HomeMy WebLinkAbout91-1901
STATE OF FLORIDA
City of Zephyrhills
PASCO COUNTY
BUILDING DEPARTMENT
1-813-788-6611
Permit :N~
1901 H
Type of Permit
~~ PLU~ ~HA-N~
Property Owners Name: {J~~ ~<--Z
Job Address: 3 6'-6.5 / - /3 ~ ~
Date
/1-/-9/
,
Legal Description:
Sub.Div.
Lot
Blk.
Zoning CI: / / - ;2 {; - d.-J - () D / 0
Description of Work #c {' /.AM- (f '<
{J .:J4oo - o/3u
F~J
Energy Code Readout:
~ \v '5.l\"L- ~~
Complete Plans, Specifications and Fee Must Accompany Application
Estimated Cost: I P--7--.5-: em
Fee: ..QS~ c"JD /.1~
SIGNATURE ~rL'"l\ .~, f ~
All work shal! be performed in accordance
with the above and all City Codes
and Ordinances,
OCCUPATIONAL LICENSE # 9' /
COMPANY
ADDRESS
TELEPHONE #
-~
P~G
----
E~L
~
a-~.k
~ MECHANICA
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 (SIO,(X))
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 far
(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.
SERVICE INVOICE
. .
FORT LAUDERDALE
500 S.W. 2,., TERR. B 103
FORT LAUDERDALE. FL33312
DADE: B21-8412
BROWARD' 791-6606
BOCA RATON: 368-1799
_..~'''UI~~~_.'E>> SPNo 54360
Southwest Inc. '/2'1/ //Yr! uJR.' N. .
CORI'ORATE OI'l'lCE C c., ~ w 1'4 -re I<. I--t 4. ~
828O~Cw~~~~~:r::_~:e~33912 TAM~A J f) --3 3Lj J p~~b2 2-.
8280 ARC WAY ST. PETERSBURG 846-1212
FT, MYERS. FL 33912 10820 - B 76th ST. N,
CHARLOTTE: 839-885B LARGO. FL 34847 LAKELAND
LEE' 276-8720 CLEARWATER' 641-7800 887-0396
COWER: 697.1890 _ _ TAMPA: 226-1379 i'Dw/ I
.- :: .STATE CERTIFIED CACO 35496 DATE "/21 /q,
. ,- ,
~ [~:E~ (1.(~~;.I'Ne 7)"NQ hUi C/
'), ..ET · /l&"A# L: Vol' L /.) 11 ,c /U l;fNE T P1.
'." 'CITY ., 'STATE ZIP
.- ,.;
WEST PALM BEACH
1387 N. K1WAN
LAKE PARK, FL 33403
PALM BCH.: 1146-1407
MARTlN' 283-9459
ST. WClE: 481-0278
"
WORKTOBEDONE TAl.! T,4t L.47 I tJA/- ..
)/,: If -r tfJ~ C/)VtPY '(w'r 7P~.
''"':._ '/'0 ._
-. .., '
/:A A"7 ..~
.,;: ".' ':
..'~ ~
~ ~_:. 4121: rt ,..~,
'- -;5' C,;?1: r1; 7
.' ' :"i. J?( tM ~. /.?fC ~1Z..J},4t [;T~'~ t. ~&ir ""-
LI_ -1- /,;A, A L~.R L:,~ ~1d/', ;'''J.~ '~J;'; ~ r(-A:?-;' AI,
" >~.-e::.;'/;,~,. . .-~_~ :"~~,._ _' -~.:,.;-. ~ c.~~:_. .: . . _ ~;- _. r&~i '~. _.~= ."~,_~ :;. ~ ",.
ro~~~~K~[~~~~~t~ED ..i.:...
. .,:,;-.'.._';~;:--.,:::t:'!r::.~:t~"_:n" .,' '~~ ";: -:' ;~ ,~'
.... '..]..0 _ .. ~,;.-=;~:.~- ~
~~ TIME '.___,....
