HomeMy WebLinkAbout94-4331
.
BUILDING PERMIT
Permit N;~
CiTY OF ZEPHYRHILLS
(813) 788-6611
4331 ~
9' -c;}6 -?'(
Date
'-I c . Vb>
-35-. c~
3'!' ~ en.)
dO.~n
MECHANICAL
Sewer Conn /;l..:/.f: c;N.J
Water Conn: ..]5,'lJ ~ tJ7.J
Water Meter: ;' 6~-: tJ7~
T.I.F.'s: I,..y RD .. tlO
BUILDING
ELECTRICAL
PLUMBING
Pmpe"Y owne'~~A~L& "f~..
Job Address: :3 7 {, _ _ _ .7'~ _"1~ _-
Parcel I. D. # S -d.. [;, -;u - 0 /s {J ~ 0 a 0 00 - b CJ
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordart:'e with City Codes and Ordinances.
FINAl-L~ - (J 7-
DATE
C.O. L2-g~/~
ATE
Inspector
BUILDING
(/Ju.~'1 ~/11 .
") C-.y
ELECTRICAL ~
Pe,m;t Fe~ ;--~~
Signature _ _ ~ _L
Company -
Address
Te!ephone# 2/3- ~S'3r ~ 7--S
,- ;;~j?!~~~ ~I/(/dt yq})~~~
Valuation or
Contract Price
c2.. ~-: ()7rz)
,
d()
City License Registration #
State Certified License#
~fL)~ 1~!1!-1ldk
PLUMBING
,I.. .:? '-;'
MECHANICAL '-.) ~
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final /1-;;;'3,614 fiat.,
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade:
a.
b.
c.
d.
e.
f.
g.
Wrong Address
Condemned work resulting from faulty construction.
Repairs or corrections not made when inspection called.
Work not ready for inspection when called.
Permit not posted on job site.
Plans not at job site.
Work not accessible.
JJ~a. 9-;Jb-?Y
;A cQ -6 -~k
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
SEP-23-'94 FRI 08:29 ID:
TEL tlO:
11274 F'02
API'LICA'flOR FOR !'BINI!
CITY 0' ZBP11D11IL1..8
BI1.lLbUO DDAlntlll'r
, .
ODO' 8 1WIL..,C?p. ~ \<. rl-A <- e Yn If -S.4,L e s
PlIO... .~ J .$ ~ 05 3 ~ -L/d ') S ---
OWN_ '5 ADDIII9S
:: ~~:::) ;;J)D ~-=:LUlYUI~ ~Ph~~~'~ T:
PARCEL I. D,' ~~ - c;{) ~ - d / - 0 ~ S 6 -- 6 cx:Jo - b (j C08TAI~ nnM PItODnIJ'Y 'I'd UO'I'10.l)
WRIt PROPOStm:hew OoGatruction ' .
--...Addl tlou -..A1teratloD ---..Repair ,- tn-tall
~1.... ---IIove ---.,I)-.oli.h
PROPOSED USia -8iDale P..~ ---If./ F _' of UDiU Lill
_ec.ercial _1nclust. -8w~. Pool _Othec
bataurant 5: B.J.th Departaent Approval
DISCIllPTl.OI OF WOJUtt &..., up Yn 0 t;5,Lf" /IGrrl C
BUlLDIIO SIZI: _
x
Square Feet..
Beipt
IBSlDlJ'I'W,l AnACII (I) rLOT PLUS I (2) SITS or IV1LDUQ fLAIl I (1) 81'1 811ft fOIIII.
COMKIROIAL I AftACII (3) SITS or IUlI.DUG PWS I: (1) SI'IIIIIIlGY ....
PIOPIIJI SuaYBt UQUD.ID FOR AU. IIn couraucnOH.
~
-8utLDIIIG
~C&L
~aaL
~;'G
mB 0' ~o.;
l'DKITS RRqfIP.STBD
~ ~ ~o
S ?1 ~" oCJcJ,~ Valuat.lou. of Total CoIuIU'UctioD.
,( S-d AIIP Service ~_ _r Oorp.-4w.~.B.c.
t':) cCl
s :7:CJC? ,.- Veluatioo of llecbmlcal IaataUetioD
GAS
IWOFIIIG SPlOIALft
--'r_ -Bteel "rrh~'JM4u;z.~ b Oth.r
B1oc:t
mUBID I'UJOIILIVAnoIS.
ft,
18 fttOJlCI 111 FLOOD ZONa AlIA t
,x
.................................*.....".
