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Job Address: ~__ _ ~ _~_, TI.F s.
Parcell.D. # / tJ -~6 --r2/- t) () &0 LJ (9/00 - C) CJ C7'V
BUILDING PERMIT
Permit N'~
CiTY OF ZEPHYRHILLS
(813) 788-6611
_418~
1- JL>!~ 'if
Date
Zoning:
._~/
NO OCCUPANCY BEFORE C.O,
FINAl~ -Il-l( 4-
DATE
Complete Plans, Specifications and Fee Must Accompany Application. e.o.
All work shall be performed in accordar<:,e with City Codes and Ordinances.
DATE
Valuation o~ 'f ~ ~ ()'~
Contract Price 0
Permit Fee
Signature v1),
Company
Address
Telephone#
City License Registration # 77 () ~
State Certified License#
PLU
L
Ftr. ,
P~e SLBTl~V ..f--
Lintel ,-<1
FRM. 1%
Insul. CL llY
WL
Breakers
Ducts Insl.
Compressor
Final
Tp. Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
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.
~"";'~. . If. - . .
APPLICATION FOR PERKIT
CITY OF ZEPIIYRIIII..Ui
BUILDING DEPAR.'IIIENT
OWNER' S RAKE
V:~G/~ If'
OWNER. · S ADDRESS
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IlLR.lfJr7l ~ l)"cJl p
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L./hlI~ ~C-cAr; €.
CIhfi) (.)1 ell-
mONE
7
JOB ADDRESS
LEGAL DESCRIPl'IOII: WT(S)
B~SUBDIVISION
PARCEL I. D.'
/0 .2(;;, ~/ (J1JOO tJ{)/ QD ~o D
~ew Construc~ion _Addition _Alteration _Repair _Install
WORK PROPOSED:
_Sign
_Move
_D~lish
PROPOSED USE:
~Sing1e Faaily
_"IF
_, of Units
_M/H
_ec-ercial
_Indust.
_S1Ift.. Pool
Other
BUILDING SIZE:
_Restaurant 6: Health Departaent Approval
( X "0, "5 ~4 IJDjf Square Feet,
Height
RESIDEIITIAL :
COftMERCIAL :
ATI'ACII (2) PLOT PLUS 6: (2) SETS OF BUILDING PLAIIS 6: (1) SET ENERGY FORMS.
ATI'ACII (3) SElS OF BUILDING PLAliS 6: (1) SET ENERGY FORMS.
PROPERTY SURVEY KIlQUIRED FOR ALL IlIILV WNSTROCI'ION.
_BUlLDIRG
$
Ie; tJ1) ~ oV
PERMITS REOUESTED
Valuation of Tot:a1 Construction
_ELECJ'RICAL
AtIP Service
Florida Power Corp.
W.R.E.C.
_HECllMUCAL
$
Valuation of t1echanical Inst:allation
_PLUKBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSmUCI'I.OR: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
*.*************.*****.***************.****
CONTRAcrOR SEct'ION
BUILDER.___~~~ GOtIPAIIY [;;;A./S~ /I-{,.JJf/~cJtf
/ :~2~'-:-:d~d Stat.e Cert:. or Regist. ,
Signatur~ ~~~~. _, City License Registration ,
.***.*..*.*********.*.****....**..****...*
77
,
F.:1_RCI1UCIAR COHPAIiY
State Cert:. or Regist.. ,
Si-t.ure Cit.y License Regist.ration ,
*****.*******************.*****.**********
PLUKBER COtIPARY
Stat.e Cert.. or Regist. ,
Signat.ure City License Registration t
..*******.********************.******.....
t1ECHAffiCAL COHPAIIY
State Cert.. or Regist.. ,
Signat.ure Cit.y License Registration ,
*.....*...**.*.***......*.....*........**.
OTHRR COHPABY
Stat.e Cert:. or Regist. .
Signat.ure City License Registrat.ion .
*.*..*..*.*.***.*.**.**..**....**.****.**.
