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BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788.6611
Permit
Nc.! 278~
11-/:J.-9:2
Date
~
PmpertyQwne, ~A~~ ;~~O~
Job Address: ...?~~ ~_~ _
Parcel 1.0, # I / -:J-~ .- ~ - ~i)/ CJ -/~'Yt)O
ELEC~
PL~
ME~ Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
- 00/ D
Zoning: ~ Energy Code:
7;on of Wo,k A "<?...., . ~'"'-'
~~ -
Radon Gas:
dyz ~'./AT~~
#/~ .. Ate~ rf
NO OCCUPANCY BEFORE C.O.
FINAL
Complete Plans. Specifications and Fee Must Accompany Application, C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
City License Registration # /" b
State Certified License#
Pe'm;' Fee;g2 fj <70 t:
Si~nature r CiP' q. l ./ _
Company
Address
Telephone#
Valuation or
Contract Price
:207r7J~o-D
."
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PL
ME
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a. Wrong Address
b. Condemned work resulting from faulty construction.
c. Repairs or corrections not made when inspection called.
d. Work not ready for inspection when called.
e. Permit not posted on job site.
f. Plans not at job site.
g. Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICATION FOR PERKIT
CI'IY OF ZEPllYRllILLS
BmI.DIIIG DEPAR'DIE'NT
OWER t S NAtlE
G~I1C.E r$J!..~u(z';
,
..J Jl'02J? ()z.d /I'vE,
JJ'.2:;5" s-Ut ,-1i/E
PRO!!iF.
7J>P2 - // '13
0W'liER t S ADDRESS
JOB ADDRESS
2- - Jllk-'--S
~H.
.J1f,< ~r
LEGAL DESCRIPTION: LOI'(S)
BLOCK
SOBDIVISIOIN1
PARCEL LD.'
JJ-~b -;2/ ...t'O/O - /6Ybt?-LP/J/O
,
hUKK PROPOSED: ~ev Construction _Addition _Alteration _Repair _Install
_Sign
_Hove
_Deaolish
PROPOSED USE:
~ingle Faaily
_H/F
_, of Ulnits
_K/H
_~rcial
_Indust.
_S.n.. Pool
Other
_Restaurant &: Health ~t Approval
BUILDING SIZE:
7 X J/ J
/<g7
.
Square Feet.
~ TO "
Height
RESIDENTIAL:
cotmERCIAL :
ATTACH (2) PLOI' PI..OS &: (2) SEI'S OF BUILDING PLANS &: (1) SEI' EliERGY FORKS. u
A1TACH (3) SEI'S OF BUlLDDilG PI..OS &: (1) SEI' ENERGY FORMS. **
*:l:COPY OF COIN1TRACT REQm:RED.
~UILDING
PERKITS REOOESTED
$
:;)()/)O. 00
Va1uation of Total Construct.ion
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
_KECllMUCAL
s
Va1uation of Mechanical Installation
_PLlJKBING GAS ROOFDlG
SPECIALTY
TYPE OF CONSTRucrIOIN1: _Block _FraIIe _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
:1::1::1:*:1::1::1::1::1:*:1::1::1::1:**:1::1:**:1::1::1::1::1::1::1:***********:1:*:1::1:
CDIIO'KACIOR SECTION
BIJTT.DER
~L
COIIfPBY
St:ate Gert. or Regist. 4#
City License Registration
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/9a
/lJ.tI/J? ..
C~~O ~yJ.;;O
#f /~b
Signature
ELECTRICIAH
CO!IPANY
St:ate Cert. or Regist.#f
City License Registration I
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SiJr0.3ture
Signature
COIIfPANY
State Gert. or Regist _ #f:
City License Registration I
:1:**:1::1::1::1:*:1::1:*:1::1::1::1::1::1::1::1:*:1:***:1:*:1:****:1::1:*********
PLlllHBER
COIIfPA.IIY
St:ate Cert. or Regist. 4#
City License Registration I
****:1::1::1:****:1::1::1:**:1:*:1::1::1::1:*:1:***:1::1:**:1:**:1:**:1:****
KECHAHICAL
Signature
Signature
COIIfPANY
St:ate Gert. or Regist. ,
City License Registration ,
**:1::1:**:1:*:1::1::1::1::1::1:*:1::1::1::1::1::1::1:****:1:***:1:*:1:*********
01'1IER
APPLICAnmi APPROVED BY
PE:RKIT OFFICER.
CONDITIONS OF PERMI~ R~~LUHV&'
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perMit May be subject to "deed restrictions" which lay be lore restrictive than City
regulations. The undersigned asSUMes responsibility for COMpliance with a"y applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONS~ITIE2
If the owner has hired a contractor or contractors to undertake work, they may 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 lisdeMeanor ,vioiation under state law. If the owner or inten~ed 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, !8131
788 -b611.
