HomeMy WebLinkAbout92-2602
BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
.~.~ ~.~
~ ELECTRICAL ~~
:::::,~:~e~?!/p-~~~':::.,_?i~:Z-
Permit
N~
26028
Date gr -;($---- Y :L
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Parcell.D. #
3 - .:l.6 " dl -/ ~ ..-0
- 4-7
Zoning: Energy Code; 1 _R~on Gas:
D"C';Pt;onOfWO"~ (f;>'<'-'<~P /.A-7:-r' '--.-(-~-~,,~ ~
t/-'d4-
NO OCCUPANCY BEFORE C.O.
FINAL
C.O.
DATE
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances,
DATE
Inspector
Permit Fee
Signature
Company
Address
Telephone#
~ Ji~~
Valuation or
Contract Price /,~ l)-zr-o. /T1J
City License Registration # / .;L
?;}te cert;~.~ L2':#Oh~ ~-
~ Ie.Jb3/ E
t2,!2f~
FRM.
Insul. CL
WL
PLUMBING
SLB <t.J~lo-Gl~ ~
Tub Set
Water
Sewer
Final
ME
ELECTRICAL
Tp. Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
~~.Jd.tc~~~
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLJ:CAYIOIil FOR PEl\i;UT
CI'IY OF ZEPHIKH.l.US
BUII.DI1IG DEPAlrn'IEIilT
OWNER'S IWIE )) d Vl(8 tFJ D J.. Ii I ~ e.. YYJ 11- e;FJ f' PHONE
OWNER'S ADDRESS ~ (;, I g ~h J' /1? 0" .t9 0 fi ,
JOB ADDRESS '2 f' PU y,f? j..}) 21 ~ ~ 1-
'7t38' - .</7~
I-=? 3,~ Z} I
LEGAL DESCRIPTION: LOT(S)
~7
,
BLOCK
SUBDIVISION
,SJLVEI1
t7~ J-r ~
PARCEL I. D. t
WRK PROPOsm:-i-Jlew Construction ~tion _Alteration _Repair _Install
_Sign
~ve
_Deao1ish
_~rcia1
_Indust.
_, of Units
.$Swia. Pool
_K/H
PROPOSED USE:
Single Faai1y
_KIF
Ot:her
_Restaurant &: Hea1t:h Depart:aeo.t Approva1
BUILDIIIG SIZE:
x
~re Feet,
Height
RESIDENTIAL :
cottItER.CIAL :
ATTACH (2) PLOI' PLAIIS &: (2) SEI'S OF B1JIIJ)DfG P1AI!i1S&: (1) SEI' ENERGY FORKS. **
ATI'ACH (3) SEI'S OF BUD.DIJiG PI.DS &: (1) SET EI!i1RRGY FORMS. **
**OOPY OF OOIITRACf lUlQlJJIRED.
-i-BUILDIIIG
$
PERlfITS REOUE:iTED
) 3, /J () tl () 0 Va1uation of Tot:a1 Construction
,
_ELECTRICAL
AKP Service
--t.-Florida Power Corp.
W.R.E.C.
KECllANICAL
.-
LPLUKBIlfG
TYPE OF OOIlSTRUCTION: _Block _Pralle _Steel
$
Va1uation of Kecbanica1 Installation
GAS
ROOFIJi4;
SPECIALTY
Or-her
FIIIISHED FLOOR ELEVATIOIilS:
PI' .
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BmUlER
COllI'I'RACIOR SECTION
r- OOI!tPAn . jJ~:T~ P, P 1- Ct).
() . I! . 09. ., / JJ State Cert. or Regist. I Ff tP p ~ z.; _9 ~ ~ 7
~/l ~ Cit:.y License Registration I ;;.
****************************************
Signature
Sismat:.ure
OOI!tPARY
State Cert. or Regist. 1=
City License Registration I
******************************************
ELECTRICIAN
PLOKBER
(;';- OOI!tPOY .1) tR ~1 e; . ~~ L
~ ~ Zk Sta'" Cert. or Regist. # fliP ""
. :t n City License Registration I
******************************************
C#.
