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Home My WebLink About94-4240 BUILDING PERMIT Permit N.~ Property Owner: Job Address: Parcell.D. # ,.- CaTV OF ZEPHYRHILLS (813) 788-6611 - -- ~~...._.,.._~ ~~~~B~ - ,4240,6' f1-~2.-9Y ,.... jJf!-.'---~ ~ ,fJ ~1 '\.~ " (~ Cu [LECTRlcffi Date - Sewer Conn !It) t) - Water Conn: ~'I)O - Water lYIJ'!jer: / ~ T.I.F.'s: 9 f.2. lJV J}j 9~o-9'f , Zoning: Description NO OCCUPANCY BEFORE C.O. FINAL ,(1--.:2 - q . DATE C.O. -1"1~ J() -c;y DATE Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordart::'e with City Codes and Ordinances. I?e //cQ'77 L3 Valuation or Contract Price AJ/J . Permit Fee Signature Company Address City License Registration # Sta Certified License# MECHANICA-7 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 Final9'-31*Q4 e,olr- ~~5J uJ/f ~~ 1U !J g,,;2:J' 7( pel ;?-dCJ -7Y Driveway ~- ~ "t- ~\ - ~'* 6&0.. REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade: a. Wrong Address b. Condemned work resulting from faulty construction. c. Repairs or corrections not made when inspection called. d. Work not ready for inspection when called, e. Permit not posted on job site. f. Plans not at job site. g. Work not accessible. The payment of inspection fees shall be made before any further permits will be issued to the person owning same. APPLICATION FOR PERKIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT OWNER'S _ fh, I 'f C OWNER'S ADDRESS '3~()3tf LAu.~D/J. ioo~ / JOB ADDRESS 38'03L.f LI'1~Ad//?/9 LOG;:? , , LEGAL DESCRIPTION: LOT(S) I'l.( BLOCKvAb SUBDIVISION ('() / t;O PARCEL LD.' (J) <900.0 (!) L$O (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPOSED:-0'ew Construction ~ddition ----Alteration --Repair _Install S~llh PHONE 77~?'6'O~/ _Sign ---1Iove _DeIIOlish PROPOSED USE: _Single Fmlily / _H/F _' of Units ~/H _~ercial _Indust. _Swia. Pool _Other --Restaurant & Health Departaent Approval X:#si~/IA-r!(l>~ O-r ~b:h !t$f'5' BUILDING SIZE: )8' X hC) . Square Feet.!{jO Height DESCRIPTION OF WORK: RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS. COttHERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ~LDING PERMITS REOUESTED $ 1 35'C;) yO C? Valuation of Total Construction _ELECTRICAL AMP Service Florida Power Corp. W.R.E.C. ---1fECIlANICAL $ Valuation of Mechanical Installation _PLUHBING GAS ROOFING SPECIALTY TYPE OF CONSTRUCTION: _Block _Fraae _Steel Other FINISHED FLOOR ELEVATIONS: FT. IS PROJECT IN FLOOD ZONE AREA? YES NO .......................................... PLUMBER CONTRACTOR SECTION ClIIIPAIlY cS; JA/R{ fp hkUSIA.JJ State Cert.or Regist. , City License Registration , ................................. -Lvc. ,. BUILDER 'jt C Signature , . ~ /L./P)Y) ....... ELECTRICIAN Signature '0 MECHANICAL COMPANY State Cert. or Regist. , City License Registration , ..................*.*........*..*. Signature COMPANY State Cert. or Regis . City License Regist at ................................. ~~, OTRRR COMPANY State Cert. or Regist. , Signature City License Registration , .......................................... APPLICATION APPROVED BY PERMIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this peIlit lay be subject to 'deed restrictions" which laY be lOre restrictive than City regulations. Ihe undersigned assUles responsibility for cOlpliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake work, they lay be required to be licwed in accordance with state and local regulations. If tbe contractor is not licensed as required by law, both the owner and contractor laY be cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing requirelents laY apply for the intended work, they are advised to contact tbe City of Zephyrbills Building Departlent, (813) 