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BUILDING PERMII 0
CITY OF ZEPHYRHILLS Permit ]I ·
(813) 788-6611
:35'
PLUMBING
:-527Q8
-
Date
/0-.3- 9S'
-
~5
-
~D
MECHANICAL
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pamoll.D..3- - -~~-- ~ -~Q- EJ_")/D
~:::~~tionty~~~~Jid:: 0.:L9' - /~; l!7,flY:=
NO OCCUPANCY BEFORE C.O. FINAL I D.. '
a;lV
Sewer Conn ~ :J7ej-
. C~~Tl.-
Water Conn: ::l ~ RE-PtT-
1)0
Water Meter: /h5'
00
I; I/~ ()" --
BUILDING
ELECTRICAL
DATE
C.O. /0 -/0 -9.!::.
I:tu TE
Inspector M1
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
~ ?J7(FG /0 -/J--~ ~ '/~Y/1
cfl77
Permit Fee
Signature
Company
Address
Valuation or
Contract Price
.
Ftr.
Pre SLB
Unto' ~ ~
FRM. ^-) C )"
Insul. CL 0 .il/' 7
WL -1 rb V
( "
Tp. Servo
Rough In
Meter Can ID - 3- 5's--
Const. Pole
Pool
Pre-Meter .. t!i:i5
Final IO"~ 1- q ') "
SLB
Tub Set
Water
Sewer
Final /O-tj-1, 1~llL
Breakers
Ducts Insl.
Compressor is 5>
Final /0 --7 - ~ 5 "'I>
Driveway
REINSPECTION FEES: When extra inspection trips are n~cessary due to anyone of the following reasons, a 0
charge of Fifteen and 00/100 Dollars ($15.00) shall be made for each trip for each trade: /1 .. . .~) L.5511).JJ1L
a. Wrong Address ~ ~ ~ S----
b. Condemned work resulting from faulty construction. /D " 9~
c. Repairs or corrections not made when inspection called. Ii, 10-1[//
d. Work not ready for inspection when called. /}-OL
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 PERl>lIT
CITY OF ZEPHYRIlILLS
BUILDING DEPARnlENT
~u 'iL'/''J--~'r
j1- 10 .
APPLICANT -1d- ~~ I l\.fTt:.R: srnT-=r.
ADDRESS -35'" z..lo 1 H uJ Y 5 ~+ ,.' (.0 EST
OI-lNER J:I A (ltl~ 4. VI1. tLS''[ '= M, $cHJV1 lTff ~
JOB LOCATION ~Ol'~ R-:ti)(f<i(~H1It bR-
OS', BLOCKOOaIJI) SUBDIVISION
3'-1b -:11 -or30-~OOOO- 0510
PlI~NI~l~~ S" L- - 7 Z-: f b'
Jlt./ 'I Id'1. f~
LOT SIZE Or; X 10o.'t]i\EEA
LEGAL DESCEIPTION: LOTes)
Z f:iJHc((l
SQ.FT. tJ(()O
R r.() (-(...,
PARCEL I, D. {!
WORK PROPOSED:.iX.J:le\, Construction
_Addition
_Alteration
_Rl2pair
_Ins tall
_Sign/Temp.
PROPOSED USE: ~Single family
_Sign
_~love
_Demolish
, .~~l/ H
-":",,,-M/F
_ii of Units
_Commercial
_Indust.
_Swim,. Pool
Other
BUILDING SIZE:
_Restaurant & Health Department Approval
IOO~
).~&,
Square fee t,
.
t <) r Oil.. ~
Height
RESIDENTIAL:
COHl'lERCIAL :
A TT ACH (2) PLOT PLANS & (2) SETS Of BUILDING PLANS (t (1) SET ENERGY FOR!-IS. **
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FOR~lS. H
**COPY OF CONTRACT REQUIRED.
:EERMTTS REOUESTED
J BUILDING
7ELECTRICAL
.-L~lECHANICAL
/ PLilllB~NG
$
dJo, 50 0
J50
$ -1~ O(J
- I .'
Valuation of Total Construction
AMP Service
Florida Power Corp.
-*-1-l.R.E.C.
Valuation of Mechanical Installation
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block
_Frame _Steel
,41 H,
Other
FINISHED fLOOR ELEVATIONS: FT.
