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BUILDING PERMIT
Permit N'~
CiTY OF ZEPHYRHILLS
(813) 788-6611
_ 42638
j7-3o-7Y
'I s: oiJ
~
P<OP'~Y OW"" ~/::~iF~ .
Job Address: -J:a &~~--'
Parcel I. D, # / / - 6 - ~
iJ- o. d""V
~ECTRIC;;)
Date
;2-0. OU
C!WMBINV
MECHANICAL
Sewer Conn
Water Conn:
l~'-~!Jb~~7
Zoning: Energy Code:
Description of Work K.J?~~~
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
- 21A'I
DATE
f)-~/2-7'(
DATE
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordar'<::,e with City Codes and Ordinances.
c.o.
Inspector
~~71
Permit Fee .
Signature G. "- tC ,V
Company
Address
Telephone#
Valuation or
Contract Price 6, crz;--z; . o-D
City License Registration # >';L 0
State Certified License#
V ;e.lj<I-+~.
BUILDING
AY(U1 /fi;L
ELECTRICAf ??
7? ~ ~.&?
(j
PLUMBING I/' y
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
Tp. Servo SLB
Rough In ~u, tj-'6'Cf-I ;:?lbTub Setti-7--q--/ Bc.<<-
Meter Can Water
Ftr.
Pre SLB
Lintel
FRM. q-7-Cff 6ic.L-
Insul. CL
Const. Pole
Pool
Sewer
Final q- Z.Z.et" ,?4..
,;JYL pre-M7Jer
t1~ C{..lJ.--Cjt/ BIlL Final '1- Z~o,c.-J
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
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
REFLECT 10/1/ S P/.l / ~fA I TII! (' _
OWNER'S BAKE -1 ~ f?.y ~ JG' Vir, rJ V ILL (;
OWNER'S ADDRESS S2/s B~(2N IJIJ-eITe... DJ7_
L A PiA 2 A S/lfJjJ! AJb ~--AJTl:--R
PHONE
g-/~- /6!' - ~lfs8
JOB ADDRESS
LEGAL DESClUPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.'
1/-2~.~;:;'J
(OBTAIN FROH PROPERTY TAX NOTICE)
. VAlteration
WORK PROPOSED:_New Construction ----..Addition ~epair _Install
_Sign --"ove _Deaolish
PROPOSED USE: _Single Faaily _KIF _' of Units ---1l/H
Leo-ercial _lndust. _Swia. Pool _Other
~estaurant & Health Depar~ent Approval
DESCRIPTION OF WORK:
BUILDING SIZE: 2CJ XsO ,
I
fO Dc) Square Feet, c::y Height
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COHKERCIAL: ATTACIl (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERKITS REOUESTED
_BUILDING
~LECTRICAL
tJ AtlECBANlCAL
v},LutlBING
$
~ 0000 D
)
IOD
Valuation of Total Construction
AIIP Service
/
Florida Power Corp.
W.R.E.C.
$
Valuation of Kechanical Installation
GAS
ROOFING
~raae _Steel
SPECIALTY
TYPE OF CONSTRucnON: --..Block
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECI' IN FLOOD ZONE AREA.,
YES HO
..........................................
CO'TR4CJOR SECTION
BUlWER
Signature ~ IJ
cotIPANY '/ C S .~ f Er7-(:::.J- AIj)O CO.
. State Cert.' or Resist. . Cl'C <:> I 110 J h
WI::: /""-ZC'L City License Registration' 4.(2()
..........................................
"
ELECTRlCIAR
COMPANY ~ () V G.LA-5 ELF-c.T\h.~C:
n !\ . ~ () State Cert. or Regist. .
\i1.~~ t:J~ City License Registration' ~7-'
... .....................................
SianAt.ure
PLlIMRRR
II +-, '{2 PLUif~)~
te Cert. or Resist. .
City License Registration' J In Y
...........................
Signature
ItECBANICAL
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
OTRRR
COMPANY
State Cert. or Resist. .
City License Registration .
..........................................
Signature
APPLICATION APPROVED BY
YJ ~ )11 ff7!-1cJ
PEBHIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this perlit laY be subject to "deed restrictions" wbicb laY be lOre restrictive tban City
regulations. ,he undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance witb
state and local regulations. If the contractor is not licensed as required by law, both the owner and contractor .Y 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 the City of Zepbyrbills Building Departlent, (813)
788-6611. ·
FurtberlOre, if the owner bas hired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
"Contractor Sections" of this a~plication for wbicb they "ill 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 JOU 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 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 - BoIeoIDer's Protection
Guide" prepared by the Florida Deparuent of Agriculture and CODSUler Affairs. If the applicant is sOl8Olle other than the
"owner", I certify that I have obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the
"owner" prior to COIIencelent.
