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Home My WebLink About91-1784 City of'Z;;hyrhlIls PASCO COUNTY BUILDING DEPARTMENT 7s--' 00 1-813-788-6611 Type of Permit C1 (J. 07) C~yc9 PL~_ MEC~ Property Owners Name: ~,~ ~ }1f" .J(_.....;OU Job Address: _? <J;) tJ () - 7.;d ~~ Permit )f~ 1784~ tf/ Date 7-/6 Legal Description: Sub.Div. Lot Blk. tY c!:l.;;}. A I?cJ6-~()- 6n/1 rJif-<.qJ-7(.ff - AP'-.:~I).N'A -...;- J LL '- ~y- ~<I~ ~? y- - _ /)p> Energy Code Readout: Complete Plans, Specifications and Fee Must Accompany Application /.J. G>r-zr-v # cr-v / J "J //-4 Estimated Cost: .r / ,.. Lr ~ . t/'"'"D .... :7-s-: OD All work shal! be performed in accordance with the above and all City Codes and Ordinances. Fee: SIGNAIURE-J--- COMPANY ~ ~ ADDRESS TELEPHONE II Ftr. SLB Pre SLB Tub Set Lintel Water FRM. Sewer InSUI.C~L q... t1--q ( (;) Final Tp,Serv. Rough In /'0-/-'11 Meter Can Canst. Pole Pool Pre-Meter Final Breakers Ducts Insl. Compressor Final Driveway Relnspectlons: When extra inspection trips are necessary due to anyone of the following reasons, a charge of ten ($10.00) dollars shall be made for each trip. (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 further permits will be issued to the person owning same. APPL'ICATION FOR PERl-lIT CITY OF ZEPHYRHILLS BUILDING DEP^RT~1ENT OWNER /! A /(1(, i.jy tiS' 1.A y'O~A (()J'V~~' t, 'cr ..r 0....... A/ A6J:;II'Po'" ~7/'I PI (J: NPJId j~~ftnoNE ~ 76 -oeJR' APPLICANT ADDRESS " JOB LOCATION LOT SIZE x AREA SQ. FT. LEGAL DESCRIPTION: LOT(S) BLOCK PARCEL 1.D.~~ 00\ -A. - Ooff'oeJ - ODII SUBDIVISION WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair ____Install ____Sign/Temp. _Sign ____Hove ____Demolish PROPOSED USE: lSingle Family ~M/F ____f~ of Units ,.____H/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 FORHS. ** **COPY OF CONTRACT REQUIRED. J--BUILDING ____ELECTRICAL :PERMITS REOUESTED /;; (JIJ... Ct) Valuation of Total Construction $ AMP Service Florida Power Corp. _H.R.E.G. ____MECHANICAL $ Valuation of Mechanical Installation GAS ROOFING SPECIALTY . ____PLUMBING .... . TYPE OF CONSTRUCTION: ____Block _Frame ____Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** A 11;(" (II^,-, 1= r;ONTRACTOR SECTIO~~ BUILDER ' Company L1-"~< / /1/ State Cert. or Regist. ii ( h- - fT QI 0 Ii- '1 t Signature f' ,,- , /J'-- ' ' City License Regi~tratinn ii J U ****************************************** (. 2.. "? t/ /1'.4/ tr' ' :J;::::~,~:Ay~ ~ ~o/ }1< ~~;~::b~~e o~e~~~~~~~i~n " ****************************************** Signature Company State Cert. or Regist. n City License Registration n ****************************************** PLUMBER Signature Company State Cert. or Regist. 0 City License Registration 0 *************************~**************** ~'.,~ I' MECHAN1CAl. OTHER Signature Company State Cert. or Regist. iF City License Registration iF -- ****************************************** PERtllT OFFICER. APPLICATION APPROVED BY CONDITIONS~O~;PERMIT AFFIDAVIT A. NOTICE OF DEEO RESTRICTIONS The ,undersigned understands that this perlit lay be sub3ect to "deed restricti~nsM which ~ay be mort rtstr,ictive than City regulations. The undersigned nSUl1ll respDnsib~lity:;for.,colp1iil,11ca,"i!.h any appl ieable deed restrictions. . .'.. . " . ,...' " " ,..' , . . ' . B. UNL I CEN'SED CON'fRACTORS ANn l;OI:'j,TRAfTOR 8.ESPONS I B I LIT I ES' '. ... . ~, '. ~.. 0.. _ If the ollnr:r has hired a nntractor or contractorl to undertake work,theY~lay be requir:d to be licensed {n' a~c~rdance with state and local regulations. If the contractor 11 not licensed as require;l.by').aw .b.oth till! ~l!ncr and cWltnctor uy be cited for a aisdueanor violation under state lall.: If the DKner (.r intended c'ontr~ctc,r 'are uneHtain ;'s'io 'what \'ieensing require.ents lay apply fDr the intended work, they are advised to contact the City Df Zephyrhills Building Depart.ent, (813) 788-6611. ' ,'" Furtherlore, if the owner has hired a contractor or contractDrs, he is advised to have the eDntraet~r(sl sign portions of the 'Contractor Sections' of this application for which they will be respomd'bil!: If ycot'l','a'S Ule- c,wl\er s.jgn jos .the c[,ntractor, you are indicating that you, rather than the contractor, are respDnsible for the wDrk. If the cDnt;actbr wishes y~u to sign as cDntractor that aay be an indication that he is not properly licensed and is not entitled tD per~itting privileges in the City of lephyrhills. 