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Home My WebLink About96-5504 BUILDING PERMII CITY OF ZEPHYRHILLS Permit ]I! (813) 788.6611 Date /- Cf- 9~ BUILDING ELECTRICAL PLUMBING MECHANICAL Sewer Conn I~ 70- (!)O . Water Conn: 6S'O.O~ Wale,Mele" l?;;s.r!>(J T .1. F .' s: Il!..LIJ.. P,operty Owne, t4~ ~~1~ Job Address: ~ Parcell.D. # ~S -dc'o,L.. J '" c> I~C-~OO~a~a.oO ff Zoning: P, LJ. /J J Energy Code: ' Radon Gas: J" ' S / Description of Work ~ - \Jt.~ ~ ~ NO OCCUPANCY BEFORE C.O. FINAL . Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. I~JL~~~~~~~~~~l~_;~'~~ V I t. Permit Fee a ua Ion or J I &, 4/ ~ Contract Price -r.Jg I 0 Signature Company Address DATE Inspector :if 5~/,~~ City License Registration # I '73 State Certified License# c: Ge a ~Cn 2. ~ C'\ Telephone# ~""(\'ODA.A , 6~ o ~~dj~ #- J 8'1 PLUMBING SLB 1-/5' lib 6u..L. Tub S'et ~.. ~o-. 9" &13 :::3-II"Qt&!r Final Q.rl.~. flu W. i:J.d.93 MECHANICAL BUILDING ~~ (( P'l1~. ..p.goc> ELECTRICAL - Ftr.~ Pre SLB. . e Lintel l-l?'7Jo tUr FRM. 'Z.-20-Qlt, Wn.Lr Insul. CL WL Tp. Servo Rough In ;l--dO-ty(" &lJFl Meter Can j- f- 9.t, Const. Pole ~Jl'1/7(,~J .' Pool pre-Meter~L .Bo b Final fVo~ '\.--' . w~ 1-1(; .fh itV-' Breakers Ducts Insl. ~- 16- Wn &.B Compressor Final REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a charge of Fifteen and 00/100 Dollars ($15.001 shall be made for each triP. for each trade: /J '0. Q /J. JI /-/ -/'-6 a. Wrong Address M~ ~J ~ b. Condemned work resulting from faulty construction. t... 7y c. Repairs or corrections not made when inspection called. ' .1 /) {l ...{;, d. Work not ready for inspection when called. f~ () ,.. oL- - 7 e. Permit not posted on job site. l> f. Plans not at job site. I g. Work not accessible. The payment of inspection fees shall be made before any further permits will be issued to the person owning same. , 0'-6" 89,53' 61,08' :--13' 5-- 7' 0' SO' BAY VILLAGE BUILD ERS 79,69' 33'-1- ---- \J OQ ~ ~ 1b ~ L C1-1B.69' t BAY VILLAGE BUILDERS '!J1'0ht 1995 'Bn,y FiUw;e B'l..Lild~T3, [nt;. CUSTOMER 'S1:tJu VER. o ~, ~t~ '(~~ ;/~ o OA 1($ .. .,Ti:j~;LJJ.~,.$. . '~'.;- :;-:~~~~<:. -o/.-:;.~; . .-:.~. '>:>~~~.~<~:D{: 1A...0..... 4~-~-~- . . : ',~."'. . ,',. ,. ~ '.' '" . '. ..t/~- .~..,::;::;-..: ,)10~,}{J ~ j"l' \' v-Y 821A B2'A o ~'~ x S:f " '" .. --, ~i ] -l> c o o 6'+," x /5;)' ~"riz. .nd.r 0' .' x of hQnz. slid~ / r--'" L__.J ;. -r u/' a:. /It~t- urdkJatiJ . r-::::-'" L__.J J~d Q,: /hf'/r/..t (t-rJ~.. Q /I. t , t.t, II" J o o o o 9' )(, 7' ~ar. ,joor 9' X 7' ~or, Ooor DOOR & vVINDO\;V SCHEDULE ADDRESS: nr.JC# ~ lXJGA ~ ra'PM" F" wt, ~ ,a '. VI i .. "'..,. 