APPLICATION APPROVED BY PERKlT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
!be undersigned uDC1erstands that this pmit iii' be subject to 'deed restrictiOll8' ,hich iii, be lOre restrictive thin Cit,
. reguJations. !be undersigned asSUle& respcmsibIlitr for cmpliance ,ith anr applicable deed restrIctlOll8.
B. UNLICSNSED'CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OlDer has hired a contractor or contractors to undertake work, ther IiIr be reguired to be licensed in accorclance ,ith
state and local regulatiOQl. If the contractor is not licensed as required br law, both the owner and contractor iii' be
cited for a aisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat lic_iDg
reguireaenta .y apply for tile Intended work, they are advIsed to contact the City of Zepbyrbills BulldiDg Departaent, (813)
788-6611.
PurthellOre, if the owner bas hired a contractor or contractors, he is advised to bave tile contractor(s) sign portions of the
'Contractor SectiOll8' of thIs applicatloo for which they will be responsible. If JOU, as tile owner sIgn as the contractor,
you are indicating that JOU, rather than tile, contractor, are responsible for the IOrt. If the contractor wishes JOU to sign
as contractor that .y be an indication that be Is not properly lic_ed and is not entitled to peraltting privileges in the
City of Zephyrbllls.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMBHDED)
I certifr that I, the applicant, bave been provided with a COllf of 'Plorida's COnstructlon Lien Law - JIoMoImer's Protection
Guide' prepared br tile Plorida DepartMnt of Agriculture and ConsUller Iffairs. If the applicant i8 8CJMODe other than the
'OWDer', I certify that I bave obtained a copy of the above described c10cuIIent and proUse in good faith to deliver it to tile
'OWDer' prior to ~ceaent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infortation in this application is accurate and that alllOrt ,ill be done in COIpliance ,ith all
applicable laws regulating construction, Joning, and land develolJl8Dt.
Ipplication is berebr aade to obtain a perait to do IOrt and installation as indicated. I certify that DO IOrt or
installation baa CDlencec1 prior to issuance of a penit and that all IOrt ,ill be perfomec1 to _t staDdard8 of all 1_
regulating construction, City codes, zoning regulations, and land developaent regulations in the jurisdictiCll. I also
certify that I under8tand that the regulations of other gOYeIDllental agencies lilY apply to the intendec1lOrk, and that it is
If responsibility to identify wbat actions I lUst take to be in COIPliance. Such agencies include but are DOt lulted to:
. Departlent of InvirODleDtal Regulation - CJPress Barbeada, lIetland Areas and InvirODleDtallr Sensitive LaIIds,
lIater/llaatewater !reataent
· Southwest Florida later Ilanagel8llt District - lIells, CJPress Baybeads, lIetland Areas, Iltering WatercoUrses
. Alii Corps of Bnqineers - Seawalls, Docks, lavigable lIatenays
. Departaent of Health' Rehabilitative Senices, Bnvironaental Health Unit - Veils, Vastewater !reataent, Septic !ants
t US Bnvironaental ProtecUII1 Agency - Asbestos abattleJlt
I also certif, that, if fill IIterial is to be used in Flood Zone 'A' or 'I,etc.', it is understood that a drainage plan
addressing a 'coapensatlng volue' wUl be soblitted wbich is prepared br a professional engineer registered in the State of
Florida prior to perlIt i88uance.
I pmit i88ued shall be construed to be a license to proceed with the work and not as authoritr to violate, cancel alter, or
set aside any provisions of the technical codes, nor sball issuance of a perlit prevent the Building Official frol thereafter
requiring a correction of errors in plans, COll8truCtioo, or violations of any code. Ivery peralt issued Bball becme iDvalid
unless the IOrk authorized br such penit is coaIllIlcec1 within slllODtbs of i88uance, or if work authoriled by tile perlit is
suspended or abandoned for a period of sllaontbs after the tiIIe the IOrk is co.encec1. One 90 day 81tensioo of tille, lilY be
allowed for the peralt ,ith fee charge of $15.00. !be 81tension shall be requested in writing to the Building Official. In
approved inspection aust be logged during each 8il aonth period, or the project will be considered abandoned.
