalf ofthe state corporation, who a partnership, who executed the
executed the foregoing i stxuramt and foregoing instrument And
acl owledged before me that same was acknowledged before me that same
executed for the purposes therein was executed.forthe ptarposestherein
expressed. expressed.
:Personallyknown X or® Producedidenti cation Type ofidentificationproduced
Signature of Notar'v Print Name A HLE CALLA IAN
NotaiyPuialic Stamp;
Comm ssioil l xpins:
ASHLEE CALLAHAN
W COMMISSION HH 296960
EXPIRES: November 30, 2026
VR/\
VIRTUAL. REVIEW ASSIST
Private Provider
Plan Compliance Affidavit
Private Provider Firm: Virtual Review Assist, Inc.
Private Provider: Debra Anne Klahr, BU1967
Address: 747 Southwest 2,d Avenue
Gainesville, FL 32601
Phone: 813-391-2959
Email: hgc rtuaireviewassist cone
Project: New SFR
Address(s): 304 ,33050,33054,33053,33060,3606 ,33066,330?2 Fallstone Way
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;LI,SN,SN1, S3,S4,S5, S6,SS, ST,DL ,PAl.0,PAI.l,
PA1.2,PA1.3,PAlA, SHI.0,SHLLS 1.2,SHL3,SHlA,SH1.5
Florida License/Registration/Certification #(s) and description:
FS468 Certified Standard Plans Ex i
License #: PX2300
f
Signature of Reviewer: �� � �.�A
SWORN AND SUBSCI IBED b're me by Debra Anne Klahr
being personally known to mew or having produced as identification
and who being fully sworn and cautioned, state that the
fre oing is e and correct to the best of his/her knowledge or belief.
Signature of Notary print Name
commission expires:
ASHLEE
ALGAH
MYC0)WM#8$10'V##44
� t X I S>° 2*80
v lnb e
`°A 2 fF
COMMERCIAL
BUILDING
BUILDING
! ? PERMIT
FIRE MARSHAL #01 -
DATE: 3/29/2023
'.�M �F .�
Building
Fj'Plumbing
�F,j Mechanical
Electrical Amp
El Ins ecfl2!� �nl
Fire SprinklersEl
El on 11e Piping
� � II�II�IIII
� � I rrigation
Fire Alarm
PotableEl I Rae � I
: Line�Backi ����
Irrigation .El I� III II
III �I l� h II
Walk-in CoolerRefrigerationu1,
Y 1,I I,
T e Construction: Risk Category: Occupancy Load
aaey Classicti®n: Assembly business ay Care/Educational
Factory Hazardous Institutional �, ®Mercantile
r Residential ®® ❑Storage ®Utility
Building Use: SINGLE FAMILY TOWNHOUSE l Alteration Level I JQLevel 2 IQ, Level 3
iy�New Construction El Interior Finish El Interior Remodel EJ Exterior Remodel El Addition ® Revision
Overall Size: Number of Stories: 'Total Sq. Ft.:
1$®4 X 63 2 195
Living Area: 1513
Covered Area: 452 # of Bedrooms: 2
# of Baths: 2,5
Cost per square foot: Estimated Value:
Roof'T e: X Shin le Tile Built-up® Metal Other S cares: 1
Zoning: WEE
o e Debris: Energy Code:
Znside Outside �405-2020
Mood Zone: X Base Flood Elevation: Finish Floor Elevation:
Hydrostatic Vents? ®Ves No Sq. Ft. Enclosed Space Below F7 :
# of Vents: Size of Vents: Total Sq; In< 1'erannt Gpenins
] Central A/C X Heat Pump ❑ Window A/C
0 Gas A/C I Gas Heat ® Electric Feat
Rear Left
As per Approved Site Plan
on
�s� �.'�`t
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Permit No �i L
Date Permitted -23
Sunder Name/Owner Nape 'Al° Control
County Parcel No. G! SubDiv:
Address/Location�1._
Classification/Type of Used Est
T NSPC�RTATIPi IMPACT FEE Rate: Sq. Ft Unit:
Exempt r""®i Yes No How Determined
Impact Fee AmountJ 180 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_
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 c
RESOURCE FEE ERU
Total Amount
Prepared By4 Checked By
t
NO CERTIFICATE OF DCCUPANY WILL BE ISSUED DR FINAL INSPECTION
PERFORMER UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND RECEIPT D 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