--~ D -:.-
- -.,., "TIME :' -
DEPARTF.n.. .= ~
~. SERVl9(PARTS.,j)f ',' ' 117{O~
SERVI~BnA ~ ...
CUSTO~UN!/
TOTAL CHARGE
SOURCE COST QTY.
'~I
I
2f1~
~ .
TRAVEL TIME::
TIME
ARRIVED
TIME ,.
ARRIVED
,,, \..:,'
p'l.. "
ODI\~~ ~
~4\ 4~
./ 1.'\ ,f1!
'" ~ ()t(~;t~
D: q? 1
.,
ITEM::
:l '"" ......__
-. PRICE
-
-r It j I A I. (; ~-f (-2.) ,~~ :: ;.
JlE"A-r r~&;bi~i:. ,-
\' u r ~jtJ : C lJ.rv( ~-
/71. -----r Jj '"
Jt/~L ":"/1 At:i.A~~~ -
PIPJf ~)lhhiA ~.
S tA f tc/YJ;1h~:' :..!... ~ -: ;.-
/ -. ..
c...
~ 1fJZ's /3 zJ.. ~ f'
-2/ fJ 1.~; Ii. t. ~'l (i:j - ~ ~
{ ,4hn x ~O:,I / /11i /J~ ~~
7103:', J ?-rj 1.tJ~j
~~IIAr,/, 'dfJ-:~ l~4 ~
I ~Al 1.1::/"
j ,
9-~~
':;:
... -
..:,,, -
DEPOSIT
BALANCE OUE
,""
$ I A 7} bl
$ /s 7 f 4v
1-
/
$
BILL TO~.. ':;' ',,'.,
~NAME ';.,; .~.~,.: -- ... u
.
:: ,S710<-, ; I ~ tJi,"~'A v e.
- _CITY '..(':: Ll4 a
l'7Ojf2 - oJ 7 J. 3
. STATE 3 Z
.. . . ..
TECHNICIAN: :
~',t/E~ f(
z;:,hU-
- , 0; ;cMAKE
.. MODEL
SERIAL NUMBER
;.
" DESCRIPTION OF WORK PERFORMED
,
,'(ji~ J{"A~ rC 41'a 7' ~nt.)f,t...
: M PL" I'LL- /)N 4~'L I
)/ .P 4tF O.-L1 ,11., L:J
-', '.,AJ f),/A ~u If ' C:/
", ""i 11 C/lie,s f b ~ /-;:,/ CL P1 ~"
,- .~,~; f~~ u%/.) .. /
;. f"-L./J ~ t' 1//.4 AI'.A ~ n..A
f/j(l,L 1- ~~o / PCd.
/.:-::
DATE
- ;.-
~. ,. ff/!A ~
~... '.-or
",,- ,...r' ~ ./ /
j,,/7 J /f. '1' '- '-
,~ I /) I. , I 1_ ,
I Y I t; -, 17 I ^
/'A. 7t1...c -':-'
:PL~ASE PAY FRO~:-- ~ICE
~~~.~~~~~~~~~~ETfON. ~~ft_.~
-"'-'- ~ ~
h....---...--_..._~~___NOTZ
==:=.vol:::--:"'-", I'" _=i::;'::':::' = 0
==__":':"__~""bor_in____........._r___ ~
I ~~ order the warit _ oudined ..... to...,.U co-. end ,.........~. '-.. thi8
intaioe ia r WI 1M ...... of -- MIIDrney for ..t:::::..
