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BUIL~!~9HY~L~RM!,! m4182$
(813) 788.6611 Date 7'- c2 ~ -9'1
ME~-
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Parcell.D. #
Zoning:
Energy Code:
/>1 1)( /9 I
Description of Work
FINAL
'};2..1-9
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordarr:-e with City Codes and Ordinances.
c.o,
DATE
Valuation or
Contract Price
Inspector
/, /1S' ~
City License Registration # '11 /l,(.V "'"
State Certified License#
,
~~Wv~
GUI!:DIN;) ~L~L
D
Telephone#
PLU~/'
----
~.-
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 Ins!.
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.
:.
&dudul.' -VYltf~4JL ,'f~t5 ern 8
APPLICATION FOR PERMIT /~ j I / ~-;-.!.. ~- _ a p; '~f rD
CITY OF ZEPHYRHILLS ".~ -b(1..U-~ -= d I I 10'-' ~
BUILDING DEPARTMENT f(}Jr ,,/
OWNER'S NAME
/'
Xu, 0 T7'ESc4!
<~ CZ 7 ~s- /fl- ~
~ j/6/flC-tff([ s
PHONE
711.2. 1(; yrs-
,7yf -- 7-StJ~
OWNER'S ADDRESS
11-1/ E.-
FL
JOB ADDRESS
LEGAL DESCRIPTION:
~tJ"""""
:~~!~
WORK PROPOSED:
BLOCK
SUBDIVISION
I - GO
?c!>
_Addition ____Alteration ____Repair ____Install
_Sign
Move
_Demolish
PROPOSED USE: l/'Single Family
_M/F _' of Units
~/H
Commercial
Indust. Swim. Pool
Other
_Restaurant & Health Department Approval
BUILDING SIZE: JC6 X !7f ,
(' A:e ?ot!--r-
Square Feet,
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.**
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. **
**COPY OF CONTRACT REQUIRED.
PERMITS REQUESTED
_BUILDING
ELECTRICAL
$
Valuation of Total Construction
AMP Service
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.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BUILDER
CONTRACTOR SECTION
COMPANY c5'd~S'~
4:? //~ State Cert. or egist.'
'. K ~ Ci ty License Registration #
****************************************
/i(,~ r/ tiff 'f/d'1'
77
(
Signature
ELECTRICIAN COMPANY
State Cert. or Regist. .
Signature City License Registration #
******************************************
PLUMBER COMPANY
State Cert. or Regist. #
Signature City License Registration #
****************************************** -----
MECHANICAL COMPANY
State Cert. or Regist. #
Signature City License Registration #
******************************************
OTHER COMPANY
State Cert. or Regist. #
Signature City License Registration #
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT ;
A. NOTICE OF DEED RESTRICTIONS
, !be undersignec1 understands that this penit JaY be subject to .deed restrictions. wbieb lilY be lOre restr.ictive than City
regulations. !be undersigned assUJeS responsibility for co.pliance with any applicable deec1 restrictiODS. .
