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BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
N~ 2648-E.1
?-/7-f".J.
Date
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Property Owner: ' . ,"'-
Job Add",,,,, ?);J,;., - ~ t(A,J2
Parcel I. D. # /). - d 6 -;;;1-/ - 0 () 61 0 - 0 CJ ,7 0 o. t') L ~ /" 0
EL~l
~G
MECH~..sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
/ Energy Code: ,/ , Ra~on Gas:
h _ xI~~ A1__'~ "h~
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
FINAL ~-
C.O.
DATE
NO OCCUPANCY BEFORE C.O.
DATE
Inspector
Permit Fee (..J.-!, --. 0<..':)
Signature,-~~ \.i:..~ ~\:\l\"\. \. C c..
Company ~\.C\ \\()~,('\.t~ \0"'((> ~"\\'\(
Address
Telephone#
Valuation or
Contract Price ! ..3-.S.-'...s.-, o-v
City License Registration # / Y 9'
State Certified License#
Jf/~'J;~-/IAAL~'-~~~ ~ .
~ E~
--
PLU~
----.~"
MECHA~L
----.
Breakers
Ducts Insl.
Compressor
I=inal
SLB
Tub Set
Water
Sewer
Final
Tp. Serv,
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr,
Pre SLB
Lintel
FRM.
Insul. CL
WL
Driveway
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.
APPLICATION FOR PERKlT
GI'IY OF ZEPUYRHIi.LS
BUlLDDlG DEPAR1lItI!'Bf
OWNER · S RAttE
'- ~()'" "'\
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PHONE
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OWNER'S ADDRESS ~C\lY'~l\ ~ ~ M\lQNlW t-OtJ\\i.i\'h:\\';:) 't\
\
JOB ADDRESS ,'~() IIQ (\ Ci lh ~\lQ rid.Q ('. C~h\,\\~\ \ \:-, \- \
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LEGAL DESCRIPTION: LOT(S) \'\arnriL ~) \l(;:.. B.I.OCK SUBDIVISION u) ~l \0 o\- II \- ')\.3:>
I N 'J.b ,40 \ D''r v:. ~l. \ 0' oS-
PARCEL LD.' \'1.9.\ n A." -()( ~ r;~D . (;CYl C'i) - ('l?J \(j, \G\-:;-.\ a\ \ ,>l. b\{\cv '1 "
z." V, \-.\r,\y~ ,~(\O.I "c~
WRK PROPOSED:_l'Ilew Const:ruct:ion _Addit:"Lon _Alt:erat:ion _Repair +Inst:all
-,Sign
--1!fove
_Deao1ish
PROPOSED USE:
Single Faai1y
_"IF
_, of llfnit:s
_K/H
_~rcia1
_Indust:.
_Swia. Pool
Other
Rest:aurant: &: Hea1th Depart:aent: Approva1
BUILDING SIZE: __X
Square Feet:.
Height:
_ RESIDENTIAL:
cottItKRCIAL :
ATTACH (2) PL.OI' PI..OS &: (2) SEIS OF BUILDING PLAIIiIS &: (1) SET ENERGY FORMS. U
ATTACH (3) SEIS OF BUII.DDiG PLUlS &: (1) SEt' ENERGY FORMS. "'*
o4oo4oCO Ill" OF COIlilTRACT KIlQIlllUlD.
PERKITS REQUESTED
_BUILDING
$
Va1uat:ion of Tot:a1 Const:ruct:ion
_ELECTRICAL
AKP Service
F10rida Power Corp.
W.R.E.C.
_KECHAlUCAL
s
Va1uat:ion of Kechanica1 IDst:allat:ion
_PLUKBIliG
GAS
:ROOFll~G
x
.
SPECIALTY
TYPE OF CONSTR1JC'l"lON: _B1ock ~ _St:ee1
Other
FIRISBED FLOOR ELIVATIONS:
FI' .
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
COIil'I'RACIOR SECTION
\ S ignat:ure
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WltPMIY N\ ~ (\ ,~) \ l \ ;.\ ('~r\
St:at:e Cert:. or Regist:. ,
City License Regist:rat:ion ,
******************************************
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BUTIJ)ER
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'L\ c.:
.
ELECTRICIAH CUllPARY
St:at:e Cert:. or Regist:. ,
Si2nat:ure City License Regist:rat:ion t
*************************************.****
PLOKBER CUllPANY
St:at:e Cert:. or Regist:. ,
Signature City License Regist:rat:ion I
*****.........***'**...****...***of,~....*t**...************
KECHMUCAL CO!IPMY
Stat:e Cert:. or Regist:. I
Signature City License Regist:rat:ion I
****...*......******.....**...*...*.......***.......***.******
0"I'1IF.R CUllPARY_
S~at:e Cert:. or Regist:. ,
Signature City License Regist:rat:ion ,
.....***......***..............**.........*.*......*...................*******
APPLICATION APPROnm BY PERKIT OFFICER.