'vL:/Z- h ~ Cu J1...l... eN
TECHJIJC~ SI~NATYRE II I ~ 0')
--e;-;".. ~- e. ,IV.. A_ - .L ~ D 0
CUSToMER'S SIGNATUR?-i 1 n, e
=-= ~'O~D (} ~/1/ rf-~. A~ 5~E B3
I'J
,. "
,
w w
m en
>- <<
<< w
::;: c:'
o <Ii
Z Z
<< 0
en ~
w <<
>- 0
::J 0
>- ::;:
~ ::;:
en 0
<< 0
o 0
cr: <<
o Cl
-' Z
u. :;
N ~
C\j u.
a: 0
w -'
>- <<
"- >-
<< Z
r w
o a:
u. w
o ~
>- 0
a: >-
<< en
"- w
u. x
o ~
en -'
Z <<
o 0
Cii 0
:; -'
o a:
a: w
"- ~
5 0
;:: a:
<< 0
a: x
>- <<
en >-
a en
w w
a: ;;!
w en
r u.
>- 0
o Z
>- 0
>- ;::
o <<
!!; 0
m ::;
::J "-
en "-
w <<
m w
>- r
<< >-
::;: Cl
en Z
Z Z
o a:
;:: w
<< 0
o Z
o 0
::;: 0
::;: en
o Z
o 0
o ;::
<< en
Cl w
Z ::J
a:: 0
w >-
w Z
'" <<
w w
en >
::J <<
o r
r ::J
a: 0
o >-
Cl 0
Z :5
a:: 0
w r
~ en
en ct.i
a: w
I 0 ~
I ~ I-
W -'
>- <<
a: 0
<< 0
::J -'
o a:
CJ w
Z ~
:; 0 w
::i 0 ~
CJ Z Z
Z <( ~
U5 x W
I <x: <( C(
w >-
~ ~ 0
o 7i ~
CJ (f) W
Z W ::;:
i= I- I-
Z << a:
w >- <<
cr (/) 8J
en 0 0
z >-
a t ~
~ ~ ~
w m -'
0- ::J <<
. en 0
>-"0 en
't:C5Q)
8..c Ol
oc:"o
c.8E
>-en
> C.
~ .~ .g
"5 Z' III
E CD 0
~ 0.-
Vl 0
~ c.~
.- :; z
00-
.c >- a::
"5 <(
Ill"'W
Ol'~ :I:
c: III
.- Ol 0
$~:::i
~~~
1-~l1.
"
a:
<<
w w
>->-0
enw<<
I"'::;:
>-0",
en::J-
wlDw
xo'"
<<zZ
>-...<<
a:-r
::J 0
o
>-
:o:l
.
i'-
....
f\i
o
w..
Cf)0
O...J
I1.w
0:1:
a::w
11. CO
w...J
:I::::!
I-S;
Zl-
Ow
CJCJ
ZO
-=>
C::co
<0
Wz
:1:<
5:2Cf)
...Jw
COx
=><
11.1-
<
N
~
to
I
,..
.j
%:to
01
Qff)
lX~
CO
a:>-
<<w
w"'w
>-00
Vl::J<<
:cm:E
>-0'"
UlW-
WVlW
xo'"
<<Q.z
>-0<<
a:o:r
::JQ.O
0...
>--
-
--
c:: >-
<t-
O....
;;D-.j
l'.J
2:0
Cl.C:
Q
o
""l .
.. 'jJ
....o1.lJ
:::)
....0
(J\~
" I-
o~
--4::;:)
"0
O1'U
(7'
.
.0
...
N
>-
>-
a: a:
~f3~
o:x>-
0-<<>-
>-en
a: <<
:0 -'
o
>-
.....
.
r-
::{l
....
>-
",to
~~
<<,..
>- :0 >-
<< f-
Z
::>
o
u
I I c:-
a::~o&
;5 Ol~-g .
:I:~g.o~
~E::l-gi=
ni ...J 0 ::J III 0
Ql lD -= C" <(
>-~",~Ql...J
x l1. 5 ~ g'<
Ql Ql'c "'~~
~ ::l'c.lij oil.
.s.sooxO
-~-~~
.E 0'- "0 ~
Ql25lij"O<
::l",Ql Qll-
1ii 8.~.2~O
- .... - D n.~
)( 5...~::1 e a:
~ 11l a. 0.0
"0 ~Olii Qla:
lijl-~Ci5.sl1.
0....
. .
