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. BUILDING PERMIT
Permit N 9
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CITY OF ZEPHYRHILLS
(813) 788.6611
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Date
Sewer Conn
Water Conn:
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Parcell.D. # IJf-~I.,-~/- (r)/t? 0 - /.JDOOO- O-ffD
Water Meter:
T.I.F.'s:
Zoning:
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Complete Plans, Specifications and Fee Must Accomrany plication.
All work shall be performed in accordance with City Co and Ordinances,
~ Inspector
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-t::::r 0 D l~ Permit Fee ' ~
~~~t~=~; p~~ce Z 7 df) . f $;gnatu,e. - ~'- _ <-L n ~
- Company
Address
Telephone#
DATE
NO OCCUPANCY BEFORE C.O.
c.o.
DATE
City License Registration #
State Certified Lic
..
Breakers
Ducts Insl.
Compressor
Final
Tp. Serv,
Rough In 4-'
Meter Can
Const. Pole
Pool
Pre-Meter
Final '-I-l1J'~b ~
SLB
Tub Set
Water
Sewer
Final :; - \0 ' '1 ~ 3otr-
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Driveway
U-Uf 4-d.b-!13 8*
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. 1/
d. Wor~ not ready for in~pec~ion when called. .3 Q -<, I D
e. Permit not posted on Job site. I ~
f. Plans not at job site. / I
g. Work not accessible. :;;_)... {- f(
The payment of inspection fees shall be made before any further permits wirn;; issued to the person owning
same.
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APPLICATION FOR PERNlT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
APPLICANT (J-ol.?! /<~'(/5 ~ t.--t~'ji /,(/YhV
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ADDRESS .:S ,frJ-:2? f;L;I.7V1(~0 /21
OWNER C-c f~J ;C::;/,<.1 -1k!-/~':j Ii //r~7..d~1
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JOB LOCATION :3 j>c;2? r-:;Let'7v7(t hV/ L27 . LOT SIZES:) X ftl AREA SQ. FT. 1/2 rf 0
LEGAL DESCRIP.TION: LOT (S) (!) l( L{ 0 BLOCKI11c.t!t..]SUBlnVIS ION J,r1;jAk</tl'7 ~f tv~N ~~
PARCEL 1. D, ,~ / 'I ;2 tv- ;L I 0/0 () () v{) 0 () (') <../ <EO -
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PHONE 7/":1.- Co ?7
WORK PROPOSED:~New Construction _Addition _Alteration ___Repair _Install
_Sign/Temp. _Sign _Move _Demolish
PROPOSED USE: -Lsingle Family _M/F _iF of Units ~M/H
_Commercial _Indust. ___Swim. Pool Other
_Restaurant & Health Department Approval
BUILDING SIZE:~X J/. I~ )!CR.-xl)", S~~D Square Feet, If,2,;JI:
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS, ,',*
**COPY OF CONTRACT REQUIRED.
97~R r Height
.
ENERGY FOR.~S. **
PERMITS REOUESTED
L-BUILDING
..LELECTRICAL
.LMECHANICAL
V__ PLUMBING
$ .3 ~~L7?"?/ /1..)
Valuation of Total Construction
10) --p
_ AMP Service
Y-. Florida Power Corp,
_'"R.E.C.
$ / ~,!f-i/. c7j/
Valuation of Mechanical Installation
GAS
ROOFING
vlFrame _Steel
SPECIALTY
/
h.4'
,
Other
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TYPE OF CONSTRUCTION:
_Block
FINISHED FLOOR ELEVATIONS: FT.
Signature
******************************
SECTION A ~.- /Ji t-f,r).
ompany F7C~ I7k
State Cert, or Regist. ,~ c,.,eCP.i'~t.rt:)
City License Registration # /iLJ
*****************************
ELECTRICIAN
Si!!nature Jict,XI-<.. Ilru'-'L
Company {I-. "
12-. _ / j~ ;1 f}/J /'l- State ~ert. or R~ is t. .4: e, S Oil 000 C?I
&gl CIU'<<J'c"RA:'Y~ City L1cense RegIstratIon l~
******************************************
fLU""'" ~
Signature .