IIARlIIIG !O CIDR: YOOR FAILORI !O BOORD I IOIICK or COlIIDCIIIIIIIAY RISUL! II YOUR PAYIIG !IIICK POI IIIPROVIIIDI8 !O YOOJl
PROPIR!Y. IF YOO IIfIID 'fO OBIIII PIIIIIICIIG, COI8UL! IIIIB YOOR LIIDII OR IllnoRDY BBPORB RICORDIIG YOUI .OIlCK OF
OIOIIICIMD!. JOBS URDU '2,500 III VILUlIlO 101_ !O RICORD UD POSf I 'IOIICK OF aJIIIDCIIIDl'l.
c~ ;;~<'--2~
SIGII!URB: CMIIR OR IGIII! SIGIA!URIl: COIIIRAC!OII
SIIII OF FLORIDA b?A'.c
coum OF r tv co
The foregoing instrument was acknowledged
before Jle this ~ ~L.y', 19.1$f by
f
SIIIB OP FLORIDA ~
COOllY OF /' A c.z;
Tbe foregoing inst~t was acknowledged
before me this c:2' U()L. ( , 19~ by
wbo is personally known to .e or wbo bas
produced
8S identification and wbo did/did not
take an oath. ~ K~
(Signature) Notary Public aiCO Co, F
~9A EXI~ M:ldl) )QQ~
(Rame. Typed, n or up )
ROTARY PUBLIC
wbo is personally known to ~ or wbo bas
produced
as identificationO?', w did/did not
take an oath
/
(Signature) Notary Public PaiCo Co, FL
(Rue Typ~ EaP'i~99S
ROTARY PUBLIC
~~
~~~
PROPOSAL SUBMITTED TO
\\ , "
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STREE
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CITY, STATE AND ZIP CODE
.~~-~. \>:,l:'A '-,
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ARCHITECT
We hereby submit specifications and estimates for:
\
'"
~:):'~"
~rnpn!ial
Page No.
of
Zr.J:)~' ''I' ~HiL~~) FL 33 4-,-
S" fU"-.~,' S, T, "l\,".'F, ~u'j MIN' IU ~M'"
_ ," __ ~ "'" L lJ, . c.. . .~,J 1 '" !; t . lj. ~";' 0;
3:'''-'23 ::;:R ';4 Wes'
'813; 78S-nOS
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 fJre, tornado and other necessary insurance.
Our workers are fully covered by Workmen's Compensation Insurance.
PHONE, ,
:-::, C2,\{>, ~\~~ ',~ ^o'l<.:-
JOB NAME
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JOB LOCATION
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_"r 'rOpOlIr hereby to furnish material and labor - complete in accordance with above specifications. for the sum
_:~~.- ~;;;. dollars ($ \J,'\JO') , :':.:::"---
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Atttpluutt nf 'rnpnllul- 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:
Authorized
Signature
"'
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~
Note: This proposal may be
withdrawn by us if not accepted within
7,,::~jJIr~&~-
..,;;..-=.----.-
Signature
PRODUCT 118.3 (NCBs/elnc.. Groton, Mass. 01471. To Order PHONE TOLL FREE 1 + 800-225-6380
Signature
Pages
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of:
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days.
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db I HJ (J7Ht)
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PIRMIT ,-
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LEGAL DESCRIPTION:
( RESIDENTIAL
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, SECtiON TOWNSH I P
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: S 11I0 H/I S ION DR OTHER LOCATION ~. fRfPTION: _
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FRONT. (
FT. )
Show all ~x1sting and proposed structures giving dimensions and setbacks. Also, indicate
any a~jacent bOdies of water and roadways adjacent to the proper~.' Indicate size of w
mobile homes such as: 12' x 60'.24' X 361.
EXAMPLES
HOUSE CONSTRUCTION
P~9t~ED . AD~IT1.o.N
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