'oc " ~' lC <a ...'" fill " " Z tJI rU It ,z., ~~ ~ :/~ :.:=. '11 I.' u ~y Z .. t;" L1 ~Ii;~i~'" ~4 ~7 '/1 X A:$' '" 17 t' '~ ,z rs fl~ = n "'z,", ~ ~ " Z ,. '-"I - It t~ XH 1,/" ~ ~,. /4' Z6;" W t-? i; Z -.r ~ lJ. '/~ 1 I:- flY' ~ ~ ~:: 1::: ,.p u x ,II' 41 I' ;( ~ .., W' % 7( ''''11' ;.c..;l/Ul l.~ r'O'II Jl4 ~ ,;~r:~ ~ ~~ ~ 'iffflrll' , ...,,. ~ rR"" . ~ rr~,ft' :: ~ ' ~"f'g.~ .. w.w... .. '##4."'17' .. #"~- ~(~ III .. ~ r( 1:Tf' ~ .. IW4 "f'~ :011 6''''''''' ^'" "'__ roo ~ I'oot" lY t"o'4 t:: ff- lY~ 60."1 rr ~ s:: J.--.. f<< Tt'" Pd'.c /'or "- rot' 1*........ J'1wa~ ~ QAS$ :>ooff$: CttlI: r:n7t tmr.trr UI II ",I' Z ,. ~'I' .u "f/I' ru'r' ~ ;.n;~~~t~ m ~t:~B~f~ I'<XSrt ~ :zu mJrl ~ Ilt... ~ t'" % 110 &,,/4'1 .t1 " ~ /, J "" ""i.( :;:j ~ n: i :a:$ ~ r., Q ~'r/" z ~ I,;" 'l(J/ "~ :r a , " hlf" 71 .. Z.'-1 ~'l' ",. ;"'4 /-r J( W '/~ :;: = t:~ i: ~;~ IurA ,~# t';~ r., '1/,- ~~ ;'t"#ZX~i!(,~ U!.I .. lj.. :r H 1/' e--~ M f,/~ Z N I';~ ff.iL 1~'(:lj..\'faV.r ~ I#- 't.z;.,C ~ (I' N.r'J ,~~ f ~ j',I' ,Ut ('N .. '/~ riilf :tS HHf: 1460. lW':r..~' 'IoU I.' '(T C"" UI' ,~" '4 ,z-:r.. 1/' /flU "'~'" C.., ~~, ~ ill,1=:: r: ~ "', (It' C ... ~.. / per unit LEGEND: LIVING GARAGE GOV. PATIO ENTRY TOTAL DATE: 1 ~. 1195 282 149 25 1651 2.'3/95 T~ r\: T ~',f~ ~, :::> 7' ~ Bi . co Co (") I . co '0 '-0 !/ I ~ %'fi' _SPNi ~ 13' 4-" + 18' 4- " 1- TO ell 18'4-" -I- 13'4-" I' 3' 5' 7' 7' 5' 3' I' '" FLAT c u; @ ,.,/ I-.!) "It 2\:x:A ~\!l '" 8M:; BY tDR / "'" BMS BY 7' 5' ,3' I' r71 /. I V V =1 ~', i ~ i / /. I 1./ : '/ ! V 'l /' I I 1,/ 'vI . VI .. I e;/ I ~ I " -----4 ~ l I , l\~ ~ ~ J 1/ ..DR ___ /]1= V~ / I'~ 'I / / ~v _,-j7 :/ / ~ '2\ IAFII ~ At SET pi rili N.Jf M d>E ~ FL AT ''''' C ,~b '" ,'" ~ ~"" ,~ "" 1 i"- " "-= 3' 0' 7' 7 s' 3' SPAN i"\..r 1~ ~ lNl ~,v--- "\ I' 3' 5' 7' ~~i "'- r "- '-I I I "- " jj@! I ", : I i'" 1 I",,! I ~l t I '" ~ i i! "'~ l- ---- 1/ I ': ~I C'l ..... Ill[) ~ r-- .... ~ -< -< 1-< /~ -< )~ -- --e-- -- IV IV / / ~/ ~ ! / LINTEL SY BLDR ~ C1 " ~ '" ~ ""- ~ "'- '~ VI- VL c. L& A8 @ ~ JC.. r.. ~~"~ ~~ b y /., ,/ / /. I 1/ /<9- / :~~ V VA VL7 C ~Lc;.. T I I ~ A8 \ '@Z ; ~, " \ LINTEL BY BlD~ - I'l"l /"- b ~? / "" C'l 1'11/ "" 7' 7' /71 ~ " 5' 5' @ "- 3' 3' I' =/ , "- = J' I. I. ScQle: " - 1/8. 14'4" 4-'8" + / I " 1- _~__I_- _..., ---- ^ II!: ~~' ...../ v ~)CV cv (I~) ..... CD 25'4" 63'4" I "- , I 1- 4'8" +--14-'4" . '1 ."