788-6611. FurtherlOre, if the OIner bas hired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the 'Contractor Sections' of this application for wbicb 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 tbe contractor wisbes you to sign as contractor that laY be an indication that be is not properly licwed 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, bave been provided with a copy of 'Florida's Construction Lien Law - HOIeOWDer's Protection Guide" prepared by the Florida Departlent of Agriculture and CODSuter Affairs. If the applicant is sOleORe otber than the "owner", I certify that I bave obtained a copy of the above described docUlent and prOllise in good faith to deliver it to the "ownern prior to cOlllellcelent. 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 cOlpliance with all applicable laws regulating construction, loning, and land developleDt. Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or installation has COlllellCed prior to issuance of a perlit and that all work will be perf OIled to leet standards of all laws regulating construction, City codes, loning regulations, and land developtent regulations in the jurisdiction. I also certify that I understand that the regulations of other goveIDIental agencies laY apply to the intended work, and that it is IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not luited to: * Departlent of EnviroRleRtal Regulation - Cypress Baybeads, Vetland Areas and EnviroDlentally Sensitive Lands, Vater/Wastewater Treatlent * Soutbwest Florida Water Hanagelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses * ArlY Corps of Engineers - Seawalls, Docks, Ravigable Waterways * Departlent of Health' Rebabilitative Services, EnvirORleDtal Health Unit - Wells, Wastewater Ireatlent, Septic lanks * US EnviroDlental Protection Agency - Asbestos abatelent I also certify that, if fill laterial is to be used in Flood Zone "A" or 'A,etc.', it is understood that a drainage plan addressing a 'cOlpensating volute" will be subtitted 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 proceed with tbe work and not as authority to violate, cancel alter, or set aside any provisions of the technical codes, nor sball issuance of a perlit prevent the Building Official frOl tbereafter requiring a correction of errors in plans, construction, or violations of any code. Ivery peIlit issued shall beCOle invalid unless the work authoriled by such peIlit is co.mced within slllORtbs of issuance, or if work authoriled by the peIlit is suspended or abandoned for a period of slllOntbs after the tile the work is c~ced. One 90 day eJtension of tile, lay be allowed for the peIlit with fee charge of $15.00. Tbe extension sball be requested in writing to the Building Official. An approved inspection lust be logged during eacb sil IORtb period, or the project will be considered abandoned. WARNING TO OWNER: YOUR FAILURI TO RECORD A NOTICE OF COHMBIfCBllBNt MAY RESULT IN YOUR PAYIRG nUCE FOR IMPROVIlIIBNIS TO YOUR PROPERTY. IF YOU INtERD TO OBfAIR FIIWICIIfG, COIfSULT WITH YOUR LErmER OR AM AnoRJIEY BEFORE RECORDIRG YOUR NO'fICH OF COMHKIfCBHENT. JOBS UffDER $2,500 IR VALUE DO ROT RBlD TO RECORD AIfD POST A "ROTICE OF COHHBIlCBHBNI'. .~.. it' . '... SIGRATURE: OVIIIlR OR.:, ::~. -. SIGIIATURK: CONT~s ~ \ r"\ ') ". ."'