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Home My WebLink About91-1873 ST ATE OF FLORIDA " City of Zephyrhills PASCO COUNTY N ~ Permit . 8. BUILDING DEPARTMENT 1873 / / 1-813-788-6611 "r..j ..- ,., -:2 OJ Type of Permit ~ 5 ~.f ,,- ,. j}u -- Date / v C>Jl. n. - "/. ,/ -BUILc.>,I~(S (~ (~~.~~ ~~r.~~ fj;) 7/F~(~O)')JJ rEE5 '-- ~._.. . / . . //tfr" !2E&U' ~ , ~:::~~r~:~ers Name: c~~;tl~/ ~9:~~-n33a1< ~ u;_ 4 Legal Description: Sub.Div. Lot Blk, fo / Zoning CI: Description of Work ,~.~,""., ~,q' Energy Code Readout: Complete Plans, Specifications and Fee Must Accompany Application Estimated Cost: //J . J~ ,I)-V Fee: / a...() - :} SIGNATUREL/~/""" 7/~- COMPANY ADDRESS All work shal! be performed in accordance with the above and all City Codes and Ordinances. ~tJt~ o UPATIONAL LICENSE # Ftr. Pre SLB Lintel FRM. Insul.cL WL SLB Tub Set Water Sewer Final Tp.Serv. Rough In Meter Can Const. 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. APPLICATION FOR PER1'11.T CITY OF ZEPHYRHILLS BUILDING DEPARTMENT f . . .... APPLICANT ADDRESS PHONE OWNER 1!1 A X riSe 1bf2 '~nl JOB LOCATION 3'13 of:> ~ ~ live, 1iU'A lie l:>>~b;l. ~J9<.OT SIZE '/0' X f'6' AREA SQ, FT ' 3, !:t' 6 LEGAL DES CRI pTIO N: LOT (., 'f /) BLO CK S DBD IVIS I ON ,if. /1" e 1>1. b:J. U... ~ ill(}( PARCEL I.D.i~ 1:;2,- Jl..,- }(-bO ;).13- OOSDO-OO()0 WORK PROPOSED:____New Construction _Addition ____Alteration _Repair _Install _Sign/Temp. _Sign _l'love _Demolish PROPOSED USE: ____Single Family _M/F _i~ of Uni ts .' ~ M/H _Commercial _Indust. _Swim. Pool Other _Restaurant & Health Department Approval BUILDING SIZE: 14 I xS(,! , Square Feet, 7i'1 Height RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.** COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FOlU'lS.H **COPY OF CONTRACT REQUIRED. ~ERM1TS 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. ****************************************** ~ONTRACTOR SECTTON Company State Cert. or Regist.!~ /1/7 ,tPt'.57J- City License Registration n ************************************* ~~:~:n~er!1~~~~~~~! ~'!tt ~ City License Registration i . **************************************** = Signature fL/#tI ,/ ifF 0<.:\377-3/ it /tJ,( / = ,r/i~S~..c k /V\ J. [ire- tJ';'> '23 Y S- iF qc; 11- / ~ I Signature Company State Cert. or Regist, n __- City License Registration it ~ .' -': /-. B~/';7i!;;JlJ;;'~:i:::/{:;dt~&>"...*,*, ..... - ~ _.. OTHER PERMIT CFFICER. APPLICATION APPROVED CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS Th,.undersigned understands that this per.it .ay be subject to "deed restricti~ns" which ~ay b~ more restr.ictive than City regulations. The undersigned a5SUles responsibility;for, compliance with any applicable dQed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a c~ntractor or contractors to undertake work, they lay be r~quired t~ be licensed in accordance with state and local regulati~ns. If the contractor is not licensed as required by law, b~th the ~wner and contractor lay be cited for a lisde.eanor violation under state law. If the owner or intended contractor are uncertain as to what licensing require.ents may apply f~r the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, t8131 788-6611. Furtherlore, if the owner has hired a contractor or contractors, he is advised to have the contractor(sl 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 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 - HOleowner's Protection Guide" prepared by the Florida Depart.ent of Agriculture and Consumer Affairs. If the applicant is sOle6ne other than the "owner", I certify that I have obtained a copy of the above dP.scribed docu~ent and promise in good faith to deliver it to the "owner" prior to cO'lencelent. I 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 lade to obtain a per.it to do work and install~tion as indicated. I certify that no work or installati~n has cOllenced prior to issuance of a per.it and that all work will be performed to meet standards of all laws regulating construction, City codes, z~ning regulati~ns, and land development regulations in the jurisdicti~n. 1 also certify that I understand that the regulations of other governmental agencies ~ay apply to the intended ~~rk, and that it is IY responsibility to identify ~hat actions I lIust take to be in COMpliance. Such agencies include bllt ill e Ii(,t li~ited t~: . ,- I Department of Environmental Reoulation - Cypress Bayheads, Wetland ~reas and Environmentally Sensitive Lands, Water/Wastewater Treatment * Southwest Fl~rida Water Manaoement District - Wells; Cypress Bayheads, Wetland Areas, Altering Watercourses I Aray Corps of EnQineers - Sea~alls, D~cks, Navigable Waterways I Department of Health ~ Rehabilitative Services, Environmental Health Unit - Wells, WasteHater Treat~errt. Septic Tan~s I US Environmental Protection Roency - Asbestos abatement I als~ certify that, if fill laterial is t~ be used in Flc.od Z(,ne "A" or "A,etc.", it is underst(,(,d t1,~t a drainage plan addressing a 'compensating volule" will be sub.itted ~hich is prepared by a professional engineer regist2icd in the State (If Florida prior t~ permit issuance. A perlit issued shall be construed t~ be a license to proceed with the Hork and not as authority to violate, cancel alter, (lr set aside any provisions of the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter requiring a c(lrredi(ln (If err~rs in plans; c(onstruction, (.r violiitions of any ((,de. Every perlllit isslll!d ;hall bece..e invalid unless the Hork authorized by such permit is commenced within six months of issuance, or if HOlk authol lied by the pertit is susp~nded or abandoned for a period of six lonths after the tiJe the Hork is [o~men(ed, One 90 day e=te~5jDli Df tile, aay be allowed for the permit with fee charge of $15.00. The extension shall be requested in Hriting to the Building Official. An approved inspection must be l(,gged during each six Ilonth period, or the prc,ject Iii II be (onsidered ab6l1dc,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 COr1MENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NE(9:50 RECORD AND POST A "I,OTICE OF COMMENCEMENT". SIGNATURE__~ ~~ SIGNATURE~ ~--- OWN~~GENT CONTRAC~~ ~ DA TE___/-~_=Al_-:::_.J._i__---------_._------ ~~~~:YO~SA~gNT~~~ MY COMMISSION EXPI~~mr~~~~~~~~~~--- MY COMMISSION EXP. JULY 1,1993 fS9~~~~ TH~U GENERAL INS. UNO. DATE_~~~_~_~_~~------------------ NOTARY AS T~ r-~ ~h< CONTRACTOR___~~~~~~------ .. NOTARY p~, STATE OF FLORIDA.. MY COMMISSION ~~~~~~~~~~i~=' \ ): ) I r- ! '\ i I .\ / i \\:~ j I t q - - \ \ \1 , f\ V \ '. \1.... "- \ i \ ""'-b /' t\ if' \ ' r.. \ \ ,~ ,\ I \ ! \_j .~ '~ \ . / . :e\:J \ \ \} \ (. \\..~'(.' , '1 'j ~ "- "'-.D \,\" . ; I ,\ \ '/ '\ y i' I\} ;..t J '\ <, / I ~'G ./ '.~_., *t'-.,.-..-_.,--~.. \, \ ! \ \' ~ , (, \. I ~i'--'-" / ,,- \ ". 'J \ \0 " \. \..)),....\- J\.. \ , \}u I L. L. r "{I_I . "-t \_, I '.' ~_} ~_} ~_, L. "+ -,1 Ul_, I.. ~_:, l_1 , :J 1 11'=:U l'IU.Ull . " ,.. i~'o)? ;. r . U 1 ... ~,~.~~ ~:;o ~/('~ !'l.O/(/iJ/1 )/~-e 1 !/J;Vc:;-( )k, d {. ! .. ~:;.j, ,. .... S3?o (j/Ju 811',1. 2",/;/1;'/,/4, /'h~j...., ,/1 ,,',{ ".' ~~ ": r'~. # ,..n1;._~.. ....'