HomeMy WebLinkAbout91-1719
STATE OF FLORIDA
City of Zephyrhills
PASCO COUNTY
BUILDING DEPARTMENT
1-813-788-6611
Permit
N~ 1719 ~)
~-I9-? I
Date
E~
PL~
ME~AL
Properly owner: Name: A -d.:!:11- /(~.,l?~
Job Address: Y h ;l j, ~
Legal Description:
Sub.Div.
Lot
Blk.
ZoningCI: 7 -~ 0 - 0
Description of Work ~ - () d/l
I'
ooou-0370
F~~
Energy Code Readout:
Complete Plans, Specifications and Fee Must Accompany Application
Estimated Cost:
0~ crz:r-o - c::ro
"
Fee: ~~ -
SIGNATUR k~~ ~-h/~
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances,
COMPANY
ADDRESS
TELEPHONE #
OCCUPATIONAL LICENSE #
~~..
Ftr.
Pre SLB
Lintel
FRM.
Insul.CL I
WL~ --4 ,/}
"~
E~AL
------
~ANICAL
~
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Breakers
Ducts Insl.
Compressor
Final
~1)JJ
Driveway
Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of L.I )
dollars shall be made for each _. /Y'd- de (/-6-tJ?) )
(a) Wrong Address .
(b) Condemned work resulting from faulty construction
(c) Repairs or corrections not made when inspection called for
(d) Work not ready for inspection when called.
The payment of reinspection fees shall be made before any furlher permits will be issued to the person owning same.
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APPLICATION FOR PERI-lIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OJ#//
1,( lJ k€c. /,~~('b;"-a.
W,'~l~l"j~ ,pr " ve
~//SI/'~ Kv kE'c
M5Ie//2)'" LOT SIZE
PHONE
7cf;<-//3~
ADDRESS
OWNER L~ t/ 15
Lou;:s
4,;z;<
APPLICANT
JOB LOCATION
4~.;Z~
x
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D. ~F
WORK PROPOSED:____New Construction ____Addition ~Alteration ____Repair ____Install
____Sign/Temp.
PROPOSED USE: ~ Single Family
____Sign
_l'love
____Demolish
_M/F
____~F of lIni ts
, .____M / H
____Commercial
____Indust.
_Swim. Pool
Other
____Restaurant & Health Department Approval
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS...
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORtIS. **
**COPY OF CONTRACT REQUIRED.
}'F.RMITS REOUESTED
Valuation of Total Construction
Florida Power Corp.
_W.R.E.C.
Valuation of Mechanical Installation
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
____Frame ____Steel
Other
FINISHED FLOOR ELEVATIONS: FT.
******************************************
Signature
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration U
******************************************
j3lJILDER
Signature
Company
State Cert. or Regist. n
City License Registration U
******************************************
ELECTRICIAN
Signature
Company
State Cert. or Regist. ~
City License Registration U
******************************************
PUJMBER
Signature
Company
State Cert. or Regist. n
City License Registration n
******************************************
MECHANICAl.
Ow
Company
State Cert. or Regist. n
City License Registration #
Signature
~j(A ~.e/~r
APPLICATION APPROVED
PERMIT OFFICER.
~
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The und!rsigned under5ta~ds that this perlit lay be subject to "deed restrictions', which may be more restrjctive than City
regulatlDns. The underSigned a~sules responsibility~for"colpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
5!ate and loc~l regulatio~s. ~f the contractor is not licensed as required by law, both the owner and contractor lay be
clte~ for a .lsde.eanor vlolat1?n under state law. If the owner or intended contractor are uncertain as to what licensing
requlre.ents lay apply for the lntended work, they are advised to contact the City of Zephyrhills Building Departlent (813)
788-6611. "
Further.ore, if the owner has hired a contractor or contractors, he is advised to have the contractor!s} sign portions of the
'Contrac!or.Sec!ions. of this application for which they will be responsible. If you, as the owner sign as the contractor,
you arelndlcatlng that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign
as contractor that .ay be an indication that he is not properly licensed and is not entitled to perlitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D.
CONSTRUCTION LIEN LAW
(CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided Kith a copy of "Florida's Construction Lien Law - HOleowner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consu.er Affairs. If the applicant is sOle6ne other than the
'oNner", I certify that I have obtained a, copy of the above described docu.ent and promise in good faith to deliver it to the
"oMner" prior to cOllenceeent.
.; ~.:'
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will be done in cospliance with all
applicable laws regulating construction, zoning, and land develop.ent. .
Application is hereby lade to obtain a perlit to'do work and install~tion as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work NiIl be performed to leet standards of all laws
regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. 1 also
certify that I understand that the regulations of other governaental agencies lay apply'to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlllpliance. Such agencies include bill ~l e JiC,t lilllited to:
. <I.'*'
I Department of Environmental ReQulatiDn - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,
Water/Wastewater Treatment
I Southwest Florida Water'ManaQelent District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlV Ccorps ,of EnQineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health ~ Rehabilitative Services, Environmental Health Unit - Hells, Wastewater Treat~err~. Septic Tanks
I US Environlental Protection AQency - Asbestos abate.ent
I also certify that, if fill aaterial is to be used in Flood Zone "A' or "A,etc,', it is understood tJ.~t a drainage plan
addressing a 'cospensating volule" will be sublitted which is prepared by a professional engineer re~ist~ied in the State of
Florida prior to permit issuance.
A perlit 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 frolll thereafter
requiring a correction of errors in plans; construction, or violations of any code. Every permit isslled ;hall becole invalid
unless the work authorized by such permit is cO.lenced within six months of issuance, or if work authDI J~ed by the perlit is
suspended or abandoned for a period of six lonths after the tiJe the work is co~menced. One 90 day e:tension of tile, aay be
allowed for the permit Nith fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection must be logged during each six .onth period, or the project will be considered obdlldoned.
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. JOBS UNDER $2,500 IN VALUE
DO NOT NEED TO RECORD AND POST A "NOTICE OF CqMMENCEMENT".
SIGNATUREQ~_~-~
~I ~ _"OWNER OR AGENT
DATE~_Hj2~___1!!2L=_-------
~~~~:VO~SA~~NT_~~~ot~~_~-~---- .
~~OTARY PUBLIC, STATE OF FLORIDA
MY COMMISSION EXPIREli{y commission expires Jan. 28. 1995
~Ol'Ide!fWU-patl:~~mr:S-eCnr J\genc)I
SIGNATURE______________________________
CONTRACTOR
DATE___________________________________
NOTARY AS TO
CONTRACTOR_____________________________
MY COMMISSION EXPIRES
"'
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