....ory..
M m
....
a::
o
o '
ZOl
W .~
~lo
<Ql
.c
>-Ql
lll.c
E-
>-m
~rn
on;
.c Ul
- 0
:J a.
III 0
Ole.
.~ rn
x:==
~a::
.cW
01-
1ll...J
w<
....
.
""'I
~
....
~:r:
J:::t
N""
00
Mrn
1
~
.
....
....
w
~U
f'f) ....
,....., N~ro-
"llf'IlU-1
2:-or<"!<oa,~
C::(7'l'rlc() C1'
0" L"'" . r-
01"1>'
;,Q"'-JMC::~
.-4-J....WO
..J ~ to[ '-0 try (1'
o :r:
O.n 411f:...1
J: 1.LJ >- Cl. ~
U~~Vl;&
'.n < .... ..l c: .
.J~...I"'C:
::z - .... 0..
C40~::tr...
..l t~ Q... c:: Cl.
..J >- ..
WO.OZ.......
...OQO~OO
c: .. > .. W .. M
... r- -J r- '-J U'l
If) IX)
>-
CI:l
'" 1,,'"
. .
~CO
\.n .j
.-4
." In
. .
,.. ....
.... \l"
....
o
ci:i 3: ~
-' <l: 0
o -' [IJ
o W -'
:r: f- <l:
U <l: U
U) f- 0
U U) --'
::::; >- >-
[IJ [IJ [IJ
::>
Cl.
.J
..,
.
'"
,..
.-4
-
.
.,!)
N
~
>-
....
-;
,-'
r
ro-
.
o
-
."
.
o
....
Wf-
Clu
<l:_
Zo:
<(f-
::;;~
0:0
Wf-
f-Z
<(w
3::i'
I U;
.... l-
N <
I ...
;!) 0 J1
C\/MUJ
I .... I
....0...1
....'e
OlLl
O~
'-0,)
N....
00"
I I
O~
.... .-4
01
OtO
Q
a
:::x:
\JCf)
\!1 \1'1 I-
~ 5:2
::,.c~
.J) Cf)
\1'1 >- 0
~~...J
z~
~ ;:) ()
za~
-=> U Cf)
.:JJ l-
ll') Z
I/Hr. ~
~ ..rt~
0< z: 11.
Q..O~
,,~Z
a: .... -
~ CZ
~UO
..JeJ ~
"...s-
-J";:!:
QV'lW
o..uO
~ :t: a:
;J.....fr
J'1 .... ...
U)
f-
U
I-~
zf-
w~
00
Z-'
W<l:
Cl.-
wU
OW
zCl.
_U)
""
.
~
,.,
.1;l
.
':"'
f\J
O.
WU)
>f-
OZ
o:W
Cl.::;;
Cl.>-
<(<(
0:Cl.
Wf-
f-[IJ
OW
>0
'..'1 ..l
~~
':J
~..J
u
-"=
lI" ...
'..,:)
l1..
-.D
.... ....
t:CO
rl-
rt)
J:"'l!\J
'''-I ...
.M
Z
~
=>
...J
o
()
o
. C\I
"'z
.:r~
..0:;)
...J
o
()
,..,
.
r"'lz
N~
"l =>
...J
o
()
<fJ
ill
X
<(
f-
>-
>-
a:
ill
"-
o
a:
"'-
--'
<(
I-
o
I-
Wz
00
u;j::
w<<
",z
0:<<
W..l
>Q.
WX
o:W
wo:
wO
"'...
:2'
....
"'w
V'1 ::-
....<
~ \11
....::I:..J
ut--I
~ ""l
UJ....:r
;:) ~
~....>-
c",:r;
;a:oQ..
OtOU,,;
O,.,N
W
::>
z -'
o :;
~ 0
c( W
Z U)
c( U)
..J W
no U)
x U)
w <(
a:
o
u.
w
c
in
w
1Il
0:
W
>
W
a:
w
w
1Il
!'\.l
OCO
Nt!)
