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Home My WebLink About91-1788 STATE OF FLORIDA City of Zephyrhills PASCO COUNTY BUILDING DEPARTMENT 1-813-788-6611 1788 ~ Date '9- / 7 - Y./ Permit N~ E u~"CTfH.c t' I ~ M~ICAL Property Owners Name: ~--- if ~.rl r:!~ Job Address: -3 <:f- / .3 s - ~ 0 Legal Description: Sub.Div. Lot Blk. ZoningCI: /1- ~~ - ,;L/ -? b / 0 /-'!:'-7o 0 Description of Work ...Y, ilA4<'-~ r .-i 4t (j-e 0/'(0 ~tJ Energy Code Readout: Complete Plans, Specifications and Fee Must Accompany Application ) Estimated Cost: ~~/ A All work shal! be performed in accordance with the above and all City Codes and Ordinances. OCCUPATIONAL LICENSE # Fee: c> 'z;, t/)} ~ SIGNATURE'~.e ( , ---fl/ COMPANY ~__ ADDRESS TELEPHONE # c~/Y1 Q A - CBUILDING~ Ftr. Pre SLB Lintel FRM. Insul.CL WL ~ --- ~AL --- M~ICAL ~ SLB Tub Set Water Sewer Final Tp.Serv. Rough In 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 (SIO.OO) 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. APPLICATION FOR PERMIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT JOB LOCATION PHONE 7'3~ - ;2; 8</ l APPLICANT ADDRESS " OWNER LOT SIZE_X AREA SQ. FT. pARCEL -r. D . ~~ \/ //_ ~:) h .:.. d.-I- CJ 6/ 0- /-5-70 0 _o/?I" 0 BLOCK SUBDIVISION LEGAL DESCRIPTION: LOT(S) WORK PROPOSED:____New Construction ____Addition _Alteration _Repair ____Install ____Sign/Temp. _Sign _Hove -ADemolish PROPOSED USE: ____Single Family _M/F ____~~ of Uni 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 FO~lS.** **COPY OF CONTRACT REQUIRED. ~ERMITS REOUESTED ____BUILDING $ Valuation of Total Construction ____ELECTRICAL AMP Service Florida Power Corp. _W.R.E.C. ____MECHANICAL $ Valuation of Mechanical Installation ____PLUMBING GAS ROOFING SPECIALTY .... . TYPE OF CONSTRUCTION: ____Block ____Frame ____Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** Signature CONTRACTOR ~ECTION Company State Cert. or Regist. ff City License Registration a ****************************************** BUILDER Sitmature Company State Cert. or Regist. ff City License Registration ff ****************************************** El.ECTRTCTAN Signature Company State Cert. or Regist. ift City License Registration ff ****************************************** PLUMBER Signature Company State Cert. or Regist. # City License Registration # ****************************************** MECHANICAL Signature Company State Cert. or Regist. # City License Registration ff OTHER APPLICATION APPROVED BY ~*********~************************* 4 . ,J?/lAJ\.AJ , PERMIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS . The.undersigned understands that this perlit lay be subject to "deed restrictions' which may b~ more restr.ictive than City regulations. The undersigned USUle5 responslbltitf:for cOlplianc!! with any applicable d~ed restrictionlO. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a con~ractor ~r contractors to undertake work, 'they lay be r~quired 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 ftay be cited for a aisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirelents lay apply for the intended Hork, they are advised to contact the City of Zephyrhills Building Departlent, t813} 788-6611. Further.ore, if the OHner has hired a contractor or contractors, he is advised to have the contractor!s} sign portions of the 'Contractor Sections" of this application for which they Hill be responsible. If you, as the owner sign as the contractor, you are indicating that you, rather than the contractor, are responsible for the wor~. 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 per&itting 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 Construction Lien Law - HOleoHner's Protection Guide' prepared by the Florida Departlent of Agriculture and Consuaer Affairs. If the applicant is sOleone other than the "oHner", I certify that I have obtained l c6py of the above described document and proffiise in good faith to deliver it to the 'oHner' prior to cOllencelent. 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 compliance with all applicable laws regulating construction, zoning, and land developaent. Application is hereby lade to obtain a pertit to' do work and install~tion as indicated. I certify that no Hork or installation has cOllenced prior to issuance of a perlit and that all work will be performed to meet standards of all laws regulating construction, City cod~s, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other govern~ental agenci~s ~ay apply- to the intended MorK, and that it is .y responsibility tel identify what actions I IIUSt take to be in cOAlpliance. Such agencies include but ~l enol lillited to: ... I Departle~t of Envir~n.ental ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive lands, Water/Wastewater Treatlent f Southwest Florida Water ManaQelent District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses I ArlY Corps ,of EnQineers - Seawalls, Docks, Navigable Waterllays f Departlent of Health ~ Rehabilitative Services, Environmental Health Unit - Wells, Wastewater Tr~at~errt. Septic Tan~s I US Environaental Protection AQency - Asbestos abatement I also certify that, if filllat~rial is to be used in Flc.od Ze,ne "A" elr "A,etc.', it is understN,d l"~t a drainage plan addressing a 'colpensating volule" Hill be sublitted which is prepared by a professional engineer regist~ied in the state of Florida prior to perlit issuance. A perlit issued shall be construed to be a license to proceed Ilith the wor~ and not as authority to violate, cancel alter, or set aside any provisions of the technical codes, nor shall issuance of a perAlit prevent the Building Official frol thereafter requiring a correction of errors in plans; construction, or violations of any code. Every permit issu~d ~hall becDae invalid unless the lIork authorized by such perlit is cOllenced within six lonths of issuance, or if wOI'k aulho(Jied by the perlit is suspended or abandoned for a period of six lonths after the ti,e the wor~ is commenced. One 90 day e:tensioll of tile, lay be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspecticln JlIust be lc'gged during each six Ilonth period, or the prcljed will be considered ilballdc,rled. 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 BECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". SIGNATURE~~-~------ owN(ffi-CJR AGENT SIGNATURE ------------------------------ CONTRACTOR DA TE--rJ-f-l-7-/-- 9!-(------.---------.------- NOTARY AS TO L "/', I r 11 J '" J OWNER OR AGENT ~Ji~~- Notary Public, State of Florida MY COMMISSION EXPIRES~~~~~~~T~ Bonded Thru Troy Fain. Insuronce Inc. DATE___________________________________ NOTARY AS TO CONTRACTOR__________~------------------ MY COMMISSION EXPIRES ------------------