99R97
/::(
Signat:.ure
COIIPA8Y
St:a.te Cert. or Regist. I
___._ City License Registration I
****"1i:**fr..1 ;....,*.,.,,~.,.,.,J-*************************
!tECIIAIfiCAL
Signature
Signat:.ure
WKPAWY ,q Je frJ } /l/ r; "T r / .Bi-'1-</':). J /YJ/ fi:J
State Cert:. or Regist:. '_. '7 .
City License Registration , __ 7~ -__
*******~~****~***.***~****~~**************
nT1fIl:R
APPLICATION APPROVED BY>> ~~~ ~",r
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS ,
The undersigned understands that this perait.ay be subject to ",,2(< restrictions" which .ay be lore restrictive than City
regulations. The undersigned assu.es responsibility for co.plia~~" ~ith any applicable 'deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the ollner has hired a contractor or contractors to undertak~ iII.>rl:, ~hey lay be required to be licensed in accordance with
state and local regulations. If thetbnfractor i~, not.,licensed ~s required by lalll both the owner and contractor .ay be
cited for a .isde.eanor violation under state 1~.1" If the owner or intended contractor are uncertain as to Khat licensing
requirelents lay apply for the intended work, they are advised iu c3ntar.t the City of Zephyr hills Building Departlent, (8131
788-6611.
Further.ore, if the ollner has hired a contractor or r.ontractors, he is advised to have ,the contractor(sl sign portions of the
"Contractor Sections" of this application for IIh~ch .l,ey lIill be responsible. If you, as the ollner sign as the contractor I
you are indicating that you, rather than the contractor, are responsible for the IIDrk. 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 UTI~ITY CONNECTION FEES.
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided lIith a copy of "Florida's Construction Lien Law - HOleollner's Protection
Guide" prepared by the Florida Departlent of Agriculture and Consu.er Affairs. If the applicant is so.eone other than the
"ollner" , I certify that I have obtained a copy of the above described docu.ent and pro.ise in good faith to deliver it to the
"ollner" prior to cO'lence.ent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate ~nd that all work will. be done in co.pliance with all
applicable laws regulating construction, zoning, and land develop.ent.
Application is hereby lade to obtain a per.it to do 1I0rk and installation 'as indicated: I certify that no work or
installation has cO.lenced prior to issuance of a per.it and that all work will be perfor.ed to .eet standards of all laws
regulating construction, City codes I zoning regulations, and land develop.ent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies aay apply to the intended work, and that it is
.y responsibility to identify what actions I .ust take to be in co~pliance. Such agencies include but are not lilited to:
f Departlent of Environ.ental ReQulation - :ypress Bayheadsl Hetland Areas and Environlentally Sensitive Lands,
Water/Wa~tewater Tc~atment
f Southwest Florida Water KanaQelent District - Wells, Cypress,Ba-heads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docksl Navigable Wat2rways
f Departlent of Health L Rehabilitative Services, Environlenta! Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environlental Protection AQency - Asbesto5 abatelent
I also certify that, if fill .aterial is to be used in Flood Lone "A" or "A,etc.., it is understood that a drainage plan
addressing a "colpensating volu.e" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to per.it issuance.
A pertit issued shall be construed to be a license to proceed with the work and not as authority to violatel cancel alter, Dr
set aside any provisions of the technical code5~ nor shall issll2nce of a perlit prevent the Building Official frol thereafter
requiring a correction of errors in plans, cons,ruction, or viDlations of any code. Every perlit issued shall becole invalid
unless the work authorized by such perlit is cOMtenced within six lonths of issuance, or if work authorized by the permit is
suspended or abandoned for a period of six lonths after the tile the work is cOllenced. One 90 day extension of tile, lay be
allowed for the perlit with fee charge of $15.vU The extension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each siy .onth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COKKENCEKENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCINGI 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". ~
X J!"..,Arl.A'" W ~ OdIn Q- ~
SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTO~ -
was aC!<nowledoed
, 1992;' by" - ,.
was acknowledged
, 19 9Z-- by
who is perS~lY.knDWn~? me or who has
produced A..l--(~~..L-r. ...;~
as identificatiDn and who did/did not
take an oath~F )(J/J.,/
(Signature) II/. L E!. 1.