RIft, .QJI
MIJ'ltim'ft1t SlctlOM
OOIIPAn ~R~"/O~c~ 7n/l .5??-Les
~ Stat. Cert.. or a..tat. . bJ../.'//:S<.o #
~~ Olty Lie...e ...tetrattOD .
...... ..............................
Sfanature
'UltRA
WKPAII (eJ,~ / OtV ,~OIV~'C' Yt d'^" S'
State Cert. or a.,i.t. 'IJ ..
city Lieenae baletraU.Oft . .__.~S ~
..............................
COIIPAn ~.eK" ~~ce-
'..<. _~~..ce.~~~,,,o!..ae.. ,!f!~!~..' ,
. ~. III........ ...J""'''''rl.J ..,.-f" _ .. ,.... .....~_ ""
.................,............
CDlPAIY 2RI"1(\j~70A/ /~~'/1.0..( ....,t-~ ~
State Cert. OJ" I.eal.t. . ~
. /' '.' .(~ Oity Lie..... ae,18tratlOO . ,J ~ 3-
t.... ...,..,............,.......,.,...
--~
0TIUtR
OOIIPAII
State Cert. or "alat. ,
. City Llceoae Jeai.tratloo .
..........................................
J1
'.
Siauture
AtPLlCAnOIl APPIWVlm BY
_ 1'1RKl'l' ornea.
CONDITIONS OF PERMIT AFFIDAVIT
A. Nona OF DBED RB8'1'RICTION8
rbe IlIldenJ,.. Illl!entaDl1l tllat tIlle pmlt .r be l.jllCt to "deed ruttlcU.... wbJeIl ., bllOr. ratrlct1" tMa cltr
revul,UllIII. ftt ...1_ __ r"pclIIIibllJtr for ClIIplll11Cl! IIJtJllD' Ippllcalll. '11C1 ruttlcUCIIII. .
B. UNLl~8EP CON1'RACTORS AND CONTRACTOR RESPOHSIBILITIBS
If tile OIIlIer 11M Un4 . llllIItllttor or contraetore to Ulldlruq 1IlIt., tiler ., be rll\lulrt/l to III UctUIl1lo accoMcl .ltJI
Itltl IIlI1local ngulaUIIU. If till contrlctor Je DOt 1IC8Mlt II rll\Jlllrll1 &r 111I, bo~ tH .. .. ..tnctAlt IIJ be
eltll1 for I .l~ dolatlon \IId.r .tate ta,. U tile 0IIIlIr or IntfJIWllllIItrector ue lIlIc:er:talD .. to eat U~J",
requlr_UIIJ 1IIP1r for the Inttaclecllllr., tiler art lll'tlec1 to tlIDtlCt tbt Citr of Ilpbrt~UlI IuJldlag ~t, llU)
788-6611.
Furtllmore, If till 0lIllU IIu IIlr111 . coatr.ctor or coatr~OIl, be II 14'11" to IIlfe tilt ClOIltrlctor(.) .111I port1gat of tIJe
'CoatrlCtol' 8ecU.' of WI IIpplie.tlOll for _Jell tiler .m be rtIpclIIIlble. 1f)'OU, II tile .. "'P II tM _UlCtor,
rou are JaaJeetlag tlltt JOU, rltllllr tbIn tile coatr.clor, m rllpOllllble for tile IOtt. If Ut CODtrector w1lllet JOU to .Iga
ae ClllItractor tW -, be III Indlcatlllll tllat ~ 11 DOt properlr UctDlllllIId II IIOt IIIt1UIl1 to pualt,tJIg ,d,n... III tIIll
Cltr of Iep/lrrllUl... . - .
C. TRAHSPORTATIOH IMPACT FIBS AND UTILITY COHNBCTIOH P1Ul:S
D. CON!'1'RUCTION LID LAW CCHAPTBR 713, FLORIDA STATUTU, AS AHBIDBD)
1 cutUr u.t I, till tppliClllt, 11m lIMa prodded ,ltII I tIlPJ of "rlorJ4a'1 COlIItruCUClII 1.111 Law w ....'. Protec:tlllll
Guide' preptr8l1 br tIIll 'Iorlda Departllat of Agriculture llIld Conauer Iff,I". If tIIllepplleat II .... otlllr tiu tile
'owoar', 1 certlfr tIIIt I be,. obt.IDIll I ClIpJ of till aboyt _dbe. doc:uIeDt IlII1 prem.. ID _ f"~ to WI,.. It to tbe
'Dllner' prior to ~t.