.
coo
.:r~
...
W
::>
-'
<("
>~
>->-
>-0:
0:<(
w::>
Cl.Z
0<(
0:-'
Cl.u.
((0
::>U)
0<(
>-
.
~...
",
~
1"'\
I
....
.:!'
!,i
,...
,.,
w
::;)
-'
<(
>
o
W
U)
U)
W
U)
U)
<(
U)
0:
<l:
W
>-
f-
U)
<l:
-'
.
...s
,.
...
.....
,~
~
o
I
..n
N
U"l
",
r'l
.
:>-
~
r:"-4
ffi:.J
[L
o
0:
0-
0:
=>
o
>-
...
o
w
:3
<<
>
o
w
00
00
w
00
'"
<<
W
:I:
I-
-'
W
~
cU
.;:::r
c:
q
w
o
.. ~
..... 00
o ffi
~ ~
0:
0-
[L
<<
>-
I-
0:
~
o
go:
w
iO'
"-
x
o
;Q
~:=;
o
>-
u.- c~
-J
u..
.
.
-
..
..
..
..
-
..
..
-
..
..
-
-
..
..
..
-
-
..
....
0'
"
C7'
"
!7'
C/)
<<0
rz
0<<
::JC/)
C/)w
wo
0:;
;::a:
Ow
zC/)
c/)-'
:E~
>- Z
ZW
0::;:
fiJ~
t~
~g
ttffi
a:r
w>-
mo
~a:~
~C:!J
~ffig:
::;:~!!!
:I:~~
o .<<
*ffiu
>>-w
~~5;
Z .>-
wwz
::;:CJ<<
"'<<a:
~~o
~~>
<<Ot:
::;:cjO
~~~
o!i:z
-'CJ::J
:;::;8
.oWa:
C:::<D::>
5;ii~
z~>-
z('Jm
:;: -.0
~~~
8~~
ct.i
>-ow
<<<<m
::;:0>-
-' a: <<
-'a:::;:
mOI
xu.o
<tOO:r
~~:;:
<<woo
z::;:w
i:LU)~
a:~:J
~CI)U
Oen<<
>-<<u.
-;f
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
, BUILDING DEPARTMENT
, : . .~. it. ......:
, ~ .,ft, ~'>"'j~li {+: l;J\;!"t,',:,' i.1 ~ "'.,
~ ,.~'~:.r{;'; f ,~' I ~ " i }, p:~, :"
.' )~',~ e~;~ ~1;1
; ,r~ ',I, i'}.'
~ ;: i
APPLICANT
ADDRESS 1 612 's' EABo~~ri i ~ I !!.!\,~ ~fo RT :MYE'RS~ ' ,
Cl1~IS!!,I~<E. D9N1\HUE ,. , '
'" ,'; / "', _. f,~" < f t ' ~'" '," ..r, 1 ": ."\~r 'j I'. \
OWNER . ".', , " " , '.
,', ";;':'1 I' 'S'\ ~~4",}'~j, Itr" ;o!\f:~~~il: ;.
JOB' LOCATION " ,.,' , I. , . I ' '. " .
~ .; . .
33Qlfl:'
, PHONE
'I -, _ ,\ -, ,:,. ':- ,\,: ~':~ ,~"., ',-~ '
~'''J'';'$i'QO' . '" " . "
'(;"~' :
,: t.. ~ , ' I .": - . :. -" :', '~
.,.' "AREA' "'S " FT' '.',
~"-' ,.': ,'Q~ .'.'
~: ' ",' ~, ~ ~ ~.t~:i
~ :;
LEGAL DESCRIPTION: LOT(S)
BLOCK
';LOT SI~E:I' '~i'
SUBDIVISION
!:' ,
'H:,lll,Hh":I~~~I."~;I'" 'I.;' ;,.H "ii'
PARCEL:I.D.f,.
;"1, ...,.
"}:i~f4~t,,;.}.tL~_;,.if'" ,,' ~il\rn _i~it .