___---1t6fi-O-iS . k.5: .
(NaIF", TYI1~d, Pl~ i nt d or Stamped) , Ma
NOT ARY PUr.,L I C Notary l'tit5l1e, ~ ~ ~ 199?
My Cnm"1i<s'on Expires Sep . , .
1~:lO is pel-~'oz.~or who has
p..oduced
as. identifiC~,ln and who did/did not
i;akF. an clath. ~~~
___.__ _ , ,(J,.
(Signat~;';-e~) 'A. . 1 '? 1
. '-" II 1L 'J '..5 .!: u~
--,..LLt t
(N,qme T\{pe::l, f'rinte or Stamped)
NOTARY PUBLiC 'Notary l'ul511c, Stat~ 'Or ~orfCftl
-..----- My Commission Expires Sept. 23. 1992
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POOL ENCLOSURE AFFIDAVIT
. .
It is understood and agreed that the OWNER will comply with the following
resulations concerning pool enclosure:
1. That t.8ediately upon completion of pool construction the OWNER shall:
a. Construct around the pool a four foot high fence with self latching
latel with no openings large enough to admit a four inch sphere; or
b. Construct a screen enclosure around the pool which is permitted by the
Pasco County Central Permitting Division.
2. That one of the enclosures described above will be completed prior to final
inspection of the pool.
3. That the OWNER will require his pool contractor and screen enclosure
contractor (if applicable) to call for a final inspection Lmmediately
followinl the structures completion.
4. If the followina conditions are found on the property, it shall comprise
presuaptive evidence that the OWNER is in violation of Section 315 of the
SLaDdard Sw~ina Pool Code and Section 530.4-D of the Pasco County Land
Development lesulacions:
a. ~re tbaa seven days bave passed since all work was completed on the
pool structure except for a final inspection. and;
1) A fence or pool enclosure as described above is not in place; or
2) Work to build a fence or pool enclosure as described above has not
c~enced and is proceeding in good faith; or
b. The pool is beina used for swiDllling or bathing purposes without a fence
or screeft enclosure. as described above.
5. That a violation of Section 315 of the Standard Swt.aing Pool Code or
Section 530.4-D of the Pasco County Land Developaent Regulations shall
result 1D the issuance of a "Notice of Violation" to the OWNER by the Pasco
County BuildtDa Official; and may result in a ftne not to exceed $500 for
each day that the violation exists.
6. It tbe silftAture of the OWNER'S AGENT appears below. the A~ENT promises in
.cod faith to aske the OWNER aware of the above described requirements and
penalties before commencing construction. .
c-:
sr TO AIIII SUIIS~18ED 8lFORE HE W!S II f.in ~ ~
',f""'. DAY OF -f~~ (-/ .. . 19~~ AG 'S 51 ATURE
~. J) ~(j, I /;/1. I t.? / \ /) ~ _____
,. h /~ tbiJlDl/S fi-. PU.5It~ HI}'fJ.ll/R '0. J tJJ7KE--
NOTARY PL'BLI / PLEASE TYPE OR PRINT NAME ABOVE
~ JJotille, ~ 'Of nmctlf
My Commission Expires Sept. 23, 1992
Florida
Power
CORPORATION
NAME 3\JQ. l.~~
ADDRESS ~(o \ ~ . . \M.OTJll. ~,
CITY L ~tA.lu- (
rX-
The pool proposed for construction at the above address DOES NOT
conflict with any underground or overhead facilities of Florida
power corporation, provided that the pool is installed in the
location shown on the attached site plan provided to us by the
pool contractor.
The pool proposed for construction at the above address DOES
conflict with:
OVERHEAD
UNDERGROUND
facilities of Florida Power Corporation.
Arrangements have been made with us for relocation of the
facilities so as to clear the pool area shown on the attached
Cost for relocation of electric facilities will be paid by:
OWNER
POOL CONTRACTOR
PRIOR to relocation of facilities and construction of pool.