E. COlf'lRACTOR' 8/OWlfBR' S AFFIDAVIT
I certu, tIlIt alJ tM illfonatlClll 10 ~ll appUcatlon II &ceIltltt IDd tbat all lIIIrt 11m be .. la ClIIpJllllllt IIltb IU
appUcaIIl1 111I ngalltlD9 ClIIIlncUlII, lOllIng, IIllIIIDCJ lItY8.le.-nt.
AppUClUoa II IIIrUr .. to obtalo . pmit to 110 IIOrt .. IneWI,Uou .. latJIClt... I ctrUfr tat 110 IIOrk or
loauU.UOIl .. ___ prior to IQ1lIlICe 01 . perIIlt ., tat allllllt. 11111 be perf 001I1 to _t ItIIaIrfI of .11 I..
teVlIllting ClIIItnctlCll, Cftr coda, lOllIng regullUOIII, III<< 1" l1Iytlu,..t ngallUOII ID tal JllI'latictJ.. I allO
certlfr tat 1 Wll1araWd tIlat tbe rlgllllUlIlII of other ",....tal aveac.I- ., awlr to u. 1Ite.W .n, IIIl1 tat It II
If rUpollIllllUtr to I_tlfr lIUt lellOll8 IlUIIt WI to be In COIplllDCe. 811d1l1pDClu lDClul1lllat an lOt IIl1l1l1 to:
, Departllllt of IDYI~talll!lulat1Ol1 - Cypr... hrblac1l, IItUIll4 Ire.. alii! InYlrOlllllltall, IUIIU" Le.a4t,
Watar/Klltellatu trllttut
· 8ouu...t 'lorlda later :t Olltrlct - ...111, CypCIII II,..., ..tllllc! Irlll, Ilterlng IIttercour_
· AIIY COrp of ....,. . 8IM1 I, Docl" 1a,lgtbl. IIttltH"
· IlIDutBt of ....g. .....l1ItlUft Banlcea, 1D,Ir_tal1II1t11lilt w "UI, IIaItllltIr !reet.t, IlpUc I.
· 1II111Y~ S- ....taI ablu.t
I 1110 c:utI , , I fllllltlr I. to be _ I, rllllllllolle ".' Or '.,.tc.', It 1. ua/ltretoocl tAt . tt..... ,lID
,adrllllag I "alIII*IIIt!Dg tOl..' 1m be .uIlIltttd .bidll. prepull1 br I profenllllla1 ..IDler regl.teh.1 Ii tM ltatl of
Flodd. prior to perllt l..llIICI.
I pmlt I...... .11 be llOlIItnec1 to be I lfCIDIII to proceed , It II tallOlk ead IIOt II lutlaodt, to dol.ta, CIIICIIllw, or
..t .dele IIIf prod.IOOI of till tecIlIIJcII cadll, 110I llItlJ I.., of . perIIlt pm8llt tbe IlIU41Ig Offici.. fa tberNft.r
requJr1lll . corrlOtlCII of mor. 1lI pI.., CIllIIUucUIlII, or dolltlllll of III coa., lflQ palt ...... IWJ __ Jnelld
unl... UlIIDr1 .tMri.1I111r .. perlin II c.mce4 ,IWD ,1111l11U1 of I...., or Jf IOrt ...r.... ., tII pmlt II _
IUlpeadId or ....., for I period of III atU Iftlt UI till tM lIIIr11...... 011I'0.., ..... of till, ., be
.UllIed for tM fIl1Jt 'Ill '" cbar91 of '.5.00, !be eatlalloa ..11 be flllllltltld ID 1l1t1nt to tlIIldWIt Omclll. III
IpprDftl11UptCt10l1 .t be 1_ 4urlao eaell .11 ..t.b padOlt, or the pro,ect .m be COIIIlhn4 .......
UIIG 10 -, !WI mLllIO .. 110111.1 0' lXIIlIIlCIIIIlllr _III _ PAflllIlIlCI . INIld 10 mil
PIlOI'II!Y. I'. IftIIO YO OIUII PIIIICIIG, ~r IIID lOll..... 1Il1lllmlllllllPOlll aaIDUG fa 1OI1C1 01
aJIIIDCIIIIl!. __.2,500 I. YAWl 00 IIO! DID 10 ..lID fOS! l 'IlrrlCl OF 1DIIlIIIlmIt'.
SIGU~ IIlII!
nAIl or MIlK
coom or
Th, fOllllolag iD.tZlDtllt II" ~OWledgtd
before .. tbie .1'/t_l;; t 19 by
IIbo 1. ~cI'Ul b~ to .. or ..hO bat
produced
.. ldat1f1caU. ODd who didl II D t
tllte oath.