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Company ,x: C "" ~ t (~ ev'"
State Cert. or Regist. #
City License Registration:ft /c::J. !,.-
******************************************
Pt~6,",/
MECHANICAl Company (/ c( It../
. (), . _ d. j ;1/JL,fj~ S~ate ~ert. or R~gi~i.'
SIgnature ~tp:Hn./~ i3~LU~ /7 OU.<~I2,. ....... Cl.ty L1cense RegIstratlon ':
*****.*************************************
C/fC 03 '17 s-S-
OTHER
Signature
Company
State Cert. or Regist. #
City License Registration #
******************************************
APPLICATION APPROVED BY
PERMIT OFFICER.
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r"'!".i1" 0' -- T 0['19 C~- PEHI,ol I T (',FF I Dr:; 'v I T
A. NOTICE OF D~~U k~bIRl~llUN8
The undersigned understands that this permit ~ay be subject to "deed restrictions' Hhich ~~y be roore restrictive than C:_ -
regulations. The undersigned assumes responsibility for compliance with any applicable de!d restrictio.s,
B. UNL I CENSED CONTRACTORS e,ND CQ/'oITRACTQR ,..f:Em~:.iJl'.:!S..L[~li~..LU E;,;::;
If the owner has hired a contractClr ot cClntractors to undertake "Clrk, they Illay be required tel b~- i-i-censed in accordance with
state and local regulations. If the contractor is not Ii .ensed as required by law, both the Clwner and contractor may be
cited for a misdeleanor violatjCln under state law. If the owner or intended contractor are uncertain as to what licensino
requirelents lay apply for the intended work, they are advised to contact the City Clf Zephyrhills Building Depart~ent, (813)
788-6611.
Furthermore, if the owner has hired a contractor or contr..ctors, he 1S advised to have the contractor(s) sign portions of the
'Contractor SectiClns" of this application for which they ~ill be responsible. If you, as the {.wner 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 may be an indication that he is not properly licensed and is not entitled to per~itting privileges in the
City of Zephyrhills.
C. TRANSF'ORT A T I ON Il'1PACT FEES AND UT I L I TY CONI\IECT I OJ:::!.. FEEfi.
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 - HOf.e~wner's Protection
Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. if the applicant is ~o~eoneother than the
"owner', I certify that I have obtained a copy of the above described docuroent and promise in good faith to deliver it to the
"owner' prior to cO~IDencement,
E. CONTRACTOR'S/DWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will be done in compliance with all
applicable lalls regulating construction, loning, and land Jevelopment.
Application is hereby made to obtain a perlit to do work and installation as indicated, I certify that no work Dr
installation has commenced prior to issuance of a permit and that all work will be perfor~ed to ~eet standards of all laws
regulating construction, City codes, loning regulations, ~nd land development regulatiuns in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to the intended work, and that it is
IY responsibility to identify what actions I must take to be in cocpliance. Such agencies include but are not limited to:
f Deoarttent of Environmental ReQulation - Cypress Bayheac;, Wetland Areas and Environ~ental]y Sensitive Lands,
Water/Wastewater Treatment
f Southwest FIClridi Water Manaoement District - Wells, Cyp~es5 Bayheads, Wetland Areas, Altering Waterco~rses
f Aray Corps of Enoineers - Seawalls, Docks, Navigable Wat~rways
f Deoartment of Health ~ Rehabilitative Services. Environmental Health Unit - Wells, Wastewater Treat~ent, Septic Tanks
f US Environlental Protection AQencv - Asbestos abatement
I also certify that, if fill laterial is to be used in FloLJ Lone "A' or "A,etc,', it is understood that a drainage plan
addressing a 'compensating voIJ!e" will be submitted 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 procred with the Hork and not as authority to violate, cancel alter, Dr
set aside any provisions of the technical codes, nor shall issuance of a per~it prevent the 8uilding Official frolli thereafter
requiring a correction of errors in plans, construction, Dr violations of any code, Every per~it .issued shall becote invalid
unless the work authorized by such permit is com~enced Hithin six months of issuance~ or if ~ork authorized by the permit is
suspended or abandoned for a period of six Donths after the time the work is cOffiffienced. One '90 day e~ten5ion of ti~e! lay be
allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the 8uilding Official. An
approved inspection must be logged during each six month period, Dr the project will be considered abandoned.
