HomeMy WebLinkAbout92-2041
BUILDING PERMIT
Zoning:
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CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
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2041!l1
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Date
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Property Owner:
Job Address:
Parcell.D. #
Water Meter:
T.I.F.'5:
-'~'
B
Ftr.
Pre SLB
Lintel
Tub Set
Water
Sewer
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\t\o\t) /ILtJ5' I~ . .1/ ...:,JJ~Y
~ l/' . .~ if 0 ~ )1Yt50
REINSPECTION FEES: When extra inspection trips are necessary due to anyone 0 e re ~
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for eac a
!Breakers
'Ducts Insl.
Compressor
Final
FRM.
Insul. CL
WL
Driveway
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICATION FOR PE~lIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
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APPLICANT.., "
I i~t
ADDRESS ~~+
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PHONE
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OWNER i' : J' t I<.:f..., 1-' I Cdt.(/
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JOB LOCATION-W. )' ) ,/ ) '1~ (, ( ,i K ' 'J
LOT SIZE
x
AREA SQ. FT.
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.lF
WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair ~Install
____Sign/Temp.
____Sign
_Move
____Demolish
PROPOSED USE: ____Single Family
____M/F
_IF of Units
._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.
PRRM1TS REOUESTED
_BUILDING
$
Valuation of Total Construction
____ELECTRICAL
AMP Service
"","\ , I _ ./
$ ,) ,(/~'. i l
_ ;;...--1-.'
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
~ONTRACTOR SECTION
Company
State Cert. or Regist. IF_
City License Registration IF
******************************************
~mLDER
company r'~ < -!= r ~ ~; .3
State Cert. or Regist.1 lFEe-or,tlS! 7
City License Registration IF //:>1
******************************************
Signature
******************************************
Company
State Cert. or Regist. #
City License Registration #
PUJMRFR
Signs-ture ,__._
******************************************
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Company ,':',l.. "f -, l((~ "/.'-.
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State Cert. or Regist. lF~~,'!
City License Registration ~ I
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t':, '.j
MECHANICAl,
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"I; i
APPLICATION APPROVED BY
Company
State Cert, or Regist. #
City ticense Registration #
'1* **..** * * ** J * ll* *." J ,.- .,~." * *." * y*/." *;,
/ . J,. ~ _ 1.1-/'}f.....,..I. _ PERMIT OFFICER.
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QI.l-IFR
S i~w.a ture
.~ CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this per.it lay be subject to "deed restrictions" which ;ay be lore restrictive than City
regulations. The undersigned assu.es responsibility for cOlpliance with any applicable need restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR_~ESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, thJ; nay 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 .isde.eanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents .ay apply for the intended wor~f they are advised to contact the City of Zephyrhills Building Departlent, IBI3)
788-6611.
Further.ore, if the owner has hired a contractor or' ~ontractors, he is advised to have the contractorls) 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 perlitting 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 Consul~r Affairs. If the applicant is so.eone other than the
.owner" , I certify that I have obtained a copy of the above described docu.ent and prolise in good faith to deliver it to the
.owner" prior to co..encelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infor.ation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developaent.
Application is hereby .ade to obtain a perlit to do work and installation as indicated. I certify that no work, or
installation has cOllenced prior to issuance of a perlit and that all w>>rk will be perforled to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations nf other governlental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
I Departlent of Environ.entaI ReQulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive lands,
Water/Wastewater Treatlent
. Southwest Florida Water Manlgelent District - W~lls, Cypress,Bayheads, Wetland Areas, Altering Watercourses
I Ar.y Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Depart.ent of Health ~ Rehabilitative Services, Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environ.ental Protection AQency - Asbestos abatelent
I also certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc,", it is understood that a drainage plan
addressing a "colpensating volule" will be sublitted which is prepared by a professional engineer registered in the state of
Florida prior to perlit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official frol thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall becole invalid
unless the work authorized by such per.it is cOllenced within six lonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six .onths after the tile the work is com.enced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lust be logged during each six lonth period, Dr the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT KAY RESULT IN YOUR PAVING THICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR lENDER OR AN ATTORNEY BEFORE RECORDING, YOUR NOTl'CE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".;
SIGNATURE: OWNER OR AGENT
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L~ . '/sIdN:T~~;:~~T~C~R
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"Lvlf."} yC>---
was acknowledged
, 19 _ by
STATE OF Fl~A
COUNTY OF It\ l' l L.4 )
The foregoing~trument
bE~fol-e me th i ~/O
vias acknovlledged
, 19~ by
STATE OF flORIDA
COUNTY OF
The foregoing instrument
before me this
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
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who is personally known to me or who has
produced :::P1" 17'''''IOlA'''' 11'( ~V\{)(..J "'-'
as i ntification and who did/oid not
tak n oath.