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 lIith a copy of "Florida's CDnstructiDn Lien LaM - HDleollner's Protection Guide" prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sDle(.ne other than the 'owner", I certify that I have clbtained a, copy of the above described de,cuJllent and prc.mi:c, in ge,od fai th to deliver it to the 'oKner' prior to cOI.enceDent. I ~ "'~~~~.' ~. Ii: E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all wDrk Mill be done in coapliance with all applicable laws regulating constructiDn, zoning, and land development. Application is hereby Dade to obtain a perlit to'do work and install~tion as indicated. 1 certify that no work or , . - installation has commenced prior to issuance of a perlit and that all work will be perfDr-med tD ~eet standards of all lalls regulating construction, City codes, zoning regulati~ns, and land development regulatiDns in the jurisdiction. I also certify that I understand that the regulations of other governmental agencies ~ay apply'tD the intended work, and that it is IY responsibility tel identify what actions I lust take to be in cOlllpliance. Such agencies include but ~l e liot liaited to: . "..#11<' . I Department Df Environmental ReQulation - Cypress Bayheads, Wetland Areas and EnvirDnmentally Sensitive Lands, Water/Wastellater Treatment f SDuthwest Florida Water'ManaQelent District - WellS; Cypress Bayheads, Wetland Areas, Altering HatercDurses I Arty Ce,rps ,of EnQineHs - Seallalls, Docks, Navigable Ilaterways I ~epart.ent Df Health ~ Rehabilitative Services. Environmental Health Unit - ~['lls, Hastellater Treat~en~. Septic Tanks I US EnvirDnaental Protection AQency - Asbestos abatement I also certify that, if fill material ~S\,to be used in Hc.od Ze,ne "Aft Dr MA,ett.', it is underste,e,d th~l a drainage plan addressing a 'coapensating volulle" wi'lf be '~ublitted which is prepared by a profe"Ssie.nal.enginc,er regi:l~ied in lhe State of ~ \ ."'" . ,: ~ Florida prior 10 ,~rllli t issuance. A perlit issued shall be construed to be a license to prDceed with the wDrk and nDt as au~hDrity tD viDI~te, cancel alter, or set aside any prDvisiDns of the technical codes, nor shall issuance of a permit prc,vent the Building official frDI thereafter ",.i.i., . ".",\i.. ,f ,..... i. pl...; ,...1..,\\.., .. ,i.l.'i... .1 .., ,.... .,... p.,.I' I..." ,'.11 ..".. ,.,.lid unless the work authDrized by such permit is tomDenced within six months Df issuancc" Dr if "Drk authol J~ed by the per.it is suspended or abandonc,d fDr a period of six lonths after the tiJe the work is cD~menced. One 90 day e=IE~5iD'\ of tite, lay be alloMed for the permit with fee charge of $15.00. The extension shall be requested in writing tD the Building Official. An approved inspectic,n l!Iust be le,gged during each six month period, e.r the prc.ject Iii 11 be cc,nsidered dbcillde.ned. 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 ~EED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". SIGNATUR~R-~~ DATE ___ _t!:2._?~-(~~_?!---------------'------- NOTARY AS TO ~, ' OWNER OR AGENT~~~~--- IIoQry btic. State of Rorida MY COMMISSION EXPIRES_JM~(~~~~J~~4~3 londed Th(u Tray Fain: In,ulance Ine. 5 I GNATURE _1---.:::" ~ - ~-------- CONTRACTOR DATE____~t'-~~~~~------------------- NOTARY AS TO r /7 ' CONTRACTOR__~~-~~~- "\ Not Public, St.t. of florida MY COMM I 55 I ON EXP I RE5~1_~!!I!!I!!~O.!!jAIIi{JL.btne..6, 19.9~ Bonded Th{u Jroy Fain: Insurance In~ APPLICATION FOR PERNIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT 7 !!- C It:, // - ,Ntr~C-r APPLICANT Ut2,.J}'.l/ S / hA~~ ' K~~~L //7 If rv d PHONE (rt 3) !~ i'- 71 ,,-1 ,/'1 Cf R"/;ft..r ' . , Zc (f It t LA" )JJ 7-(........ ftv'<l. j ~S9AoT SIZE_X AREA SQ.FT. ADDRESS d- f"1 ( tJ ' OWNER ~AVO/"\\A JOB LOCATION :J I ~ a-o LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL 1. D .1t WORK PROPOSED:____New Construction ____Addition ____Alteration _Repair ____Install ____Sign/Temp. ____Sign _Move ____Demolish PROPOSED USE: ____Single Family ~/F _~~ of Units ' .____M / H ____Commercial _Indust. ____Swim. Pool Other ____Restaurant & Health Department Approval BUILDING SIZE: x ,.,J..,<{(rO 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 FOR}lS.** **COPY OF CONTRACT REQUIRED. FERMTTS REOUESTED ,/ BUILDING $ ~Y;)D~ Valuation of Total Construction ____ELECTRICAL AMP Service Florida power Corp. _W.R.E.C. ____MECHANICAL $ Valuation of Mechanical Installation ____PLUMBING GAS v ROOFING SPECIALTY TYPE OF CONSTRUCTION: ____Block _Frame ____Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** BUTT.DER J)"'1 =<...... ( Signature J:)~ v /J -f ~ONTRACTOR ~ /J I-~ f(."" ,,.') 