-f( * **-1(*..'e *i:*"*** *********** * ofe * -;e ..'cofe '1e..'-: .:c ..'e ....; -1; 'I'; :'; ....: ..'; * ..';
.cONTR~~~~~n~E~lil:i-e :c ~f--rfJ'Z~mT-E /'
State Cert. or F.c(',ist, ii ~~
Ci ty License FCf','i~; ('.1';\ L i.nn il ~ '-l-7-
"' * 1: ** * * * * * * * ******* * * * 1,,', i, 1: * 1, i, i, i, i: ,', ,', .:,;, i, ,', ,',;",.:: -.
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7
Company :..JJ t::1---S0 U (Z Y ('() A----N
State Cert. or Regis t. !.~ ~
City .License Registration ii ..r~, J.1<t
*****************************************
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. Company 6A-H-i(.." ~E. cl--I'Y~C
State Cert. or Regis t, 1'-
- tl~ . City License Registration " /
>.....*...*********...***.*..********",.** ~7
DTHF:R
Signature
Company
State Cert I or ReGis t. 1,~
City License Registration,
******************************************
PER~lIT OFFICER.
APPLICATION APPROVED BY
CC;~,lD IT:;: Ot'-lS C,:-, i=>Efif'1 I T ,',:'-F I Dn'.' I ";-
A. NOTICE OF DEEp RESTRICIIONS
Thf,undersigned understands Ihet thl~ per~it may bf subject to "deed restrlctiDns' Hhich may be DDre restrjctlve than City
regulations. The undersignDd aS5u~e5 responslbllity~for compliance Hith any applicable deed restrictions.
E. UNL I CENSED C[\NTRA,CT..ORS AND CONTRACTOR RESPO]\IS I fl I LIT I ES
If the owner has hired a cDntractDr ,or contractors to undertake Hork, 'they nay be required tD be licensed in aCCDrdance Hlth
state and local rcgulatlo'ns, If \h" cr,ntractor is not liceml:d as requirl:d by liill, b(,H, the ('\lner and cDntractDr ~ay bf
cited for a ~isde~eanor viDlatiDn under statf laH., If the owner or intended contractDr are uncertain as to Hhat licensing
requirelents aay apply for Ih~ intended Hork, they are advised to cDntact the City of 2ephyrhills Building Depart~en!, (8131
788-6611.
Further~ore, if the owner h~s ~irrd a cDntractor or contractors, he is advised to have the contractor(s) sign portions of the
'Contractor SectiDns' of this ~pplicition for which they Hill be responsible. If YDU, as the owner sign as the CDntractor,
you are indicating that YO\:, fiilhcr th3n the contractor, are respe,nsible for the H[,rI:. If the [(,ntracte,r wishes y('U to sign
as contractor that may be an iildjc3~ion that he is not properly licensed ~nd is not entitled to perlitting privileges in the
City of Zephyrhil Is.
C. TRANSPORTATIQl0_t1~f\CT FEES AND UTILITY CON!,Ir::CTIO~L..E.f:TS
D.
CONSTRUCT I Of\! .L"J,j=:N LA\.-L
(CHAPTER 713~ FLORID~ STATUTES, AS AMENDED)
I certify that I, the applic2nt, have been provided with a copy of 'Florida's Construction Lien La" - Ho~eowner's Protection
Guide' prepared by the Fle,ridil !)['par\~;ent of Agriculture and Consui:\er Mfairs. If the "[,pliciln! is s(,:c6ne Dther than the
'owner', I certify that I :';:'12 e,bL,incd a, copy of the above described dHument and pr('IT,i~e in 0.c:od faith to delil'Dr it to: the
'owner' prior to CDs~encemcrt.
~ I .. .; 7 \
E. CONTRACTOR'S/DWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all Hor~ Hill be done In co~pliance with all
applicable laMS regulating CGnstruction, zoning, and land develop~ent.