- 1 .1 NOTE: ALL TRUSS TO \~ALL CONNECTIONS ARE TO BE SIMPSON ETA20 OR APPROVEO EQUAL FOR MASONARY AND SIMPSON H5 OR APPROVED EQUAL FOR FRAME UNLESS NOTED OTHERWISE ON TRUSS LAYOUT. @ ~ 'SIMPSON i-TS I~ (D - "':::,1 M PSON M T'SI io @ :::. S/Nl P5DN H cTA2..o 5' 7' *SPECIAL NOTES* *NO BACK CHARGES WILL BE HONORED UNLESS APPROVED IN WRITING BY AN OFFICER OF WiD Lu~BER & TRUSS CO, *SPECIAL NOTES* *AEY PARTY WHO CUTS OR DAMAGES A TRUSS SBJQL BE RESPONSIBLE FOR , THE ENGINEERING DESIGN A..ND FOR THE COST OF THE REQUIRED REPAIR! *SPECIAL NOTES* *VERIFY ALL SPANS, CONDITIONS A~~ DIMENSIONS ON THE DRAWING AS THE TRUSSES WILL BE MANUFACTURED ACCORDING TO THIS INFO~~TION! ~........:y *CONTRACTOR NOTE:* *TRUSSES MUST BE ERECTED IN ACCORDfu~CE WITH HIB-91 SUM~ARY SHEET. mJ(ill~31f 0 @@[fJW LOT 2f SIL.V(~ oAI<'S # 28 1 7 0 WID ~ tUMBER & TRU~~ an ~ FECP co. - - -P& J.. of 2- - -- ~ ......... - - -- N OlE-: ALL bR.G,.'S A (2.f:. AT 81 ;~~- ----/ f/ AI \- I- I. -'f1' 12'8' To A 4- 38'a' A'5 "'0 A7 ~ 18'11"12 19'~' 18'8'12 2.5 =- 1-n. -.1, + 17'8' ~ AS ~5 2'1 - - _ 1'5" L, {<" - - - _ __ K' 51') f; +--6'4' -1. 1f+" - . ..., - (~uD@Tr Q (~~lrD)W7 .l!J ~~ _~r lJ WID -~ LUMBER ~ TRU~~ an ~ FECP co. Lo, 2 f # 2 8 1 7 0 S( L v E{~ oA~ 5 ~Ai v I u..AGE.. ~L.bl<:-S -SILVe,e" oA~~ VILLAs ~.2.. PITCH CS T.C.Lf- B.C. if LOAD S~ TAILS 'PL O.C. 7..<{ II H./2.11 BRG. 61/ SCALE.vb:'= I' DATE \\/J(~/q5 DRAWN BY:JL~ REV. P& 2. o~ 2... 5N'1 \/l L-Lc)6(' tS01LOj~ tal/o7 u,\u~U~~o u I I /'1 !::VAlJ.)I\ll:.tJ 7. 41a/g~l. ~(, /'1 I'! \30'L\.')II~G- I:; \,., ' ,j :.:LiiCTP. \C I,. fh-)I",\~N(.:~ t, : I A-~ c () I oJ ';), ii HH~i \\A1\)jU\L- " 30, J ~ I . . 'I SvBTi> rrtL- ,i (j{j-;-iH 'I :~ -_:)0.00 L/ /5. ,,0 101~ (~J ThL '! ! ~ i 1'1 I ; il! / ~,. r;- ; ; LCNNtl-CnCN rl;..rz-S -5b tJ f;, f~ I" I" . )k"~ :"/) III V'U" (I-r,,- I, i Il,\lifiLf, ":: 'I "-lL~rf\ L III I" 1'1 , \ I z.. 7 cg~ c> IJ 3,"'0 c>o . :.7 . I ~.; 0"'~ I; 7tJ 3 :: <> /I(;~I :11 !" I\A\)tN t,1'\~ ," ,1" (__, f)', gl- J ... ~ , t' I. i a- 1'1 . I" I: 1-7~t)rJ6 P(,a-Tn-fi ~^' In1/~'lCr' fiLJ:.- c.~ I:! Iii N J1'r, I Ii II I:: Iii , I" i'l ,., 1" .. i I, " I '! I" 1'1 35~ t-() It ,. i '1 ~ . J I, C ;";< 1/50 .' . 6), n-: l-lVIN 6- ~'1' f-r. oTI't1l-lL ,-~(), CJ:V ''?I? r= ;).;_ A:i. -" n':S- OWNER'S IWm 8AY tlJl/~tje iJ..1A It/) eeS PHONE 99/- ?~6 6 " OliIIER'S ADIlJIBSS /765/ ~R~ ~ _ 1J"'wP/$ ..". . JOB ADDRESS f)-A LAuRe. J},fA/(! 6 ~o7 ~eL--~p,-,/ LEGAL DESCRIP'lION: LOT(S) 2-8-11 BLOCK SUBDIVISION 5ILC:>e,e, O/J1ts PA1lCEL X.D.# O::? - {)b - ;;2 / - O~.9 O-Cl':7a1 a ~ (OQ16JR F1l(llI l,'IlOPEI\II Th lIonclll WORK PROPOSED:~ew Construction ---..Addition ~teration ~epair _Install. APPLICATION FOR PERKIT CITY OF ZEPIIYRHI.LLS BUILDING DEPARTKEBT _Sign ---..Kove ----Peaolish PROPOSED USE: )( Single Faaily ---..KIF _' of Units --1l/B _ec-ercial , _I.ndust. _Swia. Pool ,_Other ---..Restaurant & Health Departaent Approval DESCRI.PTI.ON OF WORK: SJ;lgL..e ~~/Y}/Lv I!p.