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BUILDING PERMIT:-
CITY OF ZEPHYRHILLS Permit N ·
(813) 788-6611
~~502~8
Date b
-/ '1- 9'~-
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
::~:::::~e'i ~~?it';~ L
Parcell.D. #
{1'" -
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Water Meter:
T.I.F.'s:
Zoning: . 'dL.. Code: ~
Description of Work AJ ./Z if A-I.
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
Valuation or
Contract Price
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Permit Fee .
S;gnaMe ~~ } _
Company
Address
City License Registration # --S6-_~
State Certified License#
90l/ - 79'/ - lC;d ~
-
Telephone#
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BUILDING
tt714-
ELECTRICAL..;2/ ?
PLUMBING
MECHANICAL
Ftr. /"'
P'e SLS<: ~ f<~
Lintel \_' ~
FRM. ...-
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
[)ucts Insl.
Compressor
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.
....-
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APPLlCAnON FOR PERltIT
CITY OP ZEPBnmlLLS
BUlLDDlG DEPAR'l'MENT
OWNER'S IWtB ;?1C\tr)\evs
0WlIER.' S ADDRESS 3lS" I () c(
-=< ~' lOCI
JOB ADDRESS --.-/ I
nf'~ga~(,_ C (~1,b7-1jd7--'6:0d
(Y/c( r Ie S€ ~ .,I"€ Ze /7A yr A.lll ~- FL._
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()1 C(. r- k ~ --'-:>-8 (.J,.."'A r e
LEGAL DESClllP'1'ION: I.OT(S)
PARCEL I.D.'
BLDCIL-SUBDIVISION
(OBTAIN FROM PROPQTY TAX NOTICE)
.
WORK PROPOSED:___.Jew Coastruction -...Addition --..Alteration
hip
Repair _Install
--.JIove
~lish
PROPOSED USE: _Single F8IIily
-b.ec-ercial
---lI/F _' of Units ---lI/B
_lDdust. _Swia. Pool _Otl;1er
Restaurant &: Bea1th Departaent Approval
Wo-- { ( S/q 1'1
/ .
~e Peet,
DESClllP'1'IOB OF WORK:
BUlLDDlG SIZE:
x
Height
RESIDEIITIAL:
COMMERCIAL :
ATTACH (2) PLOT PLABS &: (2) SETS OP BUlLDDlG PLANS &: (1) SET DERGY POR!lS.
ArlACH (3) SETS OP BUlLDDlG PLANS &: (1) SET BRERGY FOlUIS.
PROPERTY SURVEY REQUIRED FOR ALL NEW COBSTRUCTION.
PERMITS REQUESTED
~UlLDDlG
$. 33..50 .~
Valuation of Total Construction
RT.RCTBlCAL
AKP Service
Florida Power Corp.
W.R.E.C.
---lIBCIIAIIlCAL
$.
Valuation of 1lechanica1 Installation
-PLUKBDG GAS ROOFING
TYPE OP COBSTJWCTIOB: __loclt _Praae _Steel
SPECIALTY
Other
FDlSIIED FLOO1l ELEVAfiOBS:
Fl.
IS PROJEct IB FLOOD ZOO AREA'
..........................................
YES NO
RIJTT.DRR
COBTRACTOR SECTION
. 1fJ- c 5)
COIIPAIIY jl-Oc;if' /' -> /If' "- i~n;f Inr.
State Cert./or Regist.' r
City License Registration . <;-srs
..........................................
Signature
RT .RC'l'RICIAIII
COMPANY
State Cert. or Regist. .
City License Registration'
..........................................
Sign~ture
PLlJllRER
COIIPAIIY
State Cert. or Regist. .
City License Registration .
..........................................
Signature
tlECllABICAI.
COMPANY
State Cert. or Regist. .
City License Registration f
..........................................
Signature
OTRRR
COMPAIIY
State Cert. or Regist. ,
City License Registration ,
..........................................
Signature
APPLlCAnOB APPROVED BY
PERHIT OFFICER.
,.,.~-.,....~~..
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
!be undersigned understands that tbis perIIit laY be subject to 'deed restrictiODS' wbich laY be lOre restrictive than City
regulatiODS. !be undersigned assUlleS responsibility for cmpliance witb any applicable deed restrictiODS.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the OIIJler bas bired a contractor or contractorsto undertake IIOrk, they laY be required to be licensed in accordance witb
state and local. regulatiODS. If tbe contractor is not licensed as required by law, botb tbe 0IIleI and contractor laY be
cited for a IisdeEanor violation under state law. If tbe owner or intended contractor are uncertain as to wbat licensing
requireaents laY apply for tbe intended work, tbey are advised to CODtact the City of Zepbyrbll1s Building Departlent, (813)
788-6611.