.. - '\ .. STATK OF FLORIDA COUR'lY OF The foregoing instrument was acknowledged before me this , 19____ by STATE OF FLORIDA COUNIY OF The foregoing instrument was acknowledged before me this , 19_____ by , who is personally known ~o me or who has produced . \,... .. '~ as identificat~oD'~ wbo did~did not take an oath. " who is pers~all\'kno"\l. to me or who bas produced ~ n as identifi . \~d w,boMd/did not take an o~th. (Signature) (Name 1yped, Printed or Stamped) NOTARY PUBLIC (Signature) (Name Typed, Printed or Stamped) NOTARY PUBLIC APPLICATION FOR PERKIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT OWNER' S NAKE PHONE OWNER' S ADDRESS JOB ADDRESS :3 P () '3 'f d ~ ~~ LEGAL DESCRIPTION: LOT(S) ~r BLOCK .. DIVISION PARCEL 1. D.' (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPOSED:_New Construction _Addition ----.J.lteration _Repair _Install _Sign ~ove _DeIIOlish PROPOSED USE: _Single Faaily ~/F _' of Units _K/H _~ercial _Indust. _Swia. Pool _Other _Restaurant &: Health Departllent Approval DESCRIPTION OF WORK: BUILDING SIZE: x Square Feet. Height RESIDENTIAL: COMMERCIAL : ATTACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS. ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. PERKITS REOUESTED _BUILDING $ Valuation of Total Construction _ELECTRICAL AMP Service Florida Power Corp. W.R.E.C. --1IECIWIlCAL $ Valuation of Mechanical Installation _PLUMBING GAS ROOFING SPECIALTY TYPE OF COIiSTRUcnOR: _Block _Fraae _Steel Other FDiISHED FLOOR ELEVAnONS: Fl. IS PROJECT IN FLOOD ZONE AREA? YES NO ..................................******** CONTRACTOR SECTION RIITI.DER Signature COMPANY State Cert. or Regist. . City License Registration . .*..*..................................... ~ ~ COKPMlYvErrf:Jl1AIJ :s,~s'tE~ C State Cert. or Regist. . .. \ City License Registration . v"""" / '=> ( ....................*.*.............*..... Signature COMPANY Vr State Cert. or Regist. . City License Registration . ~ .......................................... PLlJKBER COMPANY f!JUI'}Q)NMiStJTI[-L- (Q~IV' . State Cert. or Regist. . Signature City License Registration' ~4f ........................... OTRIT.R COMPANY State Cert. or Regist. . Signature City License Registration . .......................................... APPLICATION APPROVED BY PERKIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A _ NOTICE OF DEED RESTRICTIONS 'l'be undersigned understands tbat this perlit laY be subject to Ideed restrictionsR wbieb lay be lOre restrictive than City regulations. !be undersigned assUIeB responsibility for coapliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the OIfIler bas bired a contractor or contractors to undertake 1fOrt, they laY be required to be licensed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the mmer and contractor laY be cited for a lisdeaeanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing requirl!leDts laY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813) 788-6611. FurtbeIlOre, if the OIner bas bired a contractor or contractors, be is advised to bave the contractor(s) sign portions of tbe RContractor Sections I of this application for wbieb they will be responsible. If you, as the OIfIler 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 laY be an indication that be is not properly licensed and is not entitled to perlitting 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 IFlorida's Construction Lien Law - HCIIl!OIIJler's Protection GuideR prepared by the Florida DepartJent of Agriculture and ConsUJer Affairs. If the applicant is sOleOne other than the aOlfDer", I certify that I have obtained a copy of the above described dOCUleDt and prtmse in good faith to deliver it to the Rownera prior to COlleDCl!leDt. 