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 developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation has COIIenced prior to issuance of a perlit and that all work ,ill be perfoIJed to leet standards of all 1818
regulating construction, City codes, loning regulations, and land developleRt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDl8otal agencies laY apply to the intended work, and that it is
IY responsibility to identify wbat actions I lust take to be in cOlpliance. Sucb agencies include but are not lulted to:
t Deparuent of BnviroDl8Dtal Regulation - Cypress 8Bybeads, Wetland Areas and BnviroDl8Dtally Sensitive Lands,
Water/lIastewater 'reatlent .
t Southwest Florida Water Hanagelent District - lIells, Cypress Bayheads, lIetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, lavigable Waterways
t Departlent of Health , Rebabilitative Services, EnvirODlental Health Unit - lIells, Wastewater Ireatlent, Septic lanks
t US BnvirODlental 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 "COIpensating volUle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued sball be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
Bet aside any provisions of the techoical codes, nor shall issuance of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery petlit issued &ball beCOlB iovalid
unless the workauthoriled by such perlit is COIIenced within sillOntbs of issuance, or if work authoriled by the peIlit is
suspended or abandoned for a period of sil IODtbs after the tile the work is c.enced. One 90 day extension of tile, laY be
allowed for the perlit with fee charge of '15.00. Tbe extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during eacb sil IOnth pariod, or the project will be considered abandoned.
WARIING TO OIIID: YOUR FAILURI TO RECORD A loricI OF alNlICBIIIHI MAY RlSULT III YOUR PIIIIG !lUCK FOR IMPROVIIIIII'S TO YOUR
PROPERTY. IF YOU IIIIND TO 08110 FIIANCIIG, CONSULI WITH YOUR LIIIDBR OR All AnORRBY BEFORB RBCORDING YOUR NOIICH OF
COHHBICmtrr. JOBS UIDIR $2,500 IN VALUI DO NOI lEBO TO RlCORD AID POST A "IOTlCI OF CCIIUlNCIIIBNI'.
r
~-L,,~d
51 IIATURI: C NfRACt R
STATI OF FLORIDA
COUIIY OF ""PA-~ D
The foregoing instrument was acknowledged
before me this AuG.. If? , 19~ by'
1'",1A'l(tl 1-'AI JII LLG.
who is personally known to me or who has
produced
as identification and who did/did not
t~7~tl: ~~du
( SYl~a~t,!re)
~lj)rT~ A. L/)t?K~~A/t
(Name 1'yped, Printed or Stamped)
NOTARY PUBLIC --
STATE OF FLORIDA
COURTY OF ~ /0
The foregoing instrument was acknowledged
before me this Au&. If ,19~ by
A-R#Ol.,l::> AJ. r?L.€A:JELl.-
who is personally known to me or who has
produced
as identification and who did/did not
tak~"'~ c:l ~~h~
(Signature)
(J#A~U7/€ A. LLJl?,e~.8/E
(Na.e Typed, Printed or Stamped)
NOTARY PUBLIC
OFFICIAL NOTARY SEAL
CHARLaITE A LOCKERBIE
NOTARY PUBLIC STATE OF FLORIDA!
COMMISSION NO. CC327159 i
, I
MY COMMISSION EXP. FEB. 24,19% \
C N ARY SEAL
OIARLOTTE A LOCKERBIE
NO'J'ARY PUBLIC STATE OF FLORIDA
COMMISSION NO. CC327l59
MY COMMISSION EXP. FEB. 24,19%
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ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name k'e;-:/~ {_7~ /' /v '?
Address :5 - L/ /'J r:; - (
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(~>> //
Classification /] t'-/ <7.. .<.-- f: S S
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Owner/Manager / /-'" if/ / , /.p
Business Phone
7:2>' -l/~)20
'"J ""'l' .." ,.",-0
Emergency Contact Phone / i;';) -.L "" ./ 11
/ /
Alarm Monitoring Co. /1,/,' /..:;. Phone # ,i/ //1
Occupancy Load
/
/: ",/ '/
TYPE OF INSPECTION CONDUCTED
o QUARTERLY
ORE-INSPECTION
CQ:l APPROVED
&FINAL 0 ANNUAL
o OTHER
o NOT APPROVED
OBI-ANNUAL
o COMMERCIAL CHECK
Listed below are items which must be complied with before this occupancy can be approved by the Fire
Department.
o CODE VIOLATIONS
This inspection report specifies code violation(s) which if not corrected could cause a fire, contribute to the
spread of fire, or prevent safe egress during a fire. Your immediate attention to the correction of these
violations shall be required, as failure to do so is a violation of the city of Zephyrhills Fire Prevention Code.