A Florida Progress Company
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TO WHOM IT MAY CONCERN
nr~ f' !.' "!.JUL. (;111'11 '(-II\IY
l~~lh J(l:,Li!\1 Ilhl\'l
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...l].!:l.~_..jf:f._._._..---.-l '} r,~
I N ALL OF MY CONCRETE DEC~~ wnm\ T U r 1 I r(f. \.JH I 1\1[; ~=l NEW 'f YPE (IF m: I NrTlHL 1 NlJ
CONCRETE ON MY JOBS. I WII.L 1'101 [II \1~'ll\J(; WIl~L 1"1[-(,1-1 IN THFlvt ~1~; II-IF: CClNCHETF
I WILL BE USING, WILL HAVE F I. HI I, 1~,1 1111 ITll\IU~F.H t-JH.ICII UOF:;WT LALL FOP
\.J 1 RE MESH.
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r1H=lI'H-:' 1'(H..1 ~I ~
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('.H, fHl.m fI )(WJ
(IFH' F; r'I.HH. U11'H'~::jNY
Lie, 22 BONDED INS.
"
<<t~ART'S POOL CO.
INGROUND CONCRETE POOLS
H(/W~Fj D
L~ ~. J X' Fa,P/:7 tJ " Ii'
2~F');;)y;qJ.lJ/-.l S
ART TOOKE
-OWNER-
BUS. (813) 788-1767
RES. (813) 788-1426
Bus: ty '.. Drive, Zephyrhllls, Fla. 33541
Res: 14-Prlee Drive, Zephyrhllls, Fla. 33541
7 3./~ <:f27..s'#
WJ 1- l f ~ ~ HOME PHONE 7 g >r -..s-9 J.-?
o ,,q BUSINESS PHONE
PURCHASER
4-
{30.6P
MAILING ADDRESS
';::-:'1-
ZIP ...;? r7'/
Contractor agrees to construct a sWimming poo' and appurtenances thereto as hereinafter provided by the plans speclflcatloros and te'~s of the contract at
INSTALLATION ADDRESS ':;13.~ F LEGAL DES~J!?:1 ~8r;;, <;' !l6 _ ';;~
POOL SHAPE C~ S7(,7/7 MAX WIDTH J.s;-' If MAX LENGTH _~f) f If WATER AREA .3 t1.ssf
~ SHdr
7.;;r I'f DEPTH: .3 ft to ...:> ft to ..3 It NSPI TYPE c;f1Iir~
,t} W.J} Y 11 Underwater lighting E V ~'N Go '- 0 21 Timer .:;; ~ 0 V
12 Main drain YE S - J 22 Tesl kit YES
,
13 Deck JfPOL Sq 11 area <i5s 0
PERIMETER
1 Excess fill
.-r;g 4" f:.
2 Filler System Ie ~5 ~
3. Pump & moto}" fJ. ~:7:. /7'"E.-
4 Method of chlOrination J;lv f f)
5 SuM ace Skimmer Y!: S - J
6 Backwash dlsp~sal ~y E 5
7. Piping & Inlets sell Y f)
8. Therapy Jets /II 0
/ (, II c.H pI C E.--
9 Trle '" .Y , Color_#_
14. Deck drainage pee - 0- P.R~//Y'" 24
I}//J
15 Ladder Grabrails
...3
16 Steps Handrail 3 c,t7/11 'c - YES
17. DIVing Bd & stano NO
18 Slide /YO
19 Cantilever 'coping tile &~hr
10 Interior finish VY'J.llf.t!. /7,fJRc,/7'E:;2o Electrica!hookup Yi:.s GFI II//J
Additiona! Provisions ;;? c;' I X if..:? I S C.q E r:,/l/ ;;dc LOS v~ r I
D () tJ rf 5 S 1./ P ~ .r) C i/ -r-r;..-1f1 ~. L c; R J D,t9
J3E-:r WE E /)/ PO S -T5
I
23 Vacuum head. Yf~ Vac hose ::fa
II 1/
Brush ~.J. J g Leaf net ~
( J
~ ,) Jk
Vr.: C;
25 Adjustable poll~
26 Startup chemicals
27 Healer -'1L.i:L-.. BTU -=- Type-=-
28. Automatic cleaner ~ 1.-1.(/7/314 G
29. Love seat -Yj:. 5 Bench /)/'0
YE.5
,
J:} J f=1 b 8A L E.. ) .::(
C,L455 <~ ~r
30 Swimoul
TERMS
Unless specially agreed and set forth herein, Purchaser hereunder agrees to make progress payments based on the tota' price set forth in this contract,
to the Contractor, as follows:
CONTRACTPRICE$/~/jOLi.OO$ -r;;;/~7E.E:/V - JHdl./(,'I7/11'D .J... ~oj(J CJ ~
10% DOWN PAYMENT ..Ji J"3 do. 0 IJ /
40% SHELL JI ~~4 no. n IJ
20% PLUMBING ...f ,.;f? ad /J r1
2Cr/o~ .:5 C Q F. E/l/ .jj ~ ~ tJ t1 012
)~ COMPLETION # J -30 Cl. O/J
Construction progress may be arrested between billing and receipt of payment for each phase of construction.