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 cDlpliance with all applicable laws regulating construction, Joning, and land developlent. Application is bereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or installation bas cOlleDced prior to issuance of a perlit and that all work will be perfoIJed to leet standards of all laws regulating construction, City codes, Joning regulations, and land developleRt regulations in the jurisdiction. I also certify that I understand that the regulations of other governJeDtal agenCies laY apply to the intended wort, and that it is Iy responsibility to identify wbat actions I lUSt take to be in CDlpliance. Sueb agencies include but are not lilited to: I Departlent of EnviroDleDtal Regulation - Cypress Baybeads, Wetland Areas and BnviroDleDtally Sensitive Lands, Water ,Wastewater 'I'reatJent I Southwest Florida Water HanageJent District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses t Arly Corps of Engineers - Seawalls, Docks, Havigable Waterways I Departlent of Health i Rebabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater 'I'reatlent, Septic 'l'anks I US BnvirODleDtal Protection Agency - Asbestos abateleDt I also certify that, if fill laterial is to be used in Flood ZOne "AI or "A,etc.l, it is understood that a drainage plan addressing a .cOJlpeD8ating vol.1 will be sublitted wbieb 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 proceed with the work and not as autbority 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, construction, or violations of any code. Bvery peIlit issued shall beCOle invalid unless the work autborized by sueb peIlit is COIIeDced within sixlOnths of issuance, or if work autborized by the perlit is suspended or abandoned for a period of six IODtbs after the tile the 1fOrk is c~ced. One 90 day extension of tile, lay be allowed for the perlit with fee ebarge of $15.00. 'I'be extension sball be requested in writing to the Building Official. An approved inspection lUst be logged during eaeb sillODth period, or the project will be considered abandoned. WARRING '1'0 omIl: YOUR FAILURE '1'0 RBCORD A HorlCE OF COtMDCBIIIR'I' MAY RlSUL'I' IH YOUR PAYING nICE FOR DIPROVIIIIIIS '1'0 YOUR PROPBR'I'Y. IF YOU IR'I'BMD '1'0 OB'l'AIH FIIWCIHG, COMSUL'I' WI'I'H YOUR LBMDER OR All AftOlIDY BBFORI RBCORDIRG YOUR JforlCB OF COMMBRCBMBR'I'. JOBS UNDER $2,500 1M VALUB 00 Nor HBED '1'0 RlCORD AND POS'I' A "NorICH OF C<IDlBRCBIIIR'I'A. SIGJIA'I'URE: OIOOlR OR AGBJI'I' SIGMA'I'URB: COR'I'RAC'I'OR srArE OF FLORIDA coum OF The foregoing instrument was acknowledged before me this , 19____ by S'I'A'I'E 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 CENTRAL FERMITTI~G OFFICES: PASCO COUNTY BUILDING PERMIT APPUCATION .. . .~~~~~~~~~~~~.i' .........,. ...... .........~g~~;t%ri~:................................................>~t9,~..............;~t >FIREpiSTflI9J: ...rEAMIT~: . . Dade City:. (904) 521-4206 410 E. Meridan Ave, Rm 234, Dade City . New Port Richey: (813) 847-8126 7432 UltIe Road, New Port Richey TYPE CONSTRUrlON' II iii Iv v vi . Land O'Lakes: (813) 996-2203 ( 9930 Land O'Lakes Blvd (US 41), Land O'Lakes DATE REC E B ' THIS APPLICATION MUST BE TYPED OR PRINTED IN INK I ~ AND IS VOID IF NOT PERMITTED WITHIN 6 MONTHS . . ------------------------------- ---------- 8 'OWNER'S NAME: I' PHONE # (8'1 J ) 7&3 - 6'" ~., 2t:NS~~::beiu~ ~_~~i~'~~~...%~lt~6:~.LO~t:.1ux~~ address (if applicable): CITY STATE ZIP ~ 8 -l 10 Z o 'IF MOBILE HOME OR RV: MAKE ~ Q. a: o lJ) w o . DESCnlPTION OF WORK: LIVING AREA: # BEDROOMS . '3 TOTAL UNDER ROOF: /650 o FRAME 0 OTHER: --------------------------------- 'Flee- tWOOIJ YEAR q'f SIZE;Lr )( 60 VALUATION: $ I...