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Inspect. Date ':1;{ 7 /~1'-1
,
Inspect. lime / "fz~'~.') . Fire Oept. 10 # 5'".; - /
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",,1 Inspeqtors Name /: /) -I !/' /:: /~
: ./ I /., 1/ j 1/ I
OwnerlManager Signature \__/,t>i( I (-::-x\ i j I" l_ ,~J< ,I / Title L/, ,/?
This building has been checked by tn/ Zephyrhills Fire Dept. under the codes & regulations of the NFPA minimum
standards, the State Fire Marshall's Uniform Fire Safety rules and other local fire safety codes.
White Copy - File Yellow Copy - Bid. Depl. Pink Copy - Business
Re-Inspect. Date
CITY OF ZEPHYRHILLS
COMMERCIAL CHECK APPLICATION
L / FEE $20.00
7 J2- q LJ GROSS SQ. FT.
I
APPLICANT: -r;'ZiLJ LJ fvV; I k
NAME 8F OWNER: LA PiA e.^ Jr
G-A LL 13 11/& .
c-- 2
PHONE /I
'1 t d.. - )-.5 -~ I
78'8 -.)..L/~F
DATE:
ADDRESS:
SLJ-oG
ZONING CATEGORY & CONFIRMATION:
PROPOSED USE IN DETAIL:
tJ (i'J L
IF VACANT, HOW LONG?
~ Sk.IN CAr~ S A It) r0
"
(YI ()Iv-fh S
PRESENT USE: VACf\1\lI
ARE THERE ANY FLOOR PLAN CHANGES? '(E~
GJl l-L.. 'S'u6fV! IT
IMPORTANT: SOMEONE MUST BE PRESENT AT TIME OF COMMERCIAL CHECK.
********************************************************************
THIS SECTIQH-FOR CITY USE ONLY.
DATE: )1-;'1-7'1
,
~():3 0
COMMENTS
BUilding,
Meeh.
9-1/}11Zt; i~~ 8-:3o-?f:! /!bl&.3il
U. t. {6~J-
SIGNE
INSPECTO
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ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name
-'\
IJ"} r ,
//:~j".-:/.,:"~j~f~~ ~/f"'/ 1,/..../9 (_/-0,
Classification
Address ~) '/ () (:."
/ I') ~ " (~
'._.\1 ,..,..... (1...._ I...:; t "." ;'L<D -:.".,//,"I / T -'"'
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Alarm IMOnitOring Co.
T
Owner/Manager '\.! 0 \,)
/
Emergency Contact Phone
I.uvu I ue
Business Phone
Occupancy Load
Phone #
o
o
o
TYPE OFIINSPECTION CONDUCTED
,
i
QUARTERLY 0 FINAL J 0 ANNUAL 0 BI-ANNUAL
RE-INSPECTION 0 OTHER
APPROVED
o NOT APPROVED
~ COMMERCIAL CHECK
Listed below are items which must be complied with before this occupancy can be approved by the Fire
Department.
o CODE VIOLATIONS
This inspection report specifies code violation(s) which if not corrected could cause a fire, contribute to the
spread of fire, or prevent safe egress during a fire. Your immediate attention to the correction of these
violations shall be required, as failure to do so is a violation of the city of Zephyrhills Fire Prevention Code.
CD
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Inspect. Date ? . ,j - ;;; V Inspect. TIme /IOC2 . , Fire O_ept. 10 # Q:~
Re-Inspect. Date Is t N .,.'<"...........~~~-:.::-(:~v'~~.b-t.
'If n ~c ors a(~ L "'/ , -- - '-, - '_"_
OwnerlManager Signature '--,~ L." . "/-'/',, .' ',; ~/ \ . Title
J) ',F ~-' ......
This building has been checked by ilk Z~PhYrhillS Fire Dept. under the codes & regulations of the NFPA minimum
standards, the State Fire Marshall's Uniform Fire Safety rules and other local fire safety codes.
While Copy - File Yellow Copy - Bid. Depl. Pink Copy . Business