... ::"..,: ~. /M..' . j; --,LJI/..' " .,..' ~;\;f "6 ~V? r" ~~! I.' '".-:;;;'/.. ;~; /). IJ~' " -;;: ~ '~I ~"~~)i<; ~ A./~ ~.~; ~. f:~ / _,_ r;',_ '1 t1~ - /, ~ .~. .' .. .'. ',::'~?i;~ ". lA"N~- ~r__ ,',"C, , .-",,' .' ," c-( f.... ...t., . . ~r}{~;rS" Xi-,: : i',(.:"' .. .. ~.' I ".:. . ..: ~ ' " ,.., . r : ~~..'.~.~:~;:: ,~' :':~1 ; . ,'~.. .:....:;'~. ~.:.;; . . . . ..',:..',. 1~;.',,/_.'l';:.',' .: I. , . 1.~'l.v:,~ .t"!ll\" ". t '.....' '..fr1,'f1:.l.t'r"~"( .. . "::l' (~J; 'i ....~I, .f( , " . ' . ,J ~ ;:3~~ . , t ;-,d oj: \~. . . " :" ~. ~' , :" 'frj~.,. . . .~~ / ',', . ',,;> ,(" . ';.' ;:. . ..... h t:) R., I /'( ttI,,/' '.,'. ,'; :' , . fXr;;~ : ..'" 101 ~~I , I' "i';;"O':' , .,{J~;~~~;;i2\jt: ~:. "'.":'.~I:<:<',':".': "." ,,~ ~.:~~'.. ".'.';::.' ',::.~':: .: :i;;'/)5~'/".;n..;". l..... . '." .,," '. ,.~.('.;...(...;..,_. ." ,.:' .... .::: ".:' ..,>::..:. . .\y.}~.r:'~':'- . "'l'.' ..'.," -I,.,.... ,; ....i(l(~~".. ',;1;;;;~:~~\~;,'ii~~.~ .~i:1~ii ~.', .,.,<...~~~...~.:.;...T,:..;'..:;,:'>/)r,.I.1..~i~.,.:..~.r!!'!> , , \ tn t.,.'l""''::'' -<I.' ::., ,.t.., I'.':) - .N-" 'i"'.".l C"\" ~".~ 0"'>' ".. . ;' 0.. ,.,.". '0, (;0.. /,/ 11'.-'-"' ..,. ~ ,~,- . "':: ...... "~"'~. . ': ;.' r, fir. ", rp... ':, . .. .. 'I ,-. ~ ;-;.:: . . I ..,...: ; (1'1 ~ ". ' 1/ ,. r .~"/ j' ~ .... I.' r... \ 1 ~/ . , ":,,';':.r:<.:/ . . . ",' ;5::<)~':', " '..;' :,://fff~i;l: ' .' ' . .. I ~l.' '. ~ ~~ l .~" . . ,', ~" .." ':~ ,. .'Ir'i,.~,l. Ill::, .} ::\. >..><r ,.<.::,,=;::'.~;, :~:\!{t.~{H~f :... \""'\"1'" .,..,J",. ;"\'(l/'..V?'.,:, ~'. ::<~,,:;<,:. ,:'! ;"., <,}":,~!,,-::;:::,, ;1 . . '- ... \.'.....1. - - -. -------------. ---:------~:"".......,--.,.."".~"-_...-.-...- ..__. ~."..._.,----- APPLICATION FOR PEIDIIT CITY OF ZEPHYRHILLS BUILDING DEPARTt-1ENT APPLICANT ADDRESS PHONE OWNER JOB LOCATION (;,ti. !tV€" PtI16//-e Ih j#t.e t,.~ LOT SIZE x AREA SQ. FT. LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL I.D.~F WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair ____Install ____Sign/Temp. ____Sign _~love ____Demolish PROPOSED USE: ____Single Family ~M/F ____tF of Un! ts .._M/lI _Commercial ____Indust. _Swim.. Pool Other _Restaurant & Health Department Approval BUILDING SIZE: x Square Fee t, 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. ~F.RMITS REOUESTED ____BUILDING $ Valuation of Total Construction <> AMP Service Florida Pow~r Corp, / _W.R,E,C. _ELECTRICAL ____MECHANICAL $ Valuation of Mechanical Installation // ____PLUMBING ROOFING SPECIALTY TYPE OF CONSTRUCTION: ____Frame Other FINISHED FLOOR ELEVATIONS: -- ~ V'.C S?b Signature Company State Cert City Licens ***************************** R6r~/c,EIl or Regist, II e= s OOO(}t161 Registration 11_ '117 Signature Company State Cert. or R. ist, # City License Regis ration 0 ******************************-*****.***** PLUMBER MECHANICAL Company Signature {,..J OTHER Company State Cert. or Regist. Ii City License Registration n Signature ****************************************** PERl'lIT OFFICER. APPLICATION APPROVED BY CONDITIONS. OFPE~MIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS - The.undersigned understands that this per.it lay be subject to "deed restrictions" which may be Dore restr.ictive than City regulations. The undersigned aSSUDes responsibilitf;for. co.pliance with any applicable deed restrictions. .,' ' B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor .or contractors to undertake work, .they .ay 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 lay be cited for a misdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing require.ents may apply for the intended work, they are advised to contact the City of Zephyrhills Building Depart.ent, (8131 788-6611. Further.ore, if the owner has hired a contractor or contractors, he is advised to have the contractortsl 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 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[,nstruction lien law - Ho~eowner's Protection Guide" prepared by the Florida Depart.ent of Agriculture and Consumer Affairs. If the applicant is so~eDne other than the "owner", I certify that I have c,btained a. CDPY of the above described dc,cullient and prorr,i~e in g[,od fai th to del iver it to the .owner. prior to COIDenceDent. ~ 1 ': .:~ ' E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all ~or~ Hill be dODe in coftpliance with all applicable laws regulating construction, zoning, and land development. Application is hereby Dade to obtain a per.it t~' do wDrk and install~tion as indicated. I certify that no work or installation has commenced prior to issuance of a perlit and that all work will be perfor~ed to meet standards of all laws regulating construction, City codes, zoning regulatiDns, anrl land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governlental agencies ~ay apply to the intended work, and that it is IY responsibility to identify what actions I must take to be in cOlllpliance. Such agencies include bill ~le Hc,t linited to: . "..r-,> I Department of Environmental ReQulation - Cypress Bayheads, Hetland Areas and Environmentally Sensi tive ldnds, Water/Wastewater Treatment I Southwest Florida Water' ManaQe~ent District - Wells; Cypress Bayheads, Hetland Areas, Altering Hatercourses I ArlY Corps ~f EnQineers - Seawalls, Docks, Havigable Waterways I Departlent of Health L Rehabilitative Services. Environmental Health Unit - Wells, WasteHater Treat~En~. Septic Tanks I US Environlental Protection AQenct - Asbestos abatement I also certify that, if fill material is to be used in Flc,od Zone "A" c,r "A,etc,', it is understc,[,d tll,t a drainage plan addressing a 'compensating volule" will be sublitted which is prepared by a professional engineer regist2fcd in the state of Florida prior to permit issuance. A permit 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 provisic,ns of the technical codes, nor shall issuance of a permit prevent the Building Ufficiol fro~ thereafter requiring a correction of errors in plans; construction, or violations of any code. Every per~it issu~d ~hall beeDte invalid unless the Hc,rk authc,rized by such permit is cc.JlI\enced within six months of issuance, c,r if \i[.It, auth[q J7ed by the perlit is suspended or abandoned for a period of six lonths after the tlJe the Hort is co~menced. One 90 day C:IE~5jDl1 of tile, say be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspecti{,n flust be lc,gged during each six month period, Dr the prc.ject lli 11 be ([,nsidNed dballdc."ed. 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 OBTAI~ 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 I! i':OT I CE OF COMMENCEMENT". DATE ------------------------------~_._------ SI GNATURE~~~L..j:V:Ur (-------- CONTRACTOR 1~- DATE_______J~ :_.O:--<~t----~~l---------- _~----L"-~ NOTARY AS TO CONTRACTOR SIGNATURE -----(:6~N~~~R-AGENT------------- NOTARY AS TO OWNER OR AGENT ----------------------------- MY COMMISSI.ON EX IRES_.::=:::;..:.-~:::..:.:.:...-...:-:....!-.:'"l " te'f~ 0\1' .....,...ON "",Nlev, n1H... OJGNO!