HARNING TO OHNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR . OR BE ORE - 0 ~OTICE OF
COMMENCEMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND p' A 'NOTI" OF
,NATURE: CONTRACTOR ~~"tl
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STATE OF FLORI!)~ .
COUNTY OF !!_ll..5 t?-O
The foregoing instrument was acknowledqed
before me th is fill Ii-, /'1 , 193..3. by -
The forege.ing inst;-ument 1'125 ackn:'I'Jledged
befctj-e me this "I--f'1f!11-. 1<1 , 19 43 bv
STATE OF FLORIDA
COUNTY OF jJ II ,.S (! 0
.
7< A y A '7?ILbl,~ ~- .-, o'
vJho i ~Ee)C5c<nal ~)l.:nOI.m tOI~.V[tj- loihc. has
pl-oduced .- -
as identification and who did/did not
take ~oath. . ~.. -1f). _
~fL-<'. l, ~4/-v( hr..__
(Signatu,-e) t<A". _c7:S,u...:J: 13 Rt'vJ AI
vER IZY' P !-1I1A/1:S
I"ho is.....~personcSry_t~Tio\'m who has
pl-oducea--- -
as identification and who did/did not
take an o:;,~ - I~ 1
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(SignatLll-e') '/(lH1f~EI{ J: 'J3RtI~JJ
(Name Typed, Printed or Stamped)
NOTAF:Y PUBL I C
(Name Typed, Printed or Stamped)
UQT AR'(J...1~f3L L~
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KATHL&EN J. BRI)WN
Slate of Flori,]:!
.., Comm. ExD. April 2, 1995
Comm.' ec 095617
~
KATHLEEN J. BROWN
State of F! 'J r r]a
Mreomm. Exp. April 2,1995
eomm. , CC 095617
38545 F'aim Grove Drive
Zephyrnills. Florida 33540
ACE
ALUMINUM
Job No.
Phone: (813) 782-2616
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SOLD TO CIJ 1. IJ I( h t<r /11/ J.I cS 1ft-It' ~
ADDRESS 7 tltJ.J8 ,,(1/Jvl)),t}..1 1,lJ/t.,. ,
SHIPTO.jYj}-YNIJLiJ NJAJOs Pljfl P/fRK . z.rplt'iell/;i-f
DATE _u._ i - .J.f'"- '.- . --
PHONE .u 7RJ-~'/)f 7 _
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PERMIT
PRICE
TAX
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The undersigned i1grees to pay TOTAL PRICE
INST AllE!RS IN f LJll ON CaMP N DEPOSIT
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BALANCE CO.D.
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Customers Slpture
PARCEL I.D, #
CITY OF UPHYRHULS BUILDING D9PARTMENT
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JOB LOCA'1'T.ON
SHOW ALL EXISTING & PROPOSED STRUCTURES GIVING DIMENSIONS & SETBACKS.
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UTILITY BUILDINQS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
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(NOTE EX~PLES 1 & 2)
STREET
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1. SETB~CKS FOR R1, R2 ZONING
60'___
2.
SETBACKS FOR R3 ZONING
60'
10'
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10' EXISTING 10'
PROPOSED
20'SGL FAM 30 ' DUPLEX
10'
10'
P E
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20'
)lRONT PROPERTY L.tNE
FRONT PROPERTY LINE
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