Application is hereby lade tD obtain a permit to'do work and instal12tion as indicated. I certify that no work Dr
installation has co~~enced prior to issuance of a permit and that all work Hill be perfDr~ed to roeet standards of all laws
regulating construction, City codes, zDning r~gulatiDns, and land development regulations in Ihe jurisdiction. I alsD
certify that I understand that the r~~ulations of other governmental agencies ~ay apply'to the intended Hork, and that it is
/tY responsibility te. identify \lhat actions I roust take to be in cDmpliance. Sucl, <1gerlcies include bid ~I C lid jir.ited to:
. ,-
I Deparhcnt of EnvirDn~ental R~o\lJation - CyprESS Bayheads, Heiland nr~as and EnvirC<r'if,cntally Sensi tjie L:li':ds,
Water/WasteHater Treatment
i Southwest Florida Water ManaQe~ent District - Hells; Cypress Bayheads, Hetland Areas, Altering WatercDursEs
I Arcy CorDS ,of EnQineer~ - SeaHalls, Docks, Navigable \/aterHays
I Department (,f Health I, [':r:l"ib.ilita\iv~ Services, Environm~ntal Hcal!h Unit - Ildl5, \lilSte\1ater Tre"t'~',f\\. Septic Tanks
I US Environaental Protection Arency - AsbEstoS abate~ent
also certify that, if fill "atr:riaJ is to be used in Fl[,od Ze,ne 'n' [.r 'JI,DtC,', it is \In[Jt'r~t(o(:d li"l a drainage plan
addressing a '[o~pensating vDlu~e' Hill be submitted "hich is prepared by a professional engin~er regi5t~r0~ in the Slate of
Florida prior to per~it iosuancc.
A perlit issued shall be lonstrued to be a license to proceed Hith the Hork and not as authority to yioj~le, C2ncel alter, or
set aside any provisions Gf the technical codes, nor shall issuance of a permit prevent the Building Official fro~ thereafter
requiring a ce.rrectle.n (,f errDrs in plans; C[,nstructie.n, e.r viol;;tions of any c[,de. Eveq r['r~it iS5\!I'j 01',011 b~ce'fD invalid
unless the ~[,rk autheori7r:d by such permit is ce'/lIilenced \lithin six Ilionths of issu.1JiCe, (,r if 11[<\ ~ ;;ull,['1 I;od by the per~it is
suspended Dr abandoned fDr a period of six months after the t;~e the \lor~ is co~menc[d. One 90 day e~le~si011 of ti~e, ~JY be
all(,wed fe,r the per"it ,lith fee charge Df ~15,OO. The extension ,hall be requested in \nitin0 t(, the' Building Official. An
approved inspectie,n ~us\ be 1e'9geo during each six month period, Of the pre,jt'd Hill be c('C1si,!crcd dbal,Gi",c,d.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COM~lENCEMENT MAY
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPER1"Y. IF YOU
INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY
BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOGS UNDER $2,500 IN VALUE
DO NOT NEED TO f~ECOFD n POST A "NOTICE OF COMtvlENCEi'lE::r\lT".
SIGNATURE AG~;-1;~-;;;;:;:Y- YJJ~~ATlInE-~~~;'AUY ~,
DATE f'-/?,.--- 9r/ DATE f - / j' - 9'1-
--------------------------------------- -----------------------------------
NOTARY AS TO' NOTARY AS TO 'A/_. A 11 ::9
OWNER an AGENT___'::-~-'rt,~,;:~L (}~_w3;-:.,~ caNTRAcTaR_____~...d- - Pv.._ ^-
klt'n-iLCl=-t..J $ 'BRC;Jk.J" K ArnL~---0... g-{fh:)iJ
MY COMMISSION Exr:nEs______________________ MY COMMISSION ExrIRES__________________
...~I\V PVe
-+~ .6. '1t
~~*
-;,~~~
. F OF f~l)~ .
KATHLEEN J BROWN
Mv Commlnlon CC448029
,,-"pires~. 02. 1S199
Bonded by I'o{FNU.
800-224-6388 .
~~..
.~..~
if,., Of ,\.O~
KAMl!!I[!N"~
MV ~QC4'49020
,~.,~.1Q99
aonded by NI'lNU
800-22408388
SITE PLAN
(RESIDENTIAL USE ONLY)
PARCEL I.D.
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SEe
TYil'
&11
SUlllJ
I) {,,' K /60 f 3'3
t;c>u; /i1. )CHM ZT/~t
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RNG
cC.PO()
llLOCK
051 ()
LOT
l'ROI'EHTY I-IEASUHEMENT
10 Lj, IJ
CUluu-xr OWNEHS !-(/If:.Ji. C/ 4 0(1.
DATE
9Jf/1S/
, .
Ai 1 c:t r<f~I-,' ttqq
five acres or less.
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PASCO COUNTY, FLORIDA
Permit No.
Date Permitted
Builder Name/Owner Name
County Parcel No.
Location
Subd.
Classification/Type of Use
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
NONRESIDENTIAL
No. Units
/
Gross Sq. Ft. (GSF)
Rate/ERU - 50.00 x 0.96*/Year
or $0. 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
Bldg/lnsp
feecal:ce