$' / BUI.LDI.NG SIZE: x Square Feet. Height RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUI.LDI.NG PLANS & (1) SET ENERGY FORHS. COMMERCIAL: ATTACH (3) SETS OF BUI.LDING PLANS & (1) SET ENERGY FOmtS. PROPERTY SURVEY REQUl.RED FOR ALL NEW CONSTRUCTION. PERMITS REOUESTED RT.F.CTRI.CAL $. 5cJ,000 . ISO $. :J. ')00 AtIP Service Valuation of Total Construction X . Florida Power Corp. "I: ---..BUI.LDI.NG W.R.E.C. ---KECIIAliI.CAL Valuation of Hechanica1 I.nstall.ation ---..PLUHBDG GAS x' ROOFING SPECIALTY TYPE OF COBSTRUcnON: X Block _Fraae _Steel Other FI.liI.SBED FLOOR ELEVAnOBS: FT. 1.5 PROJECl IN FLOOD ZONE AREA? .......................................... YES NO CONTRACTOR SECTION' Signature R~ .., . " ) mHPAHY BAv fh/M~, k{v.,L{)eRS r. ~ State Cert~or Regi,st. # Cb~~"OI~q '-^- City License Registration . I ~ . ...................................... , 'COMPANY 0 5' c:c::~ .'. .. .. ~ State Cert. or Regist.' ~/L ~ 2 t5 t;t7~ ~ . City License Registration'. - ~- JtJ'""P .......................................... ' . ~ BUJI.Dm RT.F.CTR:ICIAli SiRnAture :u~~ ;:t, ~.., PLmm~ COMPANY / . State Cert. or Regist. Signature~d~/L<{ Ci.ty License Registration' .......................................... , HECIIAlfi~d ~ COMPANY A..R_ G A,}(J COA/,,{} . ./} .'/J State Cert. or Regist. f C RC 6:?'::;;~~~ Signature "4,,,-. C /J//f\ CP/lI.,t) City License Registration f /~I . < ~.......................................... .~ ...---- OTRF.R COMPANY State 'to or Regist. . Signature City Liv::ase Registration t .............**.....................*..... APPLICAnON APPROVED BY PERKIT OFFICER. .~....' ~ CONDITIONS OF PERMIT AFFIDAVIT ~. NOTICE OF DEED RESTRICTIONS fhe unc1ersigne;d understands that this perlit liar be subject to .deed restrictions' which lily be lOre restrictive than City regulations. fbe undersigned asSUles responsibility for COIpliance lith any applicable deed restrictiODS. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the OIfDer has hired a contractor or contractors to undertate work, 'theYIilY be required to be licensed in accordance ,ith state and local regulations. If the contractor is not licensed. as required by law, both the 0IfDer and contractor lilY be cited for a lisdueanar violation under state law. If the owner or intended contractor are uncertain as to ,hat licensing requireaents aay apply for the intended work, they are advised to contact the City of Zepbyrhills Building DepartJent, (813) 788-6611. FurtberlOre, if the OIfner has hired a contractor or