NOTICE TO PURCHASER
DO NOT SIGN THIS CONTRACT BEFORE YOU READ IT OR IF PERTINENT INFORMATION IS MISSING FROM BLANK SPACES,
This is a home solicitation sale. If you do not want the goods or services conlractud for, you may cancel this agreement by mailing a notice to the seller.
This notice must indicate that you do not want the goods and services and must be postmarked by midnight the third day after you signed the agreement.
This contract shall be deemed an offer to the Contractor and shall be null and void unless accepted by a duly authorized officer of the Contractor within
fifteen days of the date and year noted above the Purchaser's signatr;res. The salesman has no authority to bind the Contractor. All agreements ana
understandings are contained in this contract and the Purchaser warrants that there are no agreements or understandings other than are set forth in this
document Acceptance of the terms of this contract by Contractor is to be communicated to the Purchaser by transmitting B copy of this contract to them
,howing .xept"" ~ ~I~" by the execul;"" 01 . du~ .ull,,,ozed 0_' 01 the COo/,.CIOl 0' bj commencing """,I,""bon. ~ ~
DATE L/~ /,.;; j 'J' 7..;{ PURCHASER
SUBMITTED BV q n ~ -r;1qifE. .. PURCHASER: ~~~
ACCEPTED BY ~q ,U DATE fS':..}~ - y~ OWNER
If purchasers are husband and wife, both must sign If owner is different from purchaser, owner must sign
PURCHASER(S), BY SIGNING ABOVE. ACKNOWLEDGE AND AGREES TO ALL THE TERMS AND CONDITIONS ON ALL PAGES OF THIS AGREE-
MENT EVEN THOUGH SPACE LIMITATIONS REQUIRE THAT SOME ARE PRINTED IN SMALLER TYPE.
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s 46 thru 49, Public Records of Pasco County, Florida.
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ify that the survey represented hereon meets the requirement& of Chapter 21 HH-6
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APPLic&'i."io~ FOR Ji>RRKIT
GI'IY OF ZIl:PIIIKiffT.i_'i
BUIIJlIJiG DEPAR'IT/IEm'
JOB ADDRESS
j)'WfJRP
~t.)g Nj/?~tJ~
"2 fPJI y,q;-))~ L.5 /
r:--
. . /
,
Y0 1.. L f" ~ 'r-
PIlOn
OWNER'S HA!fE
OWNER'S ADDRESS
;:::-1.
LEGAL DFSCRIPl'ImI: LOT(S)
BLOCK
SUBDIVISION
<.J j, Vi: If1
PARCEL I. D. f
,";J - =i!~"-- ~J
Jd
f) - ~~ 7
WORK PROPOSED :+lIew Construction _Addition _Alteration _Repair _Install
_Sign
_Hove
_Deaolish
PROPOSED USE:
Single F;mily
----1I/F
_K/H
_~rcial
_' of 1lJnits
-A-Swia. Pool
_Restaurant &: Hea1t:h Depart:aent Approval
_Indust.