~ w~~ . WORK CODE:::::::~i~::~::::::~:f:~l~~i:~i:::j PLANS ON FILE? 0 NO 0 YES MODEL NAMESifouu;f~'-I'f --------------------------------- . BONDING COMPANY: ~ ADDRESS: CITY STATE ZIP 0 0 . ARCHITECT/ENGINEER: -l 10 a: ADDRESS: CITY STATE ZIP w ~ l- . MORTGAGE LENDER: 0 ADDRESS: CITY STATE ZIP ~ 9 10 a: o I- o < a: I- Z o o PHONE# (8'13 ) 7~~ .bC>'iJ7 STATE51 I ZIP J ~S'T.1 COMPUTER 10#: oCJ :;>'7Y/ . MECHANICAL CONTRACTO SIGNATURE: ADDRESS: STATE L1C # (if applicable): o NEW OALTERATION VALUATION: $ . PLUMBING CONTRACTOR: SIGNATURE: ADDRESS: STATE L1C # (if applicable): # FIXTURES: <OWN ~fl---- PHONE # ( CITY STATE PASCO CO COMPUTER 10#: - SEPTIC PER #: SEWER: WATER: PLUMBING FEE: $ ZIP WELL: . OTHER CONTRACTOR: SIGNATURE: ADDRESS: STATE L1C # (if applicable): TYPE CONTRACTOR: CIIY PHONE # ( STATE PASCO CO COMPUTER 10#: OTHER FEE TYPE: AMOUNT:S . ---------------------------------- JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT" TOTAL BUILDING PERMIT FEE: (permit form 10/91) EDITIONS OF THIS FORM RELEASED BEFORE 1/91 ARE OBSOLETE AND WILL NOT BE ACCEPTED BY CENTRAL PERMITTING STAFF . · .. NOTiCE.... BOTH THE OWNER AND CONTRAC.'TOR OF RECORD (License Holder) MUST READ AND SIGN THE REVE~SE SIDE OF THIS APPLICATION CONDITIONS OF PERMIT AFFIDAVIT A, NOTICE OF DFED RESTRICTIONS The undersigned understand that this permit may be subject to .deed restrictions. which may be more restrictive than County regulaJjons. The undersigned assumes responsibility for compliance with any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a oontractor or contractors to undertake work, they may be required to be licensed In accordance with state and local regula- tions. If the oontractor Is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor violation under state law. If the owner or intended contractor are uncertain as to what licensing requirements may apply for the lntendod work, they are advised to oontact the Paf,CO County Building Division - Ucenslng Section at (813) 847-8009. Furtllermore,lf the owner has hired a contractor or contractors, he Is advised to have the contractor(s) sign portions of the .Contractor Block. of this application tor which they will be responsible. If you, as the owner sign as the contractor, you are Indicating that you, rather than the contractor, are responsible tor the work. It the contractor wishes you to sign as contractor, that may be an Indication that he Is not properly licensed and Is not entitled to permitting privileges In Pasoo County, C. TRANSPORTATION IMPACTIUTILlTIES IMPACT AND RESOURCE RECOVERY FEES The undersigned understand that Transportation Impact Fees and Resource Recovery Fees may apply to the construction of new buildings, change of usa In existing buildings, or expansion 01 existing buildings, as specifiodln Pasco County Ordinance numbers 89-07 and 00-04, as amended. The undersigned also understand that such tees as may be due will be identified at the time of permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees mIst be paid prior to receiving a .certificate of occupancy. or final power release, If the project does not involve a cenificate of occupancy or final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact fees are due, they must be paJd prior to permit issuance, In accordance with applicable Pasco County Ordinances. D, CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended) If valuation of work is $2500.00 or more, I certify that I, the applicant, have been provided with a copy of .Florida Construction Lion Law _ Homeowner's Protection Guide. prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone other than the .owner: I certify that I have obtained a copy of the above described document and promise in good faith to deliver it to the .owner. prior to commencement. E. CONTRACTOR'S/OWNER'S AFFADAVIT I certify that all the information in this application is accurate and that all work will be done in compliance with all applicable laws regulating construc- lion, zoning, and land development. Application is hereby made to obtain a permit to do work and Installation as