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BUILDING PERMIT
Permit N~
CITY OF ZEPHYRHILLS
(813) 788-6611
4565 fj
Date /;l - ~/ - 7 'f
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
'~
Property Owner:. A'1
Job Add.." ,~-:/h, - ~ - - . Llt" P r
Water Conn:
Water Meter:
T,LF.'s:
Parcel LD. #
Zoning: Energy Code: Radon Gas:
Description of wor;:?(v~'Y'E ~;;~L~ ../AJ-71P i
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NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordar'ce with City Codes and Ordinances.
Inspector
"'3.b
Pe,m;l Fee ~'V --?"M..~
Signature ' c-<
Company
Address
Valuation or
Contract Price ~ J trl7 - n~
City License Registration #
State Certified License#
Telephone#
'104--7<;1 -' ~r'1'\ 4-
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BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
Tp. Serv.
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
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.
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APPLICAnON FOR PERKIT
CITY OF ZEPBYlUIILLS
BUILDING DEPARTHENT
OWNER'S NAHB
~l>V\ Hrl.V"\" 'rlvte\ Tr<A-:5-1-
OWNER'S ADDRESS
54~<
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Co V""\ \,0 r'\ j PHONE
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'8\'?'!-1'82- \'507
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JOB ADDRESS
5435
LEGAL DESCRIP'lION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.#
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:-Hew Construction -.-.Addition ~teration -.Jlepair _Install
_Sign
-Jove
-Deaolish
PROPOsmUSE: _S~leF_i~
_::~.J~~erCial
-JIF _' of Units ----1I/H
_Indust. _Swia. Pool _Other
Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: R €- \'V\ 0 '\I e. fd r -\ . I t \ OY\ W d \ \ (1 r..c\ \ e.. - \ )'\ ~ \- tl \\ c\ 00 ,
BUlLDIRG SIZE: 1"2. Z. X ~ 0 ,\ D I q ~ 0 Square Feet, Height
RESIDEBTIAL:
COMMERCIAL :
An'ACII (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
An'ACII (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
/ BUlLDIRG
PERMITS REOUESTED
$
~o 0
Valuation of Total Construction
RT.RCTRICAL
AIIP Service
Florida Power Corp.
W.R.E.C.
--.JIECBAI'1CAL
$.
Valuation of lIechanical Installation
-PLUllBIRG GAS ROOFING
SPECIALTY '
TYPE OF CONSTRUcnON: ---Bl.oclt _Fraae _Steel
Other
FIlfISBED FLOOR ELEVAnONS:
Fl.
IS PROJECT IN FLOOD ZONE AREA?
..........................................
YES NO
CONTRACTOR SECTION
" . . ."
BUTl.llBR ~~... . . CliIIpAIIY La,;e-(ec E,,'ll . L."".... ;L~.
~ State Cert. or Regist. # c: e,c.. 05 fa <=\ -, ~
Signature ' Af ; City License Registration' 93 b
./ . ........................................
RT .RCTRICIAII
COMPANY
State Cert. or Regist. .
City License Registration .
..........................................
Si DnA ture
PLUMBER
COMPANY
State Cert. or !legist. f
City License Registration .
..........................................
Signature
IlECllANlGAL
COMPANY
State Cert. or !legist. f
City License Registration f
..........................................
Signature
OTIIRR COMPANY
State Cert. or Regist. ,
Signature City License Registration .
..........................................
APPLICAnOll APP1lOVllD BY '-11a.4d "'~ JJJ ~J PIlIIIlIr OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
fbe undersigned understands that this Pl!Ilit lilY be subject to 'deed restrictiOll8' wbieb lilY be lOre restrictive than City
regulatiOll8. fbe undersigned assUIeB responsibility for COIpliance with any applicable deed restrictiOll8.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OIIIler 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 lisdeJeallor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirelents lilY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtbeIlore, if the OlOler bas bired a contractor or contractors, he is advised to bave the contractor(s) sign portions 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 wishes JOU to sign
as contractor that lilY be an indication that be is not properly licensed and is not entitled to peIlitting privileges in the
City of Zepbyrbills.
C. TRANSPORTATION IMPACT FEES AND UTILI~ 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 'Plorida's construction Lien La - BoIeoImer's Protection
Guide' prepared by the Florida Departlent of Agriculture and ConsUIeI Affairs. If the applicant is SOIeOIl! other than the
'owner', I certify that I have obtained a copy of the above described docUIent and prolise in good faith to deliver it to the
'owner' prior to C~Cl!lH!llt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoIliltion in this application is accurate and that all work will be done in COJpliance with all
applicable laws regulating construction, loning, and land developll!llt.