BIQII7lIIIIC~~
Ifln 01' fUlIN
coum or
Tbe foregoiag 1JI8tr~~ .... Ie
before _. this _~, 19
1ldged
by
.bo 11 ~~ to .. or who bii
produced
II ldaatlf1cltioo aad wbo dldi Id t
take o.tb.
/'
~1A,p
..... .",.
~....
.....~ 1 A..s>.",.
~\.\....
JAMES F. NICOLETTa
'ltt. .t florid.
COlIlll,,,,OI No. t CC050283
lIy Cllllltli. (xp. Sf_I. 24, 1994
[.j
~
/~ftv/) 9-Jllr71f
(!r9/c pAOf'V<::- /O~ ffil2tf:'f'V
13/3-. d(l./O-IS- ?V
L-e~v<:.. /77"f!!'$S4c5 '<-
PHONE &"1 3- 10::; 3 -4c2 7J-
APPLICATION FOR PERKIT
CITY OF ZEPBYRBILLS
BUILDING DEPARntENT
,
OWNER'S NAHK
\~ ~1Z-I<
FLAL~ ')'1'/1 H :SALes
OWNER'S ADDRESS
JOB ADDRESS
3 7 ~Li ~
.PL/fC-e
WORK PROPOSED:__ew Construction --...Addition ---^iteration ---.Jlepair _Install
_Sign --.JIove -Deaolish
/'
PROPOSED USE: _Single Feaily ---1l/F _' of Units ..-.6/H
_ec-ercial _Indust. _Swia. Pool _Other
---.Jlestaurant rr Health Departaent Approval
DESCRIPTIOR OF WORK: ~ 0 131 Le... /-I0Fr7 -e S e r u ~
BUlLDIRG SIZE: ct; ~ X 'I r.
Square Feet,
Height
RESIDBRTL\L: ATTACH (2) PLOT PLARS rr (2) SETS OF BUlLDIRG PLARS rr (1) SET ERBRGY FORMS.
COtlKERCIAL: ArlACH (3) SETS OF BUlLDIRG PLARS rr (1) SET ERBRGY FORHS~
PROPERTY SURVEY REQUIRED FOR ALL NEW CORSTRUCTION.
~
-BUlLDIRG
V;;RcnuCAL
~CIL\II1CAL
~~~niG
PERKITS REQUESTED
$ {-? S; OOOr 0" Valuation of Total Construction
I .5-0 AIIP Service Florida Power Corp.
00
$ 9 () 0 .:--- Valuation of tlechanica1 Installation
W.R.E.C.
GAS
ROOFING
SPECIALTY
TYPE OF CORSTRucrIOR: .-Block _Fraae _Steel 17l06.1e ~~ther
FIIIISBBD FLOOR ELBVAnOBS:
F'l'.
IS PROJECT IN FLOOD ZORE AllBA1 4
YES NO
..........................................
BIITlnRR
CONTRACTOR SECTION
mKPARY /il~ /hc <- /77 // ~es
d State Cert. or Regist. .
r'~ City License Registration' 0 H )1 330 .H
*................................
COMPANY ~ /01'0./ e/l/e ~C1/\JS
~ State Cert. or Regist. .
t::' City License Registration' ,d.5:' Y
........................................
COKPARY A-Rf ;::%c-~ $# J};Les
'. LState Cert. or Regist. .
.,.,;er City License Registration' l')/~ // 3JcJ /7-
*...............................
COIIPAIIY ~$v<k<vv ~..-w1...., ,f--,.-7', ;,c.
State Ce t. or Regist. .
City License Registration f j ~ ~
........................................ I
OTRRR
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
APPLICAnOR APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
Tbe undersigned understands that this pel'ltt lilY be subject to Ideed restrictionsl wbieb lilY be lOre restrictive than City
regulatioos. !be undersigned asSUJe8 responsibility for COIpliance with any applicable deed restrictiCHl8.
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 regulations. If the contractor is not licensed as required by law, both the owner and contractor lilY be
cited for a lisdl!leanOr violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirl!lents lilY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtherlOre, if the owner bas hired a contractor or contractors, be is advised to bave the contractor(s) sign portions of the
IContractor SectiCHl8.1 of this applicatioo for whieb 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 wort. 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 peraitting 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, have been provided with a copy of IFlorida's COnstruction Lien Law - BoIeoImer's Protection
Guide' prepared by the Florida DepartJent of Agriculture and ConsUIeI Iffairs. If the applicant is 8OIIOIle other than the
lowner., I certify that I bave obtained a copy of the above described docUleDt and promse in good faith to deliver it to the
"owner' prior to COlleDCl!llJlt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infol'liltion in this application is accurate and that all work will be done in cCJlpliance with all
applicable laws regulating construction, loning, and land developleDt.