WORK PROPqS~~~~N~~"'.co.n~,~rtt~ti~tl, :-,;.....A?di,tion ----Alter~tiori~epab.. ,; F~;t; {'Install;'
k ':, ,1' .:;: "., < J~;>f~~i':;f!:;~:.4:j~LJn;~}~!~l~~t'il;',ll ,';
,):-4Si.sn/Temp., ",.,_Sign ,'> > \) ,,!'Move 7:~L'IPlllt\n~olfsh
PROPOSED ~SE: -1Sill~~l~f "F~iii;:~,lf~i~t~t~~J :Hir .:' It'! ; ,1__4~~~ftLu~itti: :t . ,", ',' H'M/H
" ,.r; ",.:i,' l. ,,~.,ii<!, .,:-.;;i;(.\' ,'>, .J" ~ I'';:, '. ,;, ,,' ...', 1'" "I' C" ' , " ' ..' .'
\,..,.,..,..,.t......~h ....."f h.... ..!.~. ~r.. f""'" ....(\. . .,11. ',,' '~.!': ,+";
'_Commercial ,,' ~Indust._Swim, : Pool. I ,
") ;' 'j \\1 an~O::":t'~ ",
,
!-.tH,;
!; i ~<~}
l_.
. I'; ; Other
,,~; ~ ';:.',~1~/f:r.' .....,.' I oj i: '. :-.'1,... '
I' 1'I\(J'~estaurant: &, Healt~~:Dep8rtinent'"Approval,
,- 'I . . ~. I ~ .. . . ~ ' !- l ' ~ i
~.~~ r:1 it
BUILDING SIZE:
x
'i 'li~: r I, o:~ ~.
,,-:,,",1
Square Feet.
Height
1 ',,'.;
RESIDENTIAL: '
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF .BUILDING PLANS & (1) SET ENERGY FORMS...
ATTACH (3) SETS OF BUILDING PLANS &1(1) SET ENERGY, FORMS... I,
I: . ""!,,.COPY .OF ,CONTRACT REQUIRED,
','" ~ r,,). " , ' ~! ' ... j .f,.'i '! '
: l I .~
PERMITS REOUESTED
_BUILDING
_ELECTRICA~, '
hECHANICAL
. '",,, ~
$
II ~ '
Valuation of Total Construction
'~~~ 1:>~C)S~~i~e , Florida Power 'Corp.
,,- 10 "
Valuation of Mechanical Installation
l ','
~ ;; ~ '
W.R.E.C.
~' / ,
$
, ,,'
_PLUMBING ,j)
, ..~ "
.' ~
GAS'f;
ROOFING '
SPECIALTY
TYPE OF CONSTRUCTION: _Block ' _Frame" _S teel '
Other
," '.',.1
FINISHED'FLOOR ELEVATIONS i"
, ',!
,<I
*****.*********.*****.********************
'FT,.
':1 '"
~.q
~ ';:' ;~
;.,
BUILDER
r.o" ,
CONTRACTOR SECTION
Company
State Cert. or Regist. #
City License Registration #
,'..******...**.*.*******.*...**.*.*****.***
Signature
11 ~: .
, '
~ .l " 11
,',\
'.,';
; t. ~
F.T.F.CTRT CT AN
d.
Company
State Cert. or Regist, #
City License Registration #
..**..*.********.*****.*********.***.*****
! I
Simature
h,' '
Signature
Company
State Cert, or Regist, #
City License Registration #
" " ' ********.****.**.****........*.*..*.*.****
"'Rlt:HARD.;n\q~l'i:;JR:.":nl .,.", t
" . .' ,~,,' " companfIR CONTRO~ SiSTE~ Sw ~,
State Cert. or Regist, WAC 035496
City License Registration #
...*..***.****.*.**.*..*.****.*...**.