indicated. I certify that no work or Installation has commended prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, County codes, zoning regulations, and land development regulations In the jurisdiction. I also certify that I understand that the regulations of other government agencies may apply to the intended work, and that It Is my responsibility to identify what actions I must take to be In compliance. Such agencies Include but are not limited to: o Deoartment of Environmental Reoulation - Cypress Bayheads, Wetland Areas and Environmentally Sensitive Lands, WaterlWastewater Treatment o Southwest Florida Water ManaQemenl District. Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses o Armv Coms of Enainoors . Seawalls, Docks, Navigable Waterways o Deoartment of Health & Rehabilitative Services Environmental Health Unit. Wells, Wastewater Treatment, Septic Tanks o US Environmental Protecti01 AQency - Asbestos abatement I understand that the following restrictions apply to the use of fill: o Use of fill is not allowed in Flood Zone "V" unless expressly permitted. o If fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a .compensating volume" will be submitted at time of permitting which is prepared by a professional engineer licensed by the State of Florida. o If fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall construction, I certify that fill will be used only to fill the area within the stem wall. o If fill material is to be used in iWl/. area I certify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating the conditions of the building permit issued under the attached permit application. If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in this affidavit prior to commencing construction. ' I understand that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included in the application. A permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, aller, or set aside any provision of the technical codes, nor shall issuance of a permit prevent the Building Official trom thereafter requiring a oorrection of errors in plans, construction, or violations of any code. Every permit issued shalt become invalid unless the work authorized by such permit is commenced within six months of permit issuance, or if work authorized by the permit Is suspended or abandoned for a period of six months after the time the work is oommenced. One or more extensions ot time, tor periods not to exceed 00 days each, may be allowed for the permit. The extension shall be requested in writing to the Building Official. An approved inspection must be logged during each six-month period, or the project will be considered abandoned. WARNING TO OWNER: 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, C UL T WITH YOUR LENDER OR A A NEY FORE RECORDING YOUR NOTICE OF CO C E SIGNATURE SIGNA TUR DATE DATE ?~ /;1</ MY COMMIS EXPIRES JUDI r.tU.ER MY CXIotMISSlON , CC 875f11J2 EXPft8: MIl' ~ 11198 ' MY COM EXPIRES JUDI MIlLER MY COMMISSION , CC 875fIIJ2 EXPftS: MIy 22. 19118 NOTARY AS TO CONTRACTOR LIMITED POWER OF ATTORNEY KNOW All MEN BY THESE PRESENTS, that I have made, constituted and appointed, and by these presents do make, constitute and appoint STEPHEN CROSS, of Tampa, Florida, my true and lawful attorney-in-fact, for me and in my name, place and stead and on my behalf, to do and perform for the me following: 1. Obtain any and all permits on my behalf necessary for the installation of a mobile home including but not limited to: set up, plumbing, electrical, mechanical, septic and any and all other permits required.. 2. Authorize and hire any and all persons necessary to complete the set up of a mobile home including but not limited to: set up, septic installation, plumbing installation, electrical installation, alc installation and any and all other items required. 