Application is hereby lade to obtain a perait to do work and installation as indicated. I certify that no work or
installation bas CDlenced prior to issuance of a penit and that all work will be perfOIJed to Jelt stanc1ards of all laws
regulating construction, City codes, loning regulations, and land developl8llt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveruental agencies lilY apply to the intencled lIOrk, and that it is
Iy responsibility to identify wbat actions I lust take to be in COI(Iliance. Such agencies include but are not lilited to:
t Departlent of EnvirODlelltal Regulation - Cypress Baybeads, Wetland Areas and InvlroDleDtally Sensitive Lands,
Water/Wastewater !reatlent
t Southwest Florida Water Hanagelent District - lIells, Cypress Baybeads, lIetland Areas, Altering lIatercourses
t ArlY Corps of Engineers - Seawalls, Docks, lIavigable lIatenays
t Departlent of Health' Rebabilitative Services, EnvirODlleDtal Health Unit - lIells, Wastewater !reatlent, Septic tanks
t US InvirODleDtal Protection Agency - Asbestos abatell!J1t
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 volUl8' will be sublitted wbieb is prepared by a professional engineer regist~ed in the State of
Florida prior to peIlit issuance.
A perlit issued shall be construed to be a license to proceed ,lith the lIOrk and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall issuance of a peIlit prevent the Building Official fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery petlit issued shall beCC118 invalid
unless the work authoriled by sueb peIlit is COIIl!Ilced within slllOnths of issuance, or if IOrk 8lltboriled by the petlit is
suspended or abandoned for a period of sil IODths after the tiIIe the work is ~ced. One 90 day atensicm of tille, lilY be
allowed for the perlit with fee charge of $15.00. fbe atension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during each sil IOnth period, or the project will be considered abandoned.
WARMIIG 'f0 omR: YOUR FAILURE !O RECORD A 10nCE OF ctIIHDCIHIII'f HAY RESUL'f II YOUR PAYDlG filCE FOR IHPROVIIIBIlIS 'f0 YOUR
PROPIR'lY. IF YOU Im1ID !O OB'flIII FUIAI1CIKG, COHSUL! WUK lOOK LIIIDIR OR AI AnGRIlY BIFORI RICORDDlG YOUR lO'flCE OF
ClJIMIIICBMBNt. JOBS UIIDIR .2,500 11 VALUE DO NO! lIED 'fO RICORD AID POS'f A "O!ICH OF C<lIIIIIICIMINI'.
UM~. ~d~~
SIGNAtuRE: OIOIBR OR IGBII1' ' tuRE: COIl1' '
SfA!E OF F~A do
coum OF Y nOi Y\
Tbe foregoin~ ~~t was AG~owledged
before me thIS , , 1~ by
_'Ra~v~
who i ersonall known to m or wbo bas
pr ced
a i t'fica. wbo di
t ath
S'fA!E OF FLORIDA ~ '
COUII1'Y OF ~ V" na
The foregoing i~s~~t_was a~pwledged
before me this ~, 19 ~. by
1.\)15. ~~~e~
wbo is sona own to itJor who bas
produced
a . d tificat. and wbo did~
e oct.. '
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(Name Typed, Pri
NOTARY PUBLIC
8AUAIA J SEWIiLL
NOTAIY PUBUC Sf ATE OF FLORIDA
COMMISSION NO. C069131
MYCOM~!S.c;lON or!', MAY 3.199@,
SEWELL '
J'l,mUC STATE OF FLOIlD
COMMl!>S10N NO. CC369731
'N r:0MM~,lO!,1 ~t:~E]~
...............-.-.
ZEPHYRHILLS FIRE DEPT
Zephyrhills Florida 33540 (813) 782-8184
FIRE CODE INSPECTION
Business Name
Classification~:i . " ,.> /
Address
I.~ " //
~.j /, "
Owner/Manager
.'
/<r/,/ " .,.~..-:., /' (
Business Phone
Emergency Contact Phone "7; / - T' ::;
Occupancy Load
Alarm Monitoring Co.
Phone #
TYPE OF INSPECTION CONDUCTED
o QUARTERLY
ORE-INSPECTION
([) APPROVEDi"
G;. 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
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Inspect. Time
i~(-:,:_,;-;,~'
Fire Dept. 10 #
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Re-Inspect. Date ."lnspectors-Name.J /" /-,'V ','- 1 ,p /t,.
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Owner/Manager Signature' ' ,/ // ,1;(.1 'l'-~' X ~.LA c,f\..~_u ~ Title<I.?//I7(,-_ '/~v /.
This building has been checked by the 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. Dept. Pink Copy _ Business
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