Application is berebYlilde to obtain a perlit to do wort and installation as indicated. I certify that no IIOIt or
installation bas cc.Jenced prior to issuance of a perJit and that all wort will be perfoIJed to .et standards of all laws
regulating construction, City codes, zoning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDleDtal agenCies lilY apply to the intended work, and that it is
Ii responsibility to identify wbat actions I lUst take to be in COIpliance. Sueb agencies include but are not lutted to:
t DepartJent of Bnvirollll!lltal Regulation - Cypress Baybeads, lIetland Areas and BnviroDleDtally Sensitive Lands,
lIater/llastewater Treablent
t Soutbwest Florida lIater ManaglleDt District - lIells, Cypress Bayheads, lIetland Areas, Altering lIatercourses
t AIIY COIPS of Bngineers - Seawalls, Docks, Navigable lIaterways
t DepartJent of Health i Rehabilitative Services, BnvirODleDtal Health Unit - lIells, lIastewater IreatJent, septic lanks
t US Bnvil'ODleDtal Protection Agency - Asbestos abatl!leDt
I also certify that, if fill laterial is to be used in Flood Zone III or II,etc.l, it is understood that a drainage plan
addressing a ICCIIpeD8ating voluel will be subJitted which is prepared by a professional engineer registered in the State of
Florida prior to pel'lit issuance.
A perlit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor sball issuance of a petlit prevent the Building Official fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery pemit Isaued sball becoIe invalid
unless the work authorized by sueb Perlit is c~ced within sillODths of issuance, or if IIOrt authorized by the perlit is
suspended or abandoned for a period of sil IOnths after the tile the work Is co.enced. One 90 day IItension of tile, Iill be
allOlfed for the perJit with fee charge of $15.00. Ibe IItension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sllJOnth period, or the project will be considered abandoned.
IIARJ1ING 'l'O omR: YOUR FAILURE 10 RECORD 1 lOT ICE OF COIIIBICIIIBIf MAY RlSULT II YOOR PIYIIG !ilIa FOR IMPROVBIIDIS 10 YOUR
PROPBIIIY. IF YOO 111110 10 081111 FI SULI IIlfH YOUR DIR OR 11 AIIORDY BIPORI RICORDIIG YOUR
allMllCIIIII!. JOBS II IUD 10 RlCORD AID POST 1 IIOT I.
L__-
STATB OF FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATll OF FLORIDA
Coom' 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 wbo did/did not
take an oCJ.th.
(Signature)
(Namf!. Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or StilllPed)
NOTARY PUBLIC
. .,
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Corv'lpLL{ W i~ BLjY; - Stl-iS~:)
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CONTRACTOR #: 999999
NAME: KAREN SYSK
ADDR: 11718 FIFE AVE
C/ST: TAMPA, FL 33617
C E N T R ALP E R M I T TIN G DATE: 02/06/96
PASCO COUNTY, FLORIDA PAGE: 1 OF 1
ISSUE OFFICE: D
RECEIPT NUMBR: 00273231
OFFICE: DADE CITY
FOR:
CHECK # CASH
RESOURCE FOR Z/HILLS #4331 B
CONTRACTOR: 999999
ACCNT
114
TOTAL AMOUNT:
COMPNY ACCOUNT CENTER
8450 - 363000 - 2
46.72
AMOUNT DESCRIPTION/PERMT DATA DRICR
46.72 ****** SOLID WASTE FEE 60
PASCO COUNTY, FLORIDA
Permit No.
Location
ClassificationlType 0
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT D
Rate $
Zone No.
Sq. Ft./U nit
Prepared By
Impact Fee Amount $
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted
by the Board of County Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy
or authority to utilize the permitted structure.
RESOURCE RECOVERY ASSESSMENT
EXEMPT D
RESIDENTIAL
~!o / 7~
NONRESIDENTIAL
No. Units
Gross Sq. Ft. (GSF)
RatelER U - 50.00 IYear
or $0. 137/Day
ERU Assign No.
Assessment - (No. Units) x ($0.137)
x (No. Days)
Assessment -
(GSF) x (ERU) X (0.137) x (No. Days)
100
TOTAL FEE $
TOTAL FEE $
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 recei
the building permit owue, on no'7"1 ~ assessmeut and fb condih e t ,
c::1- ~ - lJ" (.
Date
-------------------------------------------------------------------------------------------
OFFICE USE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. N<bl13:2 3 I
DATE
DATE
;).- b- q~
BY
BY
~
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal:ce
PC93113094/A