PLUMBER
Signature
; ~,
" .. 'f,'
,;,1'.1;,
i ' ~
Company
State Cert. or Regist. #
City License Registration #
Signature
APPLICATION
~ ., . ~.*..*.*~.~********..*************..**
APPRO~D B~ " i ~~~~ f;./ ~ ~A/:7,~"\.. ,. :.
,i ;i~ '::1~ifL
:, ;-'~.t" ''::'
PERMIT OFFICER,
H~~;.;~ i:',:;'-j "
~ ~, -.i
CONDITIONS OF PERMIT AFFIDAVIT
I
A.
RESTRICTIONS
The undlrligntd'undlrltrndl thlt thil plrlit IIY bl lubjlct to 'dlld restrictionl' which lay be lorl rll~rictivl thin City
regul,l~l.n~~~i!.~! ~~~,!r~,~,~~~~,~~'~1I r~~~onl,lbi~~tl/or colplllnct wUh Iny IppHubl. dud re~tricUonl.
. ." " "
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
'. : ."it, -: ll'~""i<.:""",. ," ;......~~ 'I..-r....t~lt... ..... ",_ ""'-' ..' . Ii '-"";' ", ',,~ -.. -:.
.
If the owntrhllhired Icontrlctor or contrlctorl to und.rtlkl work, they IIY be required to b. licensed in Iccordlnce with
Ibte Ind loul'ttgulIUonl,"''''Jf'thl'contractor II not Hctnled .. required by law, both the owner Ind contrlctor IIY be ;r
cited for I lildlle~no~Y\.Jltion under,ltat. llw. If the owner or intended contractor are uncertain 15 to what licensing
requirelents'lay Ipply for'th,'intlnded:Nork, thlY are adviled to contlct the City of Zephyrhilll Building D'plrtlent, 1813)
788-6611.. '
"I. f'1;.-,. . ,~..,:~ _;" .,...,~,j,:, ,,,,": -~' ~
;" ~
, ..
i
, .,....T.l
+' ,..
Furth.rlore, if the owne~ hn hired I contractor Dr contractors, h. il Idvised to have the contractorls) lign portions of thl;
'Contractor Stdionll' of'thil "Ippliution 'for wblch they wlll be relponsible, If you, .. the owner lign as the contractor, ' . '1
you ,ar'tl,n~~f'l~~gt~I~'Y,~,~,r~th.r thl,thl, CD,,:tractor, Irt re,ponlible for ~he work. If the contractor wishes you to lign ". .
'IS contrador1'bat IIY ~'IJl)ndl,tIUDnithat h. h not propedy Ucenlld Ind IS not entitled to perliUing prhillgel in th.,ll"
'I;' ! ^l' ,;~"(,, . . ,
Cl ty .of,,1.IP.,h. vrhills"r r;'!~\" ': ,,;
l~r~.,,~,r.. (. ~. ,... ~",. .J'6:-."'~\~
p
C.
TR~~peORTATIO~ IMP~~!F.~'8 A~D UTILIT~ CONNECTION. FEES, i
CON~r,~~~I!~~,.,~! EN L~~ ,l 'r!~ fJ'fAPTER 7 ~ :3, ,~FLOR I DA ST A -r:UTE8.,: ~S
~ ,;,'. I :
','
D.
AMENDED)
I certify that ,I, the applicant, haye been provid.d with a copy of 'Florida's Construction Lien Llw . HOleowner'l Protection
Guide' prepared by,the Florida D,plrtllnt of Agrlcultur. Ind ConsUler ,Affairs. If the applicant is SOltone other than thl
'oNner', I CI!U!y lthat I hav~~~~~~~d.l,j~~"!Dt the aboy. d!5crib.d docullnt and prolise in good flUh to de!iver, it to t~.