MY PUBllC. ~auta Gf rllJf\~, ill I';';'J';
;~v C0rnrl)1~,$;I)n [X;:';f~ i1~Y ?, :,~;-j4
;:-~,r.',,[.a ~~ l~l,; im", (..lc,._r:q,t.al.$' 'Id, ~J
IName Typed, Prlnted Dr S~ompe~)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed Dr Stamped)
NOTARY PUBLIC
u
. I'OftT LAUD!"~
SOO S,W. 2111 TERR. 11~
FORT lAUDERDAlE. Fl33312
DADE: 821-14'2
BROWNlO: 711-MOl1
BOCARATON: *"1718
WUT"ALII HACH
'317 N. KJWAN
IN<E PARI<, Fl33403
PAUlICH,: 146-1407
MAAT1N: ~t45I
ST.lUCIE: 411.(127'
i:F...... ~ 11101 :)'-Ysmrns
Southwest Inc.
COllPORATE OFFICE
0280 ARC WAY. FO~T MYERS. Fl33812
FL WATS: 1 (800) 432-55ll2
1'0ftT 1IY2",
82IONlCWAY
FT. MYERS. FL 33812
CHARLOTTE: I3I-M5I
LEE: 27~720
COWER: lWI7.118O
SP No. 'S'S 311
WORK TO BE DONE ~ ZA~L'P JZ /J~~/7
f:?/7 . .. STR~Y)I' ~72:0? 5'7 I Pzr-A"-9 -339
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SOURCE COST OTY. ITEM PRICE /.';
/. ~-VVcP// z:.~ -/ BILL TO _
,'/ NAME '/ .
l->...e:1 ~~ "'-l"'" Z~-" ~....( ? STREEJ'l--7A-.J ;:'~.5 ~?;Z7 TPHONE
a v./ Clrv STATE ZIP
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7 - {;'//~f6'~ 2 ~ ~ /. I'
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v2 / / Z~-;;:.H TECHNICIAN: ~"c?Y55
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MA7 MODEL SERIAL NUMBER
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~ 5h ~/ 7 DATE DESCRIPTION OF WORK PERFORMED
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.~ HF ~I:RVICE ~VED
IF YOU ARE SA T1SFl__
TODAY TELL A FRIEND. IF NO r r -U~.
rRAVEL TIME TO FROM PLEASE PAY FROM THIS INVOICE
;'IME TIME TERMS: NET DUE ON COMPLETION
\RRIVED DEPARTED en
'IME TIME :::'::'-:;~.: 'ull,IC' I. · F,nonco C...'"., 1.1 2.. "' ...."'.. "'MUll '",".n..,. "'"" of .., ....". " ~
~r~~ ~#'~ DEPARTED c "._--'_..._-_._-_.,.__.._~
SERVICE PARTS *orn. h.lu,.. 01 PI" oIlh, '.., '''1'' whIr. Ih.., .r. placid Slid PI"I 'nclI .qUlpm.n, ,hili II ,II ..
t,m,in P"tOnll IM'GpI'rry .nd .h, lltl. 'hi. 110 ,hili ,.mll" In thl ..'I" Unlll...tvrn,nl III 'ull.1 ''''IV Buv.'
r:J721)b6 he,.by Igr... Ihl. ,II p.n. and ~ulpm.", ml., be '''''''''Clln Ihl .Y_"I 01 non".Yln'''1 a,., .,.. lief,
SERVICE LABOR I.. .......". .nd ,n.If..,oOII, . /. c.n
'''..-''.....-'"eff'~m .,.,...",... ..-. "
CUSTOMER DISCOUNT ~,"" .-, '- 'i/A'-.// k. ~ V
Il~b $l2J4']~ ...-~ Kit' 'L..v.~--<
TOTAL CHARGE vr?NfCfAN SIGNAl~_.. '-' If A _(' /J~.. ~ 0 / ..
$ //4t<'~ ~
DEPOSIT I/CUSTOMER'S'SIGro.JURE p
BALANCE DUE $ /....A.A J,. ~' CARD EXP. B3
//A:.V U) NO. DATE
-
TAWA
IT. Hn"''''''G
42.1 11-. TERR. N.
CLEAAWATER, Fl ~
CLENlWATEA: 573-MOo
TNM'A;, ~1371
PAleo
146-1212
LAKELAHO
"7~
STATE CERTIFIED CACO 35496
""""OTA
3e$-427t
DATE /-/0 -~
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