Ot:her
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL :
COttKERCIAL :
A1TAGH (2) PLOI' PLUS &: (2) SETS OF BUII.DING PLDS &: (1) SEt' ENERGY FORKS. u
ATTACH (3) SETS OF BUII.DDIG PLUS &: (1) SEt' ENERGY FORKS. **
**COPT OF COWl"RACl' RIlQ1lJIRIlD.
PERnITS RECUESTED
_BUILDING
$
Valuation of Tot:.a.1 Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
_K.EGHAIilCAL
$
Valuatioc of Mechanical Installation
_PLUKBlllG GAS ROOFTItiG
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fra8e _Steel
Other
FTIiISHED FLOOR ELEVATIOBS:
FT.
IS PROJECT IN FLOOD zon AREA?
YES NO
******************************************
CODIITI1L\CIOR SECTION
<DIPMY'
State Cert. or Regist. ,
City License Registration ,
******************************************
RmT .DRR
Signature
ELECTRICIAH
CO!IPARY
State Cert. or Regist. ,
City License Registration f
************************~*****************
. SiPn::lture
CO!IPABY
State Cert. or Regist. I
City License Registration t
****************************~*************
PUJKBER
Signature
a:JIIiPANY
Sta~e Cert. or Regist. t
City License Registration I
**********************ft**** *************
,--:;-
KECllAllICAL
Signature
OTRF.R
k<<?7Z'
Signature
,
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS . .
The undersigned understands that this per~it lay be subject to "deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assules responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake wortl they may be required to be licensed in accordance with
state and local regulations. If the 'con1ractor isno~tlicensed as required by lall, both the owner and contractor lay be
cited for a lisdeleanor violation under state 13~, If the o~ner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, IB13J
788-6611.
Furtherlore, if the o~ner has hired a contractor or contractors I he is advised to have the contractorlsJ sign portions of the
"Contractor Sections" of this application for which they will b~ responsible. If you, as the ollner sign as the contractor I
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 lic~nsed and is not entitled to perlitting privileges in'the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LA~ (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 Departlent of Agriculture and Consuler Affairs. if the applicant is sOleone other than the
"owner", I certify that I have obtained a copy of the above described docusent and prosise in good faith to deliver it to the
"owner" prior to cOIsencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land developlent.
Application is hereby lade 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 work will be perfor.ed to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulati'ons in the jurisdiction. I also
certify that I understand that the regulations of other governlental agencies lay apply to the intended workl and that it is
IY responsibility to identify what actions I lust take to be i: cOlpliance. Such age~cies include but are not lilited to:
. Departlent of Environlental ReQulation - Cypress Bayheads, Wetland Areas and Enviro'ijJentally Sensitive Lands,
Water/Wastewater Treataent
. Southwest Florida Water KanaQelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
. ArlY Corps of EnQineers - Seawalls, Docksl Navigable WaterwDYs
f Departlent of Health L Rehabilitative Services. Environlental Health Unit - Wells1 Wastewater Treatlent, Septic Tanks
. US Environlental Protection AQency - Asbestos abatelent
I also certify that, if fill taterial is to be used in Flood Zone "A" Dr "A,etc.", it is understood that a drainage plan
addressing a "colpensating volule" will he sublitted which is prepared by a professional engineer registered in the State of
Florida prior to pertit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violatel 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 pertit is cOllenced within six tonths of issuance, pr if work authorized by the per.it is
suspended or abandoned for a period of six lonths after the tile the work is cOI.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 e?ch si~ lonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT KAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR lENDER OR AN nTTORNEV BEFORE RECORDING YOUR NOTICE OF
CO"KENCEKENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEHENT".
SIGNATURE: CONTRACTOR
SIGNATURE: OWNER OR AGENT
,19_
......
ur
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
b~fD;-e mp this ____~ 19_ by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befctl-e me this
was acknowledged
who is personally known to me Dr who has
produced
as identification and who did/did not
take an oath.
--
who is personally known to me or who has
pl-oduced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
.
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed~ Printed Dr Stamped)
NOTARY PUBLIC