\ I .. ... nv. ~11\"'Il' toI0lSSIWWO' )oW ttlY' .LV VG'.O'. .0 ....VI.S ",,;n. 1....10" MY COMMISSION EXPIRES ---------------------- APPLICATION FOR PERl-lIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT APPLICANT B \.LA j 1 ' s .~ tJ b ~. I ~".' :Y-o WI e ADDRESS \ cro7 S'~l..<.V\cters 1(C)' Ll ~~ \ls OWNER VVlA'f ~~\..OV"'Ia.V)\. . JOB LocATIONJ 93 '-Is ~t:k live. '2' )/,'/I~ LEGAL DESCRIPTION: LOT(S) Lor ft> BLOCK SUBDIVISIONS;'rtA.llll-e fH#fAte.K... PARCEL I.D.l~ /2--.2" - .).,/- OiJ~B '-oarbO-1) 000 PHONE 7 i'J. - (j 0 () I LOT SIZE 'f()/x ?9/ AREA SQ.FT. WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair ____Install ____Sign/Temp. ____Sign _~Iove ____Demolish PROPOSED USE: ~Single Family ~M/F ____i~ of Units ,.3LM/H ____Commercial _Indust. ____Swim.. Pool Other ____Restaurant & Health Department Approval BUILDING SIZE: ,1 '-I' X S6: 'I if Square Fee t I Height RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORHS.** COM1'1ERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORHS.** **COPY OF CONTRACT REQUIRED. PERMTTS REOUESTED ____BUILDING $ Valuation of Total Construction ____ELECTRICAL AMP Service Florida Power Corp, _H,R.E.C. ____MECHANICAL $ Valuation of Mechanical Installation ____PLUMBING GAS ROOFING SPECIALTY TYPE OF CONSTRUCTION: ____Block ____Frame ____Steel Other FINISHED FLOOR ELEVATIONS: FT. ****************************************** ._.~ I lV\ \ '\ I \ CONTRACTOR SEC.IP2N " 1 II v'nUTLDF.R JJLAi:)--l)\.t S 1I\l\b\ e \"\<>~. Company \.~lH-l("j": ~ mClbi ~ H-oM..e.. w. , 1.\ 0 \\ State Cert. or Rebst. iF Signature~f})\...X.:'-lkJ \~.ll A .. City License Regi~tration if 5.79 U * * * * * * * * * * * * * * * * 1r * * * * * ." ic ic ic * ic ." * * 1c ;c ,': ;c .:: ;c ;, ,', ;, ,'c " ELECTRTCTAN Sionature IUd Company l)c G KE r I< I ~ €.(A-Tt 0 N L. / / I /J/J State Cert. or H.egist. if E'StJ60o<J' / /<. ~ -fi'j ~ fJ~oU'L City License Registration iF #1 ****************************************** ..,...~l"\fi> ~ f'\~ 0\C"I. ~ c.3<.- Q \ f\a.elic ~ . Company .~)<t.[')~^,1 ~ /ec.Jdc. State Cert. or Regis t, i!..a()ooZ" I 60 ~1d..r\o-Ad) City License Registration iF -~7 ****************************************** II PLUMBER Signature MECHANICAl. Signature ~ I< Company A e e. t ~ r I? I ~ E lA-it 0 AI h _/ A . /1/J State Cert. or Regist. i,!~C. tJ 3"11.3':'- fl~r--"- C/Uk,J[tq~ City License Registration il &3 ****************************************** OTHER Company State Cert. or Regist. if City License Registration # Signature APPLICATION AP7ROVED BY ******** ****~~;'********* *ic;:;c ,'c;: 1: .:c 1:;c ,'ci, * i, * 7 0 A-\ At...l a 0./\ /J\" 'r " --- PERNIT OFFICER. CONDITIONS OF,PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS . lhe.undersigned understands that this permit lay be subject to "deed restricti~ns' which ~ay b~ ~ore restr.ictive than City regulations. lhe undersigned aSSules responsibilitf;for..co1pliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITI~S If the owner has hired a contractor or contractors to undertake work, .they lay be r~quired to be licensed in accordance with state and local regulations. . If the contractor il not licensed as required by law, both the ~wner and contractor ~ay be cited for a .isde.eanor violation under state law. If the owner or intended contract~r are uncertain as to what licensing require.ents lay apply f~r the intended work, they are advised to contact the City ~f Zephyrhills Building Departaent, (813) 7B8-bbll. Furthermore, if the owner has hired a contractor or contract~rs, he is advised to have the c~nlract~r(s) sign portions of the 'Contractor Sections' of this application for which they will be responsible. If you, as the cowner sign as the c~ntractor, you are indicating that you, rather than the contractor, are resp~nsible for the w~rk. If the c~ntract~r wishes y~u to sign as contract~r that .ay be an indication that he is not pr~perly licensed ~nd is nDt entitled t~ p~r&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 provi'ded with a copy of 'Florida's C~nstructi~n Lien Law - H~leowner's Protection Guide' prepared by the Florida Department of Agriculture and ConsUler Affairs. If the applicant is s~te6ne other than the 'owner", I certify that I have e.btained a. CDPY of the above described de'cul1l~nt and pr~~lise in g~od fai th to del iver it to the 'owner' prior to cOllencelent. I :'1':.':.' " E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the inforIDation in this application is accurate and that all w~rk will be d~ne in c~apliance with all applicable laws regulating c~nstruction, zoning, and land developaent. Application is hereby lade to obtain a perlit to.do work and install~tion as indicated. I certify that no work or installati~n has co..enced prior to issuance of a permit and that all work Hill be performed t~ ~eet standards of all laws regulating constructi~n, City codes, zoning regulati~ns, and land development rcgulati~ns in the iurisdicti~n. I also certify that I understand that the regulations of other governmental agencies ~ay apply. t~ the intended work, and that it is IY responsibility te. identify what actions I !Dust take to be in compliance. Such agl?ncil?s include bill "Ie IIe,l litlited to: I Departle~t of Envir~nmenial ReQul;tion - Cypress Bayheads, ~etland ~reas and Environmentally Sensi tive l~nds, Water/Wastewater Treatment I Southwest Florida Water' ManaQeaent District - Wells; Cypress Bayheads, ~etland Areas, Altering Halercourses f Arty C~ros ~f EnQineers - SeaHalls, Docks, Navigable Waterways f Depart.ent of Health L Rehabilitative Services, Environmental Health Unit - Wells, Wastl?Hater Treat~en~. Septic Tanks f US Environeental Pr~tection AQencI - Asbestos abatement I also certify that, if fill material is to be used in He.od Ze.ne "A" or "A,etc.', it is undNstco(,d \h"l a drainage plan addressing a 'cotlpensating volule' will be sublitted which is prepared by a professi~nal engineer ,egist~,ed 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 n~t as auth~rity to yi~l~te, cancel alter, or set aside any pr~visi~ns of the technical codes, nor shall issuance of a permit prevent the Building Official fr~1 thereafter requiring a C[,rrection c.f errors in plans; construction, e.r violations of any cc,de. bery per~it iSSIIL'd "hall becc'le invalid unless the Hc,rk authe.rized by such permit is cCllUlenced within six !tonths of issuance, c', if liC'lk a\!tl,c'll,ed by the per.it is suspended or abandc.ned fc.r a period elf six .onths after the ti:ae the liork is c~Menced, One 9(; day .:~ltj.5ioll of tile, say be all~Hed for the permit Hith fee charge of $15.00. The extensi~n shall be requested in writing t~ the Bu\lding Official. An approved inspecticon fluSt be logged during each six lIlonth period, or the prr,jecl \iill be cc,nsider!'d dbcil,dc,"ed. 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 COMMENCEMENT". SIGNATURE /"\'"4~_A ~ ~~a&.-- ~~C~TR~R DA TE_~__5:_1 15) - -------- --------- ~~~~::c~~~~ MY COMMISSION EXP!REs_JY1~~C6_1S~~- SIGNATUR~GENT~-~---------- DATE ___UAY--.- S__J2_~_1__-----_.__._------ NOTARY AS iO r"",.. .: ~ ~ . . OWNER OR I':\GEN~~~Q~ MY COMMISSION EXPI8ES~~-~~~