contractors, be is advised to have the contractor(s) sign portiODS of the 'Contractor SectiODS' of this application for which they will be responsible. If you, as the owner sign as the amtractor, you are indicating that you, rather than the contractor, are responsible for the wort. If the contractor ,ishes you to sign as contractor that laY be an indication that he is not properly licensed and Is not entiUed to pt!IIittfng privileges. in the' City of ZephyrhiIls. C. TRANSPORTATION IMPACT. FEES AND UTILITY CONNECTION FEES D. CONSTRUCTION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMBHDED) I certify that I, the applicant,bavebeen'provided lith a copy of 'Florida's Construction Lien Law - lmeowDer'a Protection Guide' prepared by the Florida Departlent of Agriculture.and ConsUI8I Affairs. If the applicant is SOleOD8 other than the lownerl, I certify that I have obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the lownerl prior to co.aencelent. E. CONTRACTOR' S/OWNER' S AFFIDAVIT, I certify that all the inforaation in this application is accurate and that all work ,ill be done in COIpliance lith all applicable lals regulating construction, Joning, and land developlent. Application is bereby lade to obtain a perlit ~o do lork and installation as indicated. I certify that DO worl or iDstallation lias ~ced prior to i8S~ce of a perI1t and that alllfOrl will be perfoIJed to .et .taDdarda of alII.. regulating construction, City codes, loning regulations, and lanel developleJlt regulations in the jurisdiction. I also certify that I understand that the regulations of other goveIDlental agencies laY apply to the intended IOrk, and that it is IY responsibility to identify lhat actions I lust take to be in cOlpliance. Such agencies include but are not lilited to: I Departlent of Envirolllel1tal Regulation - Cypress Blyheads, Wetland Areas and EnviroDl8Dtally Sensitive Lands, lIaterfWastewater !reatlent I SoutJnrest Florida lIater Hanag8lellt District - lIells, Cypress Baybeads, Wetland Areas, Altering Watercourses t AllY COIPS of Engineers - Seawalls, Docts, lavigable lIaterways I DepartJent of Health & Rehabilitative Services, KnvirODlental Health Unit - lIells, Wastewater freatlent, Septic lanls I US BnvfrODlental Protection Agency - Asbestos abatelent I also certify that, if fill aaterial is to be used in Flood ZOne lA' or IA,etc.l, it is understood that a drainage plan addressing a 'cOlpensating vol_I lill be subaitted which is prepared by a professional engineer registered in the State of Florida prior to perlit issuance. A pmit isaued shall be construed to be a license