HomeMy WebLinkAbout91-1863
STATE OF FLORIDA
City of Zephyrhills
../
I)_D
PASCO COUNTY
BUILDING DEPARTMENT
1-813-788-6611
186~
Date-t'l) .- ,;21 -7' /
Permit :N'~
,e of Permit
c~ E~AL PL~ ~--_.
Property Owners Na..c;;1;.e~-
Job Address: ~ _--1__ _ -------.: _ _ 'i
Legal Description: SUb.D(Z),.AI!2~ Lot Blk.
Zoning CI: - ;;2
Description of Work
Energy Code Readout:
J/ -4
~
/
Complete Plans, Specifications and Fee Must Accompany Application
~ S.P~
Estimated Cost . d< .
Fe4 ,?( (); ~-
SIGNATURE~/~<.
COMPANY
ADDRESS
TELEPHONE #
,6 ;t~_
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances.
------
OCCllJ~.~T10NAL L1CENS~
8P?J~
PL~-----.
srL
Tub Set
Water
Sewer
Final
ELEC~-...
---
Tp.Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
MEC~ICAL
~
BUILDING
Ftr.
Pre SLB
lintel
FRM.
Insul.CL
WL
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 PEmlIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTt'lENT
ADDRESS
~h/r1?
t:,~ ~~ ~'A-~K sr
oWNER (8o~. .~..~~
JOB LOCATION ; ~ . r.' .
8
'DEt:?t{
PHONE g /3 -. 7 n - cJf"~
APPLICANT
BLOCK
LOT SIZES'S X F..s AREA SQ.FT. L/%~
SUBDIVISION 0#1-
() j~--I
LEGAL DESCRIPTION: LOT S ~~-
PARCEL 1. D. ~~ 12 - .5l C, - 2..-1 - 3'""- !J
~ddition
WORK PROPOSED:____New Construction
_Altern.tion
_Repair
____Install
____sign/Temp.
PROPOSED USE: ~ingle Family
_Sign
_~love
____Demolish
~M/F
____~~ of Uni ts
, .____H I H
____Commercial
_Indust.
_Swim. Pool
Other
____Restaurant & Health Department Approval
BUILDING SIZE: ~
x It:, ,
.
s:a ~JUZ Y\.. Kat:) X\ Square Fee t,
/9;:J-.
Height
RESIDENTIAL:
COMNERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FO~~S.**
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FOmlS.**
**COPY OF CONTRACT REQUIRED.
~r.RM1TS REQUESTED
VBUILDING
$
3df)', t2.!:.-
valuation of Total Construction
_ELECTRICAL
AMP Service
Florida power Corp.
_\-l.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 0ECTION
Company
State Cert. or Regist. lj
City License Registratinn 0
******************************************
:Ti:::~:: aN n-
Company
State Cert. or Regist. 0
City License Registration 0
******************************************
Signature
Company
State Cert. or Regist. 0
City License Registration 0
******************************************
PLUMBER
Company
State Cert. or Regist. 0
City License Registration #
******************************************
MECHAN1CAI.
Signature
APPLICATION APPROVED BY
Company
State Cert. or Regist. 0
~~ CitY)License Registration if
;' /;" * 1< ,{ * aft)* * * * * *,( * */~ * ~ :;'~'." ,"",:" 7fl/,~~, * ;( ;:
\...,... ~ C ../j~~lLlt PERI-lIT OFFICER.
" . ~
DTHER
Signature
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Th',undirsignid undirstands that this perlit .ay bl sublect to "d~ed restrictions' which ~ay b~ ~ore restr,ictive than City
regulation~. The undersigned assul~s responsibllity~for, cOlpliance with any applicable deed restrictions.
E. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor ,or contractors to undertake work, 'they may 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 lay be
cited for a lisdefteanor violation under state law., If the OHner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of 2ephyrhills Building Depart.ent, (813)
789-6611.
Furtheraore, 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 work. lf the contractor wishes you to sign
as contractor that aay be an indication that he is not properly licensed ~nd 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 C(lnstruction Lien Law - HODeowner's Protection
Guide" prepared by the Florida Departaent of Agriculture and Consuler Affairs. If the applicant is sODeCne other than the
'owner", I certify that I have obtained l c~py of the above described document and promise in good faith to deliver it to the
"owner' prior to cOI~encement,
:1.....:
, '
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all wor~ will be done in co~pliance with all
applicable laws regulating construction, zoning, and land development.
Application is hereby lade to obtain a permit to'do work and install~tion as indicated. I certify that no work or
installation has COl2enced prior to issuance of a perlit and that all work will be performed to roeet standards of all laws
regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies ~ay apply. to the intended work, and that it is
IY responsibility tc. identify what actions I must take to be in compliance. Such agencies include bill i'1 e liC.t li~ited to:
. ".~ ,
I Department of Enviro~~ental ReQulation - Cypress Bayheads, Hetland Areas and Environmentally Sensi tive Lands,
Water/Wastewater IIlci~i1iell~
. Southwest Florida Water. ManaQelent District - Hells; Cypress Bayheads, Wetland Areas, Altering HatercDUfses
I Arty Corps ~f EnQineers - Seawalls, Docks, Navigable Waterways
I Departlent of Health L Rehabilitative Services, Environmental Health Unit - Wells, Wastewater Treat~en~, Septic Tanks
I US Environaental Protection AQency - Asbestos abatement
I also certify that, if fill material is to be used in F\c,od Zc,ne "A" clr "A,elc.', it is underst('(ld lllilt a drainage plan
addressing a 'colpensating volule" will be sub.itted which is prepared by a professional engineer rp.Qisleip.d in the State of
Florida prior to perlllit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to viDl~te, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Offici.1 fro~ thereafter
requiring a correction of errors in plans; construction, or violations of any code. Every per~it issu~d ~hall becole invalid
unless the work auth(,rized by such permit is cC'JUlenced within six ftlonths of issuance, (,r if liC,d: a\11he'l ILed by the per.it is
suspended or abandoned for a period of six lonths after the tiJe the work is commenced. One 90 day e:le~5ioll of tile, lay be
allowed for the permit with fee charge of $15.00. The extension shall be requested in Hriling 10 the Building Official. An
approved inspectie,n oust bl: logged during each six month period, (IT the project liill be cr,nsider!'d db6I,de,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 Al"TORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE
DO NOT NEED TO RECORD AND POST A "I"OT I CE OF COMMENCEMENT".
SIGNATURE
- ~-~-----
E OR AGENT
SIGNATURE
------------------------------
CONTRACTOR
DATE
-----------------------------------
MY COMMISSION EXPIRE5~~a~E~~Sucr~~~~mugA-
MY COMMISSION EXP. DEC.17.1994
BuNDED THRU GENERAL INS. UNO.
MY COMMISSION EXPIRES
------------------
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