3. Act on by behalf as an owner for the performance of any and all of the items referenced above. I hereby ratify and confirm that the said STEPHEN CROSS as my attorney-in-fact, shall lawfully do or cause to be done by virtue hereof, it being my intent and purpose to confer upon my said attorney-in-fact the broadest possible powers to be used and exercised in the discretion of my attorney-in-fact for my use and benefit. , -. .._.. 'IN WITNESS WHEREOF, I have executed the foregoing power of Attorney this A4 c~S?f/ Signed: . ACKNOWLEDGMENT STATE OF FLORIDA ss. COUNTY OF PASCO Before me personally appeared A, J4P Sm J f J....... , who has identified himself with a Florida Drivers License, who acknowledged to and before me that he executed the above instrument for the purpose therein expressed, and who did not take an oath. WITNESS my hand and official seal this'1J1..- day of fVJlt ~~\~ PAUL 80lDSTEIN f.W: i.f MY COMMISSION ,CC ~. < EXfIlIRES: ~ 'Z1, 1 '.P.f~l~' IIondId ThnI NolIry NlIIc . A.D., 1994. ,/> SITE P.l...h.~ (RESIDENTIAL USE ONLY) PARCEL LD. I "I SEC ;;1.6 'fWP ~I RNG () 160 - SUED 00000 BLOCK 01:;( LOT PROPERTY MEASUREMENT CURRENT OWNERS 7 G. ..>-- x 9/, &'6 DATE ?i(0j{ All drawings shall be drawn to Beale for all parcels or lots five acres or less. ~ '~I ~ --"1 , ~ (1). ~. 0\ ~ , ~ ~. ~ "C ~ l~.~ .... ~ ~ \.t" i 30. I- .76.6-' r' ... VI '"\ , /., )-cJ r' L AWA,II/ () I't ide:; f SHOW ALL EXISTING AND PROPOSED STRUCTURES GIVING DIMENSIONS AND SETBACKS. ALSO, INDICATE M"Y BODIES OF WATER AND ROADWAYS (INCLUDING NAMES) ADJACENT TO THE PROPEHTY. INDICATE THE SIZE. YEAR, AND NAME OF MOBILE; SUCH AS 121 x 601. 1981. FLEETWOOD. HOUSE CONSTRUCTION S'ALf: 1-. .0' PROPOSED ADDITIOI'4 "ALE; 1-. .0' MOBILE HOME SETUP ICA.Ll: 1-. 10' roOf (601..) IJ :I Cl z ~ 7." o D: - ~ ::' o Q !'lO' ~O' ~ - - - 0 0 0 If) '" 7." ~ ., 2" UI.llnO ::; - - S~'d . .. - :! ... ... . - . 20' 00' P/L ROAO NAME ROAO NA....E Hc.u.. 7.!J' ~ .. ... ;; . ... ;; 20' ROAD NA....E siteplall:ce OWNER-BUH.DER AFFIDAVIT STATE OF'.FtORIDA ) COUNTY OF PASCO ) BEFORE me, the undersigned au thod ty, pe",ona]] y appear cd 2 [".e ;-) CA_-dM __, who being by me first duly sworn, under oath, deposes and states as follows: I do hereby swear/affirm: That I own the property described as /tf ~O J/ (JIlo (}OOOrJ (..J I S'() Disclosure Statement State law requires construction to be done by licensed contractors. You have applied for a permit under an exemption to the law. The exemption allows you, as the owner of your property, to act as your own contractor even though you do not have a license. You must supervise the construction yourself. You may build or improve a one-family or two- family residence or a farm outbuilding. building e.t B cost of $25,000.00 or less. You may also build or improve a commercial Tile building must be for your own use and occupancy, It may not be built for sale or lease. If you sell or lease a building you have built yourself within one year after the construction is complete, the law will pre- sume that you built it for sale or lease, which is a violation of this exemption. You may not hire an unlicensed person as your contractor. It is your responsibility to make sure that people employed by you have licenses required by State law and by County or municipal licensing ordinances. Any person working on your building who is not licensed must work under your supervis ion and must be employed by you, which means that you must deduct F.I.C.A. and withholding tax and provide Workers' Co~pensation for that employee, all as prescribed by law. Your construction must comply with all applicable laws, ordinances, building cades, and zoning regulations. That I have read the foregoing, and am awnre of my responsibilities and liabilities for construction work on the above-described property and do hereby agree to each of the aforesaid stipulations, FURTHER AFFIANT SAYETH NOT. -') o ~# Ie 5tt'1L-/{) ilk/Y' l.