COND I T IONS OF PERM I T AFF I,D A 'v' I T
A. NOTICE OF DEED RESTRICTIONS .
The undersigned understands that this peraitaay be subject to "deed restrictions" which lay be lore restrictive than City
regulations. The undersigned assuaes responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contracto~ or ,c~~tractrrs to undertake work, they lay be required to be licensed in accordance with
state and local regulations. If the conttactor isftDFlicensed as required by law, both the ollner and contractor aay be
cited for a aisdeaeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requireaents aay apply for the intended work, they are advised to cOll~act the City of .2ephyrhills Building Departaent, (8131
788-6611. I
Furtheraore, if the owner has hired a contractor or contractors, he is advised to have the contractorlsl sign portions of the
"Contractor Sections" of this application for which they will be responsible. If you, as the ollner sign as the contractor,
you are indicating that you, rather than the contractor, are respofisible for the work. If the contractor lIishes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to peraitting privileges in 'the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEE~.
n CONSTRUCTION LIEN ~AW (CHAP~ER ~lZ, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided lIith a copy of "Florida's Construction Lien Law - Hoaeollner's Protection
Guide" prepared by the Florida Departaent of Agriculture and Consu.er Affairs. If the applicant is soaeone other than the
"ollner" , I certify that I have obtained a copy of the above described doculent and promise in good faith to deliver it to the
"oNner" prior to cOllencelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforaation in this application is accurate and that all work will be done in coapliance lIith all
applicable lalls regulating construction, zoning, and land developaent.
Application is hereby aade to obtain a perait to do work and installation as indicated. I certify that no work or
installation has coaaenced 'prior to issuance of a pe~ait and that all work will be perforled to .eet standards of all laws
regulating construction, City codes, zoning regulations, and land developaent regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies lay apply to the intended work, and that it is
ay responsibility to identify what actions I .ust take to be in coapliance. Such agencies include but are not liaited to:
f Departaent of Environaental ReQulation - Cypress Bayheads, Wetland Areas and Environlentally Sensitive Lands,
Wa ter tWas tewa ter T rea tll!n t
f Southwest Florida Water "anaQe.ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
f ArlY Corps of EnQineers - Seawalls, Docks, Navigable Waterways
f Departlent of Health ~ Rehabilitative Services, Environ.ental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
f US Environmental Protection AQency - Asbestos abateaent
I also certify that, if fill cJt!ri~l ~5 ta ~, :,r~ '? rls~~ -. 'C"r "nle~r." ~t is undprst~od th~t a drainage plan
addressing a "colpensating volute" Mill be suhaitted which IS prepared by a professional engineer registered in the State of
Florida prior to perait issuance.
A perait 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 pertit is co..enced within six tonths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six tonths after the tile the work is com.enced. One 90 day extension of tile, lay be
allowed for the perait 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, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORDA NOTICE OF COKKENCE"ENT "AY 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
COKKENCE"ENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
~r;;;;~V-
SIGNATURE: OWNER OR AGENT /' SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
befc'J-e me th i s
STATE OF FLORIDA
cn!J~T'f !IF
Qo\~
was acknowledged
, 19_ by
The foregoing instroment was acknowledged
before me th i s \"\ tY\. ~~\-, 19 -S.O.- by
~6~N \- ?\.~ me r
who is personally known to me Dr who has
produced \'\) L -\! \=- IllS lo. ..\ l.1'~ <;l ~ - 14.1
as identificatio'~l and. Wh.O dl./~d~id 'nc.t
take an oath. ~ A.~ l
'- \j l\ v lJd -\ ~U .
<Signature) ~ \ \
\\"'\ff Q..:~.:o-_. (:\ \ 'l \
(Name Typed, Printed or Stawped) .
NOTARV PUBLIC
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
<Signature)
lName Typed, Printed or Stamped)
NOTARY PUBLIC
i:,: <". ); '.'; 'r~" :~~- ~:--::..('~_j';\~
:\. ;\';~.';J ~ "" t >,,~ :-~)J.: ~~1. . J~:;3
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Phone 858-4569
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JOB ADDRESS *\I"r\e
FENCE SPECIFICATIONS
TYPE HT. GA. MESH
MID-FLORIDA FENCE COMPANY, INC.
7125 North Highway 98
Lakeland, Florida 33809-9324
John Farmer, Owner
For
Address
Phone li~ 4l\IQ
Lot. No.
Subdiv.
FENCE PROPOSAL
Date ~~ \1 S,\c\Q
Blk. No
Survey Stakes Visible: Yes D
NoD
'b~
SIZE HT.
q\
J ---... (' Q.,
I \\ D\) -:;
\0 \\
..
,
\0
Fabric In D Out D Barb up D Down D
Level D Step D I Roll D Straight D
Line Posts Set ~ on center if! 11 ~
Top Rai II OD
Top Rail II 00
Braces No. II 00
Braces No. II 00
GATES SIZE FRAME TYPE
--4- ~x s ' .~" 00 \l..)(\~\"
--L ~x~ ~" 00 dnw
~x_ _" 00
'x _"00
EXTRAS:
TERMS:
Permit Fee $
TOTAL CONTRACT $
Down payment (Date Paid_____l $
Balance due $
\ '!:he I~
-u:~
Location of all work on the property and/or damage to underground objects or utilities are the responsibility of the owner,
Unless specified, quotations do not include grading brushing, or jackhammer work which are charged by the hour as need-
ed. This proposal becomes a contract when accepted by both parties and is su bject to cancellation. I nterest will be charged
at 1% per month on past due accounts. Costs of collection if any, including Attorney fees, will be added.
APp'ox;~a'e ,w';ng da'e~ _,
By~~e.\ I.~~ 1:kL\'l t U C
MID.FLORIDA FENCE CO., INC.
Approximate completion date
Accepted
Date