FurtbeIlore, if the ower bas bired a contractor or contractors, be is advised to have tbe contractor(s) sign porti0D8 of the
'Contractor Sections' of tbis application for which tbey will be responsible. If JOU, as tbe ower sign as the contractor,
you are indicating that JOU, rather than the contractor, are responsible for the work. If tbe contractor wiabes you to sign
as contractor that laY be an indication that be is not properly licensed and is not entitled to perJitting privileges in tbe
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, tbe applicant, bave been provided witb a copy of 'Plorida's construction Lien Law - lkIIeoImer's Protection
Guide' prepared by the Plori4a Departlent of Agriculture and ConsUIeI Affairs. If the applicant is 8CIIeOIle other than the
'OIIIler', I certify that I bave obtained a copy of the above described docUIent and prolise in good faith to deliver it to the
lownerl prior to co.enC8IIeDt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the infoIliltion in this application is accurate and that allllOrk will-be done in COI(lliance witb all
applicable laws regulating construction, lOlling, and land developunt.
Application is hereby Jade to obtain a perlit to do work and installation as indicated. I certify that no IIOrk or
installation bas CDleDced prior to issuance of a perIIit and that all work will be perfoned to _t standards of all 1_
regulating construction, City codes, zoning regulations, and land develOplll!llt regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDlleDtal agencies laY apply to the intended wort, and that it is
If responsibility to identify wbat actions I lUSt take to be in COJpliance. Such agencies include but are not liJited to:
* Departlent of Bnvi1'Olllelltal Regulation - Cypress Baybeads, Wetland Areas and BnvirOllleDtally Sensitive Lands,
Water ,Wastewater 'freatllent
* Southwest Plorida Water ManageleDt District - Veils, Cypress Baybeads, Wetland Areas, Iltering Watercourses
t ArIY Corps of Engineers - Seawalls, Docks, lavigable Waterways
t Departlent of Health i Rehabilitative Services, BnvirOJlleDtal Healtb Unit - Vells, Wastewater 'freatlent, Septic I_
t US Bnvil'OllEltal Protection Agency - Asbestos abatl!leDt
I also certify that, if fllllaterial is to be used in Flood loIle III or II, etc. I, it is understood that a drainage plan
addressing a lCOIP8D8ating vol_I wll1 be sw.itted which is prepared by a professional engineer registered in the State of
Florida prior to perllt issuance.
I ~it issued sball be construed to be a license to proceed witb the IIOrk and not as authority to violate, cancel alter, or
set aside any provisi0D8 of the technical codes, nor sball issuance of a perlit prevent tbe Building Official fIOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery perJit issued sball becoIe invalid
unless the IIOrk authoriled by such perlit is ~ced within si1lO1ltbs of issuance, or if IIOrk authoriled by the perlit is
suspended or abandoned for a period of sil IOIltbs after the tile tbe work is ~ced. One 90 day atension of tile, laY be
allOlled for tbe perIIit witb fee charge of $15.00. Ibe atension shall be requested in writing to the Building Official. In
approved inspection lUSt be logged during each sil atb period, or the project will be considered abandonecJ.
DIlHIIG 'fO <*ID: YOUR PIlLURE 'fO RECORD IIO'fICE OP CCIIIDCIIIII'f MAY RlSOL'f II YOUR PIYIIIG 'fIIICE POR.IMPROVIIIBI'fS 'fO YOUR
PROPIR'fY. IF YOO mmm 'fO 0B'f1Il FI_IIG, COISOLr VI'fB YOUR LIlIDIR OR II 1'f'fOHDY BIFORI RJaIIDIJIG YOOR DICE OP
aJIMIl(CBHBII'f. JOBS OlDER $2,500 II VALUI 00 1O'f KIID 'f0 RECORD lID POS'f I 'OICE OP ClINKCIMD'fl.
SIGII!URI: (MIIR OR IGIII'f
jd-~
SIGIII'fURI :
Stili OF FLORIDA
COUII'fY OF
The foregoing instrument was acknowledged
before me this , 19_ by.
SliD OP FLORIDA
coum OF
The foregoing instrument was acknowledged
before me this , 19_____ by
who is personally known to me or who has
produced
as identification and who did/did not
take an oa.th.
who is personally known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Name Typed, Printed or Stuped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
ROGERS S!GN DEPOT INC.