~L; h/ 2 "'-fjYJ!ft~ssd( 5'/1'11/ ~~L,? ,.tate at Large My Commission ~ ---- r------__. __.---' -._______~ NeTAlty ,,-~'" .......... E. - ~ ............ "AT! CF FtClRm'" "'" XpD~~SS'/'ON iXP n i __ ~ ..JIJLI 1l,.I.lIl1:) . G!NERAL D1S. lIW. \- ~ ......-- -'-. Print, Type, or Stamp Commissioned Name of Notary Public . ---~_.- Personally Known _____ or Produced Identification ~LP 60- 'lgG, (4 ::L~O-IO Type of Identification PC93053047 -.~'~ ........--...,....,..".....---=..--- ....,..,..,.....~,-.~. - -- - --.......L-- - - -"--;.-,,~ ~ - - - -- ,--- -.-- -..- ,- --'-1 . . . C E N 1 R ALP E R M I T T PASCO COUNTY, FLORIDA I N G i I I r \ I ( I r I r I I ! I f f 1 I I f I ( [ f I I ( I f I I I I j I I I I I I f f I I ( I I I I I COI\nF'ACTOf~ #: N{.,ME.: :;:;UI'-.IR T :3E HULlS I (\le; I NC (4L.DR: 14--:::::/:..-:,:;: 1-' 0:1. ,SO"'OOOOO-.O 1 ~:.O C/3T: 38034 LAWANDA LOOP [iAn::~ OS'/20/94 FfIGE: 1 elF 1 T. :;:;::;:UE (.IFF ICE: D RECEIPT NUMBR: 00224502 OFFICE~ DADE CITY FOR: CHECY *i :l4:3::: f4CCNT 11 ~~ TOTf.""JL {~MOUNT: CC;MPNV AC:COUNT CEtHER 1'". ,-,,-. ..: . ::- (=~ 8i~.50- :::::;~,:::;~)UO ..- .'-. .... (iMOL,NT DE:~:CHIPTION/F::::m.1T DATAUR/cn 13.98 ****** SOLID WASTE FEE 60 PECEI'JED BY ....' (..' / ..... - / '. / .. ... / / //./(/,1(/. / /. ; / ,. (tf'I//' _,__t-1~..,___~:-__'~_":", _L.L__p~_-t_.__~, ::.~ _.:._. _:__._~_:____~__ 1__ / / --"--"'~'::':;-.--:- !""".~""""""'7'""~n.....'1''':,~,~.".\~,~~'''IJ'C '''~;</>''''~J':.I!.J'~.f"'itf',t.~::~~;.\.~ (:' ~~'~, .' <"c.,-j' ..", '. , '~'!C.~~'~ PASCO COUNTY, FLORIDA Permit No. :/ c ,r) Date Permitted '7 ':/ Builder Name/Owner Name " ~ ." / ~. /..~'~./ .,e~f .../..1 , _. County Parcel No. /- ~/! ' I, (, (j .~,. /", ~" l' /:(j - l..-:-., ( ) Location ~- ,) i _1 L... .__~ .'>r._~/ Subd. Classification/Type of Use h I. 1. ,".~;.'~).l..;:,,, ~ -..,..- .' ., if" TRANSPORTATION IMPACT FEE CALCULATION EXEMPT D Rate $ Zone N\). . Sq. Ft./U nit Prepared By ~_..- Impact Fee Amount $ n.... The above impact fee has been estgblisheapursuant to the Pasco County Transportation Impact Ordinance as adopted by the Board of County Gomm-j's'sioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or authority to utilize-tIle permitted structure. RESOURCE RECOVERY ASSESSMENT EXEMPT D RESIDENTIAL No. Units / l NONRESIDENTIAL Gross Sq. Ft. (GSF) Rate/ERU - 50.00 x 0.96*/Year or $O,1315/Day ERU Assign No. Assessment - (No, Units) x ($0. 1315) x (No. Days) Assessment - (GSF) x (ERU) X (0.1315) x (No. Days) 100 TOTAL FEE $ TOTAL FEE $ *Discounted for Prepayment The above assessment has been established pursuant to the Pasco County Ordinance No. 89-07 and Resolution No. 89-197, as commended. THE ASSESSMENT WILL BE CALCULATED AT THE TIME OF ISSUANCE OF THE CERTIFICATE OF OCCUPANCY. NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY. Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form, placing the building permit owner on notice of this assessment and the conditions of payment for same. Date Received By --------------------------------------------------------------------------------------------------------------------------------------------------- OFFICE USE ONLY TRANSPORTATION REC, NO. RESOURCE RECOVERY REC. NO. DATE DATE BY BY White Applicant Canary Trans/Finance Canary RR/Finance Pink Office Green Bldgllnsp feecal:ce ----_._-----~----~-~-_._~~_._-_.