to proceed lith the IOrk 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. Every perait issued shall beCQ18 invalid unless the work authorized by sueb perlit is couenced within sillOnths of issuance, or if worl autborlled by the pmit is suspended or abandoned for a periOd of sillOntba after the tile the work Is C08enced. One 90 day utension of tile, lilY be allowed for the peIlit with fee ebarge of $15.00. Tbe utension shall be requested in writing to the Builting Official. In approved inspection lUst be logged during eaeb sillOnth period, or the project will be considered abandoned. WARJIUG fa OIflfKR: YOUR FAILURE fa RECORD A KOrICE OF C(JOfBHCBJWI1' HAY RESULf IK YOUR PAYIKG fIIlCE FOR IHl'ROVIIfDIS fa YOUR PROPIIm'. IF YOU IJIDID fO OBrAlK FIJlAHCIJlG, COIISULJ VIIB YOUR LBJlDER OR 111 AJrORIBY BEFORE RiCORDIJlG YOUR IOfleR OF COHMEXCBJWI1'. JOBS WIDER $1,500 II VALUE DO liar HEED fO RECORD AlfD POS! A -KaTICE OF C(JIHElfCBJWl1'I. ~~~ SIIII OF FLORID! coom OF The foregoing instrument was aCknowledged before me this. , 19.=-- by SlAfE OF FLORIDA coum OF The foregOing instrument was. aCknowledged b,efore 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 knOWll to me or who has" produced as identification and who did/did not take an oQ.th. (Signature) (Name Typed, Printed or Stamped) NOTARY PUBLIC (Signature) (NUle b'Ped, Printed or Stamped) NOTARY PUBLIC ~, ."" /ybTE:5 ; - ---\ ~f -( \ vAtA .\--\ e:P I'I!Df05 J.lOcJSE: .s.t=c. 1, f TI4I1' tl. $ ~6C t/ c- . e'OVNr7A~l{ -..!C)f(y,E9 _ I kl S/l"lEIt. OAK DRIVE ~~7'...~ fK!lf$l-- tX-''-' (#~~) :~ ---' I . ,~.'V 4AvR'l...WOoC1 I~~ PRIVe ~~ (cvt.-pe-.5Ac) :\ J~ ~ (" ", t'11#/ ~ J-ICAf , t. __ /' It! 1t(l so --- //WPfKlfI!t. -- , /"" ~1(,6) !It) 7' A. lS"oo"S'i3-- ,I!: So.oo' A = I~,Z.~' ~$' S.z4.ss~'~. Co. /~,Z()' /. v/VpaG~(/;fIp /.MfetWE/lfEtJr5, //" A#'1, ,A//Jr NE,of-sv,eE:1? \ ..~ -S\ ~ o~ V ~ .' S.8'.72- 't.7"e, L.O r- ..2~ \ \' SiN Cot}lqz. of '-"'r 1.. ICGCIIO: 1.1. . IRON 1('0 I.P. . /1011 rlr, C.H. - CONclcre -."1iT filii. - 'OIMI lEt. - If.trrt/lce ,. - ru rlU p. - I'U mCRII'TIClIJ H. - IIf4SllUp PArA C. . CALCULATEI' pMA Ett~. . EleVATION ~w . NATIONAL Gecru Ie VflfTlCAl t'AIlIN 8.'. . PA.~e '1(\'l1l ftEllArIOll l'eJf /?IP.C"f ('f'r;.f"j . FU'Op CflfTlflCATlOJII .'IIlIJCcr PAICEl LIES 1/1 1M C- o, THl 'e!lfIAl f.l1fllliElCr ~ Al:CIfCr Irtl14I, tltlOP llISUWIct ~It 'II' Irrlll" .rnu T~e NMITY PAllEl /Zu 1:.,,, 0 S C'c.,. AAI ~,,~- OATfD~s:~ B,f ~61lTlfl€r:> n>~ rl(;,() nn..€, /N~. AlHclZfC.4# f'OAJe~~ Ttru IIISIJ~4NU ~lAfA, "liE. )t~~""'6~ ~E ~ My Y1u..AI-€ !lUILPa-s" 1#(;... "J LEGAL DESCRIPTION: . 0