'company<;)rA~ /)1'-1 }'Co." rr-r) , A- ,State Cert. lr Regist. iF "Co 0 G:, 0 &0 ~ RU-e- City License Registration IF ~7 ****************************************** Si2nature Company State Cert. or Regist. # City License Registration # ****************************************** f.T.ECTRTC1AN Signature Company State Cert. or Regist. # City License Registration # ****************************************** PLUMBER tlECH.AlU CAT, State Cert. or Regist. # City License Registration # ****************************************** Company Signature Signature Company State Cert. or Regist. ff City License Registration # OTHER ****************************************** PERMIT OFFICER. A~PLICATION APPROVED BY CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS . The ,undersigned understands that this perlit lay be subject to "deed restrictions" which may be more restr,ictive than City regulations. The undersigned assules responsibilit)(;for, coapliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor ~r contractors to undertake work, they lay be required to be licensed in accordance with statt and local regulations. If the contractor is not licensed as required by law, both the owner and contractor lay be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing require.ents aay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (8131 788-6611. Furtherlore, if the owner has hiTed a contractor Dr contractors, he is advised to have the contractorlsl sign portions of the 'Contractor Sections' of this application for which they will be responsible. If you, as the owner sign as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that lay be an indication that he is not properly licensed and is not entitled to permitting 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 with a copy of "Florida's Const~uction Lien Law - Ho.eowner's Protection Guide' prepared by the Florida Departlent of Agriculture and Consuler Affairs. If the applicant is sOlec.ne other than the 'owner", I certify that I have obtained I copy of the above described document and promise in good faith to deliver it to the 'owner' prior to cOllencelent. ~ j. '-:' 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 cOlpliance with all applicable laws regulating construction, zoning, and land development. . Application is hereby aade 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 will be performed to meet standards of all laMS regulating construction, City codes, zoning regulati&ns, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governuental agencies ~ay apply'to the intended work, and that it is IY responsibility to identify Hhat actions I lust take to be in cOlllpliance. Such agencies include hill ~Ie liCIt lillited to: ... ~.... I Department of Environmental ReQulation - Cypress Bayheads,Wetland Areas and Enlironmentally Spn~jtive Lands, Water/Wastewater Treatment I Southwest Florida Water ManaQe!ent District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses I ArlY Corps ~f Enqineers - SeaHalls, Docks, Navigable Waterways I Departlent of Health ~ Rehabilitative Services. Environmental Health Unit - Wells, Wastewater Treat~€n~. Septic Tanks I US Environllental Protection AQency - Asbestos abatement I also certify that, if fill material is to be used in Flood Zone "A" Dr "A,etc.', it is understc.e.d lli~t a drainage plan addressing a 'colpensating volullle' will be submitted which is prepared by a professional engineer fegisl~ied in the State of Florida prior to perllit issuance. A perlit issued shall be construed to be a license to proceed with the worK and not as authority to viol~te, 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 code. Every permit iSSlIed :hall becole invalid unless the work authorized by such perllit is COlllllenced within six months of issuance, or if Mork author lied by the perlit is suspended or abandoned for a period of six lonths after the ti,e the worK is commenced. One 90 day e~tf~sioll of tile, say be alloMed for the permit with fee charge of $15.00. The extension shall be requested in Hriting to the Building Official. An approved inspectic,n J!lust be lc.gged during each six Ilonth period, or the prc.ject Hi 11 be considered dbcillde,ned. 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 PDST A "NOTICE OF COMMENCEMENT". SIGNATURE_~~_~_~~------- CONTRACTOR ~. ~' SIGNATURE _ _______~--------~--~-~~- OWNER OR AGENT MY COMMISSION EXPIRES ---------------------- DA TE_____~-=-jj------CZL--------------- ~~~~~~C~~R:~__~~-~~--- ' " NOTARY pg~pC. STATE tff FLORIDA AT LARGE MY COMMISSION E~~&tMI~ION EX~lg3_~ijfi....1...199a. Nb~THFlOlJaFfA!HTON ^GENCY. INe. DATE ------------------------------~_._------ NOTARY AS TO OWNER OR AGENT -----------------------------