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas bired a contractor or contractors to undertake work, they laY be required to be licensed in accordance with
state and local regulatiODS, If the contractor is not licensed as required by law, both the owner and contractor laY be
citec1 for a lisdl!leallor violation under state law, If the owner or intendec1 contractor are uncertain as to wbat licensing
requirelellts lily apply for the intended work, they are advised to contact the City of Zepbyrhills Building Departlent, (813)
788-6611,
Furthenore, if the owner bas bired a contractor or contractors, he is advised to bave the contractor(s) sign portiODS of the
.Contractor Sections. of this application for wbieb 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 wisbes you to sign
as contractor that lilY be an indication that be is not properly licensed and is not entitled to penitting privileges in the
City of Zepbyrbills,
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, bave been provided with a copy of .Florida's construction Lien Law - BaIeowner's Protection
Guide. prepared by the Florida Departlent of Agriculture and COnsUler Affairs, If the applicant is SOIeODe other than the
.owner", I certify that I bave obtained a copy of the above described docuIent and prlllise in good faith to deliver it to the
"owner" prior to COllenCl!lellt,
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, loning, and land developl8llt,
Application is bereby Iilde to obtain a perlit to do worl and installation as indicated. I certify that no work or
installation has ClIIIenced prior to issuance of a perlit and that all work will be perfoIled to .et standards of all laws
regulating construction, City codes, loning regulations, and land develDpElt regulatiODS in the jurisdiction. I also
certify that I understand that the regulations of other QOVerJlleDtal agencies lily apply to the intended work, and that it is
If responsibility to identify wbat actions I lUst take to be in COIpliance. Sueb agencies include but are not lialted to:
t Departlent of BnviIOllllelltal Requlation - Cypress Baybeads, Wetland Areas and InvirOllleDtally Sensitive Lands,
Water /Wastewater !reatlent
t Southwest Florida Water HanageleDt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Ifavigable Waterways
t Departlent of Health & Rehabilitative Services, BnvirODlelltal Health Unit - Wells, Wastewater !reatlent, Septic !ants
t US Invil'ODllental Protection Agency - Asbestos abat8lent
I also certify that, if fill aaterial is to be used in Flood Zone "A. or "A,etc,", it is understood that a drainage plan
addressing a .COIpeDSating vol." will be suhlitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance,
A peIlit issued sball be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
set aside any provisiODS of the technical codes, nor sball issuance of a perlit prevent the Building Official fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code, Ivery perlit issued &ball becme invalid
unless the work authoriled by sueb perlit is COII8Ilced within sil IODtbs of issuance, or if work authoriled by the perlit is
suspendec1 or abandoned for a period of sillODtbs after the u.e the work is COII8Ilced, One 90 day utension of tile, lily be
allowed for the perlit with fee charge of $15,00, !be eatension sball be requested in writing to the Building Official. An
approved inspection lUSt be logged during eaeb sil IODth period, or the project will be considered abandonec1,
IfAlUfllfG !O lJIIIR: YOUR FAILURE !O RECORD A 1f00ICB OF C<JIIIICIIIIH MAY RESUL! IN YOUR PAYING RICB FOR IHPROVIIIBITS !O YOUR
PROPIR'fY, IF YOU InBIID !O OBfAIIf FIIIDCIIIG, COIISOL! wlm YOUR LlllDBR OR All AnoRDY BEFORE RECORDllfG YOUR 1I001ICB OF
COMHIIfCBMBIft', JOBS UlfDBR '2,500 IN VALOI 00 If 0'1 DID !O RICORD AHD POS! A IlIfO'1ICB OF CIJlllIfCIMIIf!.,
SIGJfA!UIIll: IMlER OR AGm
SIGlfA!UIIll: COIf1'RAC'fOR
SfA!1 OF FLORIDA
COUIf'fY OF
The foregoing instrument was acknowledged
before me this , 19____ by
S!AR OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19_____ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
5
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Show all ixisting and proposed structures giving dimensions and setbacks. Also. indicate
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mobile homes such as: 12' x 60'.24' X 361.
HOUSE CONSTRUCTION
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Page No,
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?7528 SR 54 West
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:813) 788,,73013
PROPOSAL SUBMITTED Tg/
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ARCHITECT
We hereby submit specifications and estimates for:
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Dr 'rnpnnr hereby to furnish material and labor - complete in accordance with above specifications. for the
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Payment to be made as follows:
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All material is guaranteed to be as specified. All work to be completed in a workmanlike
manner according to standard practices. Any alteration or deviation from above specifica-
tions involving extra costs will be executed only upon written orders, and will become an
extra charge over and above the estimate. All agreements contingent upon strikes, accidents
or delays beyond our control. Owner to carry fire, tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance.
AtttptuUtt nf 'rnpnliul- The above prices, specifications
and conditions are satisfactory and are hereby accepted, You are authorized
to do the work as specified. Payment will be made as outlined above,
Date of Acceptance:
PRODUCT 118 3 i0Cc~elnc.. Groton, Mass. Ol47! To Order PHONE TOLL FREE 1+800-225-6380
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