"
Furtherlore, 'if the owner has hiTed 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. Ifyou"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 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 doculent and promise in good faith to deliver it to the
"owner" prior to cOI.enceMent.
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 COMpliance 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 perforled to aeet 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 of 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 co.pliance. Such agencies include but are not lilited to:
, Departlent of Environlental Renulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands,
Water/Wastewater Treatlent
, Southwest Florida Water Mananelent District - Wells, Cypress 'Bayheads, Wetland Areas, Altering Watercourses
, ArlY Corps of Ennineers - SeaMalls, Docks, Navigable Waterways
, Depart.ent of Health ~ Rehabilitative Services. Environlental Health Unit - Wells, Wastewater Treatlent, Septic Tanks
, US Environ_ental Protection AnencI - Asbestos abate.ent
I also certify that, if fill laterial is to be used in Flood lone "A" or "A,eic.', it is understood that a drainage plan
addressing a "colpensating volume" will be submitted which is prepared by a professional engineer registered in the State of
Florida prior to pertit issuance.
A pertit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, Dr
set aside any provisions of the technical codes, nor shall issuance of a perlit prevent the Building Official froD 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 lonths of issuance, or if work authorized by the pertit is
suspended Dr abandoned for a period of six tonths after the tile the work is coslenced. One 90 day extension of tile, lay be
allowed for the pertit with fee charge of tI5.00. The extension shall be requested in writing to the Building Official. An
approved inspection lust be logged during each six tonth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT HAY RESULT IN YOUR, PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU TO IN NANCING, NSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COMMENCEMENT OBS UN t2,500 VALUE DO NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
d/N-~
SI6NATU~: CONTRACTOR
J,,: OWNER OR AGENT / .
/(It 1 It D f}tJ itS ..s
STATE OF FLO~A ft1 t\. /
COUNTY OF AS C 0 '-I It I..;I);J, (}, ~
The foregoing instrument was acknowledged
before me this 11- ID I 19R by
STATE OF FLORIDA~
COUNTY OF IlS CO
The foregoing instrument
befcO\-e me t.h i s JI~ 10
/1181[(<( SI (V)~
was acknowledged
, 19 qd.- by
who is pel sonally known 0 m or who has
produced
as identification and who did/did not
take an tt.h"4 /J/J1~/
(Signat&-;r . , I'
-:\,..1(7 H. m Ot't-TcC :re..
(Name Type , PrInted or Stamped)
NOTARY PUBLIC
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who i personally known to m OT who has
pl-oduce
as identification and who did/did not
tak~ oath:;:
:AA.
(Si atu e)
-Se..e. "',J H YY1 OATE~ reo
(Name Typ~d, Printed OT Stamped)
NOTARY PUBLIC
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CITY OF ZBPHYJ~.lILLS BUILDING DEPARTMENT
OWNER a~At,~ F.E~~14eci
JOB LOCATION' :f,P :J3! /;/lr /yUlE
PARCEL I. D. # /1-.:7b .,;;.} .1J{)"f) - /6'/"6)- ~t!)/O
/ a1.Jtr
SHOW ALL UJ:STIHG &: PROPOSED S"I'RUC'l'URBS GIV:tHG DDlENSIONS &: SETBACKS.
"to f '
ALLEYWAY AC:'ESS FOR
GARAGE OR 1.~,ll.RPpRT -
15 FOOT SE',~;'\ACK
REQUIRED.
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MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
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FRONT P~PERTY
. '
LINE'
$ 1> ~.J ~ S'...t:!f /1 t/.,I?
(NOTE EXAMFLES 1 & 2)
S'rp..EE'r
...
2. SETBACKS, FOR R3 ZONING
60'
1. SETBACKS FOR R1, R2 ZONING
60' ..
-.......
10'
P E
R X
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~.O ' P S 10'
0 T 1 0'
S' I
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D G
20'
FJ?' J'H'l" PROPERTY LINE
10'
,
10' EXISTING 10'
PROPOSED
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20'SGL FAM 30'DUPLEX
1 0'
FRONT PROPERTY LINE
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38545iPalm G'roveDrive
Zephyrhills, Florida 33540
ACE
I~LUMINUM
Job No.
Phone: (813) 782-2616
,~
~~LD TO _,_ &rt1t' /;.- /7:-,.. fA: ,'!/ / .
ADDRESS __;'"1 i" d--:J '8" ~f4/..- . (' f r/-z
SHIP TOI__.. 2EPHY~III'-'-- S. "FIJI L ,
DATE -+-),1. - '9- q.,2
PHONE -L r;~. / / y ~?
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The undersigned aglees to pay
INSTALLERS IN FULL ON COMPLETION
PERMIT
PRICE
TAX
TOTAL PRICE
DEPOSIT
BALANCE C.O.D.
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