904799065:=:.
P.01
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Signatu~e of El~ctri~al Contractu
Cvlltractor License NUl;loer
~~
STATE OF FLORIDA
CO~TY OF PINELLAs
Her~ bc!fore me appeared John It- Kavula: personnally known
13th day of June. 1995.
."'l-;;''i.!''~", SHARON L MATI.OCK
l~~." ~; MY COWJJSS10N , CC339618 EXPIRES
~~ '~ ',January 4, lssa .
"'. . ..;;l.~:-., SOllCfD Tr1RU 'lilOY FAlH lHSUl'!ANCE.1/lC.
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Post.lt'" brand fax trar:smija! memo 7671 1101 pages ..
T~
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Dept.
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ROGERS SIGN DEPOT INC.
9047990653
P.02
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SiKn~t, Ine.
101 DANIEL AVENUE
B O~K.$VILLE, FL 34601
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Contract
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'(904) 799-1923
, I
. FAX 799-0653
o te ,. 4L 26-9.5
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GENTLEMeN~ Rogers Slon Depol, Inc. proposes 10 manufacture and/or deliver, and/or Install the Ilems deserl din thl;s proposal, subject
to the terms and condlllons set forth on both the front and ba,ek 01 this proposal, Prices charged lor serv CBS renfered and/or lIems
manulactured are quoted in the schedula below. Terms and condrlrons on back are part of this contract. :
I ' "
Proposal Submitted To I Work To Be Perfor I
"A Sign Of Quality"
"
NlIm8 Matthews Orthoped:i,~ ._C1inic__ Street Florida ~e.~ical
Street .__S-f-/q '7 1l1..~ 26-- City ._S.uite# ,t1a~
City ___-_StaI9____ DateofPlans_",
TQIQphol'leNumber AO~42S-88_Q2__ '_. Store Front__ '_'_
We will furnish JiI~~ ~ufMd 7m-a~i1s. ~~~~Wg guarantCIJi~tt al~p1,;j,fat.I;;,1 JeSw'" perfor", a
completion of: .
li~ib
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at~.tiua n~ ~ ~~ph.Y rh ilL
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the labor required for the
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Manufacture and Install one set of 16" illuminated charine
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le~ters
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:
Copy: MATTHEWS ORTHO~DIC CLINIC
co~ors: as per approved drawing.
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Layout:
as per approved drawing.
. ,':t:.
AMOUNT
,.;.
fdc.K# 9/0
Bala
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Ta
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Total
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$3,350.00
100.00
Letter blank panels - two 2' x 11'6"
Pan Faces
..
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Copy: as per customer specifications.
Pe
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Co'lors: Blue :11=
Lettering
included
-.'
.00
1 , 725 . 00 # "'_
. .~,
$1.725.00
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(1) P~nTone Colors are 100.00 per color eXlra.(2) CU5tomer 15 responsible for fInal electrical connection to gn a'nd ;tor location of Sign.
One drawing per contract will be lurnlshed_ (3) Gontract to be paid In full on in6tallation_ Each addlllonaltrlp r collection will be Charged
an ad,dil1onal 50.00 min., (4) Changes In the above !OPllcltlcalions may be made only upon wrlllen agreame t. and el'tra Charges will btol
mllde. All ~grQQmQnls are contingent upon :'ltrikes, ac;cldBnl:'l or delays beyond our controL You are to c rry fire,! tornado and other
nec"~9ary In6ur~nCQ upon above work. Our workers are IUlly covered by Workmen's Compensation and Pu lie liability Insurance. This
propoesl may b.. withdrawn by us al any time before cCBptance_ (5) Payments to be made as !ollows: . i
500 Down and Balance U on Com~ lon
NOrlCE
. Acceptance
111.. ..tJovo Price. "''". "p"ceilicdllon, an" condition,; are accepted, Payments will be made as ,fe~lh 8,bOV~
T t---:. _~ _
HH,.p.lr.t',u'lly ~;Thmltled _ _ Bob Roger s, V i c~_ Pre s . SignalUr~ . vcs-tc:-'?-:'. . J~I"
tor Madeline Sefsick, Sales Rep.;
ADDITIONAL TERMS AND CONDITIONS ON BACK
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Colors:
Face - ee.cQ'
Returns - ~
~e
Trir1 - Go IJ<
Raceway - IJ I ~
Facio - ~~e
Bu i ldinQ:
Store front: 'vi -60 H -Oil(
Construction - ~oo f2
Stte Plan -
Electrician -
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110 I.bl t Lac
jQ Pa,Jio fcm
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