'owner' priOf: lo,collenc:llent.' ' " ., . '
E. CONTRACTOR'S/OWNER'S,AFFIDAVIT
; ..~,!.,; \;-,~ \ I . (
: ". ", ,'"
I certify that III lh. inforlation in thil applicltion is accurlte and thlt all Nork Nill be done in cOlplilnce with III
, applicable,laws regulating, construction. loning,lnd llll!l.d.,yeloplent~
, . :: ; 'I ,. ;. ~.I.' :"
Application b herlby .adl tD!obtlin I ,.r.n tD"dD ltDrk ;Indin.hllltion IS indicated, 1 certify that no work Dr
inltlllltion hllcollene,d pr,lor to ilsulne. of I plr.lt Ind thlt III work will be perforltd to leet Itlndlrdl of 111 llWI
regulating tDn.tfu~liDn,Ctity COdl., 'loning1f.gu.ltionl, Ind Ilnd deYlloplent r.lgulations in the jurlsdlctio~. 1,1110
certify that I ,understand that thl regulationl of other governlentll Igencies lay apply to the intended work, and that it is
IY responsibility to ide"Ufywhat.. adio,nl I;,ult take to be in cOlpllance. Such agencies include bllt ill! 1I0t lilited tot
I DeDartlNt of EnvireJtl.n"'l ReauhUoD,;',Cyprtls Blyhelds, WeUand ~rels and EnvironltntaJJy sensi tl ve lands,
'. ; " '..' lIater/lllltewlter Tr.atlent
I Southwlst Floridl lIater "InIQI.ent District. Utlls" Cypr~s5 alyheads, Wetllnd Arlls, Altering Wltercourses
I ArlY CorDS of Enoineers - SelNllls, Dockl, NaYiglbll IIlterMIYI
I DeDlrtlent of Hellth lRehabilitatiye Seryices. Environlental Hellth Unit - IIells, IIllteNlter Treatlent, S.ptic Tlnks
I US EnYiroRlentll Protection AalntY - Asbelt~1 Ibatelent ' '
... :;:c. '."J .' ! '~I'~
I 1150 certify thlt, if fill laterial is to be uled in Flood Zone ~A' or "A,etc.', it is understood that a drainage plan
addressing I rco.penslting ,volUII~:Nill;be lublitted which il prepared by a professional engineer registered in the stlte of
Florida prior to perlit issulnce.", ,; hI, . , '
" \
'. I. ,;
A perlit issued shill be tonstrued to be I license tD proceed Nith the Mork Ind not 15 authority to violate, cancel alter, or
set aside Iny provilions of the technical COdIS, nor shall illulnce of a perlit prevent the Building Official frol thereafter
requiring I correction of errors in pllns, construction, or yiolations of any code. Every perlit issu~d shall becole invalid
unless the Mork luthorhedbysuch perlUi."collfnced wUhin six lonths of issuance, or if "ork luthorized by the perlH is
suspended or,lblndoned, for a period of Iii tontbl Ifter the U.e the work is to'lenced. One 90 day extension of tilt, lay be
Illowed for 'the plr.it with fll tharg' of $15,00. The e.tension shall be requested in writing to the Building offlcill, An
approved inspection lUst: bl logged during IIch IIx .onth period, or the project NiH be considered abandoned.
, ~ ,- .
WARNING TO OWNERI, VOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAV
RESULT fIN, YOU~'; pAVING' TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU
INTEND TO OBTAXN.FINANCING, CONSULT WITH VOUR LENDER OR AN ATTORNEV
BEFORE'RECORDING VOUR NOTICE OF COMMENCEMENT. JOBS UNDER $2,500 IN VALUE
DO NOTk NEED,i;,TO, RECORD", AND POST A "NOTICE OF COMMENCEMENT".
SIGNAT~!~~l~
, ,'\; ',;.~,(]~E,~9R,AGENT,
DATE_~_~____-LjJ.Z~_~~~~~_~~~__~_________
NOTARY;'~S;'~O ,;:~'~'~"() j rl7-r
. OWNER ~I.~"~:~___
MY COMM~SS~O~ '~X~I~ES~_~_~~L~_d1.~-------
, SIGNATUR
NOTARY AS TO
CONTRACTOR____
MY COMMISSION EXPIRES___~~~~~~~__