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Home My WebLink About23-6479Rim" Issue r 06/30/2023 dt tj � 1 CONTRACTOR SIGNATURE q OFFICE -*DERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIOft CALL .xe INSPECTION . ? r NOTICE REQUIRED PROTECT nMK:, CARD WEATHER 13 70�-oozo City of Zephyrhills Permit Application Fax-813-780-0021 Building Department Date Received I ( Phnne Cnntart for PermiBina 1r 908 ) 770 __ Owner's Name Owner Phone Number CAL HEARTHSTONE LOT OPTION POOL 03 L P 813.574.5700 ' Owner's Address 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 L N/A JOB ADDRESS 36493 Camp Fire Terrace LOT# 2011 SUBDIVISION Abbott Square PARCEL ID# 04-26-21-0160-02000-0110 �---nnn (OBTAINED FROM PROPERTY TAX NOTICE) WORK PROPOSED NEW CONSTR 8 ADD/ALT SIGN Q DEMOLISH INSTALL REPAIR PROPOSED USE V SFR COMM OTHER TYPE OF CONSTRUCTION u r u BLOCK E:] FRAME t STEEL DESCRIPTION OF WORK Multi -family / Screen Enclosure / Fence BUILDING SIZE U/R SF 1939] SO FOOTAGE 1� 1 HEIGHT 23 BUILDING $ 232680 ••��•d!! Lu 1.!./ (ELECTRICAL � $ 349021-71 [JPLUMBING $ 23268 b (MECHANICAL $ 16287.6 =GAS L.7_.d ROOFING Q FINISHED FLOOR ELEVATIONS BUILDER SIGNATURE Address 4301' W Boy Scout ELECTRICIAN SIGNATURE Address PLUMBER SIGNATURE Address MECHANICAL SIGNATURE Address OTHER SIGNATURE VALUATION OF TOTAL CONSTRUCTION M PROGRESS ENERGY W.R.E.C. AMP SERVICE VALUATION OF MECHANICAL INSTALLATION SPECIALTY = OTHER FLOOD ZONE AREA I IYES Do �, p COMPANY REGISTERED 600 Tampa, FL 33607 COMPANY REGISTERED COMPANY REGISTERED Y :D Y D Lerrnar I Iames, LLC Y / N FEE CURREN I Y / N License # CGC1518166 Edmonson Electric, Inc. Y / N FEE CURREN I Y / N License # I EC13005408 Bayonet Plumbing Heating & AC, Inc Y / N FEE CURREN I Y / N License # ICFC042998 Plumbing, Heating & AC, Inc FEE CURREN Y / N License # I CAC058062 C Sterling Quality Roofing, Inc FEE Address License # [CC-0057991 i1llii11i11111i111I1111#'Iilit111111ii1111111111111i11111ii1711111I! 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 subdivisionsf arge 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. (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" 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 intended work, they are advised to contact the Pasco County Building Inspection Division —Licensing Section at 727-847- 8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractors) sign portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco County. TRANSPORTATION IMPACTIUTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and 90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances. CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I 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 compliance with all applicable laws regulating construction, zoning and land development. Application is 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 certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is 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 "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. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the job is considered abandoned, OWNER OR AGENT Subscribed and sworn ro4(or affirmed) before me this 11wln by _ Christopher Smith Who islare personally known to me or has/have PFQdWGed as identification. Notary Public Commission �� 1.296057 Stephanie Farmer Name of Notary typed, printed or stamped EUSUKHOLLEPAN R PVk, Exomsjurte$,2024 x to Subscribed and sworn to (or affirmed) before me this _!IW2023 by Christopher Smith Who Ware personally known to me or has/have produced as identification. Notary Public ZAW6� Commission No.' Stephanie Farmer Name of Notary typed, printed or stamped 444 M", ELI&MM, ROLL" EViftJU1106,2024 DESCRIPTION: LOTS 11-16, BLOCK 20, ABBOTT SOUARE PHASE 2, ACCORDING TO THE PLAT THEREOF, RECORDED IN PLAT BOOK 90, PAGES 28-33, OF THE PUBLIC RECORDS OF PASCO COUNTY, FLORIDA, PROPOSED ELEVATIONS AND GRADING SHOWN HEREON ARE TAKEN FORM THE ENGINEERING PLANS OF ABBOTT SOUARE RESIDENTIAL", PREPARED BYWRA' PROVIDED BY CLIENT ALL ELEVATIONS REFERENCED TO NORTH AMERICAN VERTICAL DATUM OF 1988 ll 7283� (P_ ) Is Ro (P) e , 10 -1 F SITE PLAN (NOT A SURVEY) This SITE PLAN Prepared for and Certified To: I ennar Homes TRACT"El-S" (CDD) PARKING AREA AND OPEN SPACE IJ89'48'04'EIP) 1211�11'(Pl HH�� — T isoe in I a 00 IF) ! RPT SEC. 4, TWP. 26 S, RNG 21 E. PASCO COUNTY, FLORIDA (ABBOTT SQUARE PHASE 2) 4 Scale: 1 20' 10,0 6_—'�'—- oLANAI ? LANAIp. LANAI LANAI A — :�1- LANAI (LANAC :� ICLO 18'0 17,3 17.3' 17.3' 17.3' 18, 0 UNFT-A Z UNITC z UNIT{ Z UNIT{ z UNIT-C Z e UNIT -A 1532 1624 1624 .1 1624 1-Z 1624 q 1532 z RO OSED PROPOSED PROPOSED PROPOSED PROPOSED PROPOSED p ROPOSED IF 2STORY -� 2STORY 2STORY vi 2 STORY v, Ln 2STORY �s 2STORY 7z ATTACHED !�ATTACHED ATTACHED ATTACHED E LIE ATTACHED 'E ATTACHED I 0: RESIDENCE 2 RESIDENCE Zi RESIDENCE RESIDENCE z RESIDENCE RESIDENCE c; LOT I6 8 LOT 15 N g LOT14 oLOT13 LOT12 LOT I1 BLOCK 20 _G . BLOCK 20 BLOCK 20 BLOCK 20 BLOCK A) 'i BLOCK 20 LOT17 :9 LOTIO BLOCK 20 108-8" BLOCK 20 0 7.0 ENTRY ENTRY 6.3' 771 6.3' ENTRY ENTRY 6.3' 63 ENTRY ENTRY 7 IT 1 10.0 0-\ I PF L0 z W W Lv W Ul W 11.0 1 1.0 I (�O' 100 '00 �10 00, 70.0 0 •0 ]��B //0 N 89-48'04- E (P) 230.65 (P) 2:J4 (P) OR (P) I 'B'do (P) 80 ell PCP 5' •CONC WALK' - S 89'48'04- W (P) 128.68 IP) 2713 7 27.3 BASIS OF BEARING N 89'48'04 E (P) — — - — - - — NOTES: - — - — - — — - — - — - — -- CAMP FIRE TERRACE - LOT GRADING TYPE =A TRACT'A" PROPOSED PAD ELEVATION =1 10,80 (CDD) RIGHT-OF-WAY FRONT SET BACK = 20'LOT = 12611 SO. FT. SIDE SET BACK = T5 LIVING AREA = 4010 SO_ FT. SIDE SET BACK (CORNER LOT) = 10 L1_901511011 ENTRY 6 SO. FT. 10.00 PUBLIC UTILITY EASEMENT GARAGE SQ. FT. REAR SETBACK = IS NOTE: ENTRY WALKS ARE 3 0 CONC 15905522012 COVERED LANAI = b5Z $O. FT, C/S-A/C UNITS ARE 3.2 X3.2 15905522013 PATIO = NA SO. FT PROPOSED: POOL AREA = NA SO. FT MINIMUM FLOOR ELEVATIONS: 15905522014 CONC DRIVE = 1200 SO FT LIVING AREA: 11 1147' PINCHED PIPE LEGEND: NC & CONC PAD SO. FT. GARAGE AREA: _-- = PROPOSED DRAINAGE FLOW 15905522015 SIDEWALK =_2,7_2SO. FT ELEVATIONS REFERENCED TO f00.00) = PROPOSED GRADE 15905522016 SIDE YARD SWALE =NA_SO. FT_ NORTH AMERICAN VERTICAL E-00�00 = EXISTING GRADE CONSERVATION AREA =NASOL LOT OCCUPIED = 64 FT. % DATUM OF 1988 AREA TO IRRIGATE % APPARENT FLOOD HAZARD ZONE:'X"COMMUNaY NO. 120235 IMAP NUMBER 12101 C-0452-F) EFFECTIVE DATE: 09/26/2014 SURVEY ABBREVATIONS A) = ARC LENGTH (DI - DEED INV-?NVTRT PC - POINT or CURVE IS) - RECORD LEGEND A/C- AIR CONDITIONER DE- DRAINAGE EASEMENT [a -LICENSED BUISNESS PCC-POI OFCOMPOUNDCUR,1E LNG - RANGE VINYL FENCE AT - ALUMINUM FENCE SEE - BASE FLOOD ELEVATION EL OR ELEV - ELEVATON EDP -EDGE OF PAVEMENT LE- LANDSCAPE EASEMENT LEE - LOWEST FLOOR ELEVATION FCP•PERM NENT CONTROL POINT P/E - POOL EQUIPMENT RRS - RAIL ROAD SPIKE R/W - RIGHT OF WAY M_cO Nc ------ BM - B.ENCH MARK E M T - EASEMENT LS - LICENSED SURVEYOR PG PAGE SEC - SECTION W OD FENCE C = C F/C -FENCE CORNER (MI -MEASURED MEASURED PI - POINT OF INTERSECTION SN&D-SETNAILANDD ISK ASPHALT (C -UZOUT&TED � FCM -FOUND CONCRETE MEE - MITERED END SECTION P K -PARKER KALON LB#8183 S -CENTERLINE CLF - CHAIN LINK FENCE MONUMENT D IRON PIPE F:P, NCF - NO CORNER FOUND CPA - OVERALL PROPERTY LINE PCII - POINT OF BEGINNING SIR - SET 112 IRON ROD LB# 8183 TS. = TEMPOR BENCH My MARK -BRICK CHAIN LINK PENCE C P-COREUGATEDMETALPEN : FOU 'N OHW OVERHEAD WIRE(Sl DOC - POINT OF COW NCTMENT TOB - TOP OF BANK COL -COLUMN C ON CONCRETE CNDIRONROD FNSD^ DUN NAT&DISK O.R. OFFICIAL RECORDS POL - POINT ON LINE TWP - TOWNSHIP ALUMINUMFENCE C/S - CONCRETE SLAT _ED FOR -FOUND OPEN PIPE Hap -FOUND UND -PLAT IB- IA T... PRC - POINT OF REVERSE CURVE PRM - PERMANENT REFERENCE MONUMENT UX - UTILITY EASEMENT COVERED CST -CLEAR SIGHT TRIANGLE I I I VF - VNYL FENCE SURVEYOR'S NOTES: 1.) Current title information on the subject property had not been furnished to Initial Point Land Surveying, 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, casements or rights -of -way were furnished to the undersigned, unless otherwise shown hereon. 3.) Roads, walks, and other similar items shown hereon were taken from engineering plans and are subject to survey. L -mine 4) This SITE PLAN does deter SURVEYORS CERTIFICATE This certifies that k" of the hereon described property w .. SMY upervision and meets th I e Practice for e e ard of Land I Igned I rats jst, N rtley LIT a o Section 4 ebo Date- ..05.18 1708 Water Oak Drive Tarpon Springs, Florida Phone: 1727)-831-1990 FloridaPLS7123,egmail,co LB# 8183 Date of Site Plan: 4-1 9-23 DWG.61-PH2-L I I - I �81_2(PSITE File: Drawn by. DJ8 — Checked by.JH — REVISIONS not reflect nor ownership. 6, This SITE c * I E PLAN is subject to matters shown on the Plat of 4'00' A BBOTT SQUARE PHA.E2, 6.) Dimensions shown hereon are in feet and decimal portions thereof. 7.) Contractor and owner are to verify ail setbacks, building dimensions, and layout shown hereon prior to any construction, — ! IDA Jeff M. r% FLORIDA;6�( R AND MAPPER NMIllifil 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 user's sole risk I A L F-1 E V i Notice to Building Official of Use of Private Provider Effective January 20, 2003 Project Name: 36493 Camp Fire Terrace Parcel Tax ID: 04-26-21-0160-02000-0110 Services to be provided: Plans Review X Inspections 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. 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 KLAHP Address: 747 SW 2ND AVE- SUITE 170,301,357,& 358, GAINESVILLE, FL 32601 Telephone: 3-SMIMMI. Email Address (Optional): deb@virtualreviewassist,com Fax: N/A Florida License, Registration or Certificate #: (LTC # 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 pen -nit 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 set -vices 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 attachments are provided as required: 1. Qualification statements ' and/or resumes of the private provider and all duly authorized representatives.' 2.. Proof of insurance for professional and comprehensive liability in,the. amount.of $1 Million per o ccurrence relating to all services performed as a private provider, including tail coverage for a minimum of 5 years subsequent to the performance,of building code inspection services. Individual :(signature) Print Name: Address: Telephone AT . Pleasp, use appropriate notary block. STATE OF FLORIDA Before me, this day of 20— personally appeared who executed the foregoing instrument, and acknowledged before me that same was executed for the purposes therein expressed - Corporation LENNAR HOMES LLQ Print Corporation Name By: (signkurq) print Name: Christopher Smith ItsAuthorized cient Telephone. No. 813-574-5700 Corporation Beforem,,this 22ND day of MAY 20 2_2 personally appeared of Lennar Homes, LLC corporation, on behalf of the state corporation, who executed the f6regoing instrument and acknowledged before, me that same was executed for the purposes therein expressed, Partnership Print Partnership Name (signature) Print Name: Its Address: Telephone No.: Partnership Bafore me, thus day of _20— personally appeared partner/agent on behalf of a partnership, who executed the foregoing instrument and acknowledged before me that same was executed for the purposes therein expressed. Personally known X or- Produced identi-tcation Typo of identification produced Signature, of Notan PrintName. —ASHLEE —CALLAHAN Notary Public Stamp: ASHLEE CALLAHAN ii Commission Expires: MY COMMISSION # HH 295980 EXPIRES: November 30, 2026 PaRe 2 of 2 VIRTUAL REVIEW ASSIST Private Provider Plan Compliance Affidavit Private Provider Firm: Virtual Review Assist, Inc. Private Provider: Debra Anne Klahr, BU1967 Address: 747 Southwest 2nd Avenue Gainesville, FL 32601 Phone: 813-391-2959 Email: 1ApX@ m r_ -virtualreviewassistco ,-- Project: New SFT Address(s): 36493 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 and holds the appropriate license or certificate: Name: Debra Anne Klahr Plan Sheets 1,2.1,2.2,,3,4,5,6,7.1,7.2,8,9,10,11.1,11.2,12,LI,SN, SNI, S3M, S4,S5,S6,SS,ST, DI,IvVP, PAI.0,PAI.1, PAI.2,PAI.3,PAI.4, PAI.5,SHI.0,SHI.1,SHI.2,SHI.3,SHI.4,SHI.5 Florida License/Registration/Certification #(s) and description: FS468 Certified Standard Plans Examiner License PX2300 Signature of Reviewer: ------ 7 SWORN AND SUBSCRIBED 1 fore me by Debra Anne Klahr being personally known tom or having produced as identification and who being fully sworn and cautioned, state that the f reg mg in is true and correct to the best of his/her knowledge or belief is Ashlee Callahan Si a e of No Print Name Notary Public: NOTARY STAMP BELOW My commission expires: ASHLEE CALLAHDAN 1 2 95980 My COMMI, OSION # I-IH 295980 EXPIRE$: November 30,2026 TRACKING # FOLIO # 36493 Camp Fire Ter mul-11111o"Umm INEM FIRE MARSHAL #01 - Required Permits I*Mkl I IM: MUSIE470 Building El Inspection Only Plumbing ❑Inspection Only V Mechanical pection Only El Ips IV Electrical —Amp [:] Inspection OnI Roof Gas E] Medical Gas E] Fire Sprinklers E] On Site Piping El Fire Line 0 Irrigation E] Fire Alarm Potable Backflow Assembly ❑ Fire Line Backilow Preventer E] Irrigation Backflow Assembly E] Demolition El Walk-in Cooler E] Refrigeration El Hood R Ansul El Fence/Wall El Grease Trap E] Other El Other Risk Category: Occupancy Load Classification:_ a ney C'a s Factory F i al Res dent Assembly Hazardous Storage E=:= f — business ��y Care/Educational nal C rcantile ❑ Utility Building Use. single family townhome 1,6New Construction E] Interior Finish Alteration I Level I DLevel 2 Level 3 Fu El Interior Remodel E] Exterior Remodel E] Addition ❑ Revision Overall Size: 18-4 x 63 Number of Stories: 2 Total Sq. Ft.: 1939 Living Area: 1541 Covered Area: 398 # of Bedrooms: 2 # of Baths: 2.5 Cost per square foot: Estimated Value: 00 Ue: ®Shin Roof FTile El i t� -,tal ElOther Squares: 13 Zoning: WiffInside Debris: El ]Outside Outside Energy Code: 405-2022 sup Flood Zone: X Base Flood Elevation: Finish Floor Elevation: Hydrostatic Vents? []Yes No Sq. Ft. Enclosed Space Below BFE: # of Vents: Size of Vents. Total Sq. In. Permanent Openings 0 Central A/C El Gas A/C 21 neat Pump 0 Gas Heat El Window A/C EJ Electric Heat Santa !j Sewer Storm Sewer Catch Basins Potable Water Under round Fire Line 2EM Front Rear Left Right 21 As per Approved Site Plan Comments: fa Permit No. Date Permitted Builder Name/Owner Name i Control # County Parcel No. C q 016 i 0 SubDiv: 4 Address/Location Classification/Type of Use TRANSPORTATION IMPACT FEE Rate: Sq. Ft Unit: 15.E Exempt Yes No Haw Determined Impact Fee Amount S ` 3 t 5 Zone No. TAZ: SCHOOL IMPACT FEE Account (056) Single -Family Detached House Amount $ (057) Mobile Home (058) Other Residential (223) 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 $ 70,® r LIBRARY FEE Land Account Land Credit Land Total Exempt r7 Yes o d ��.131M jWfX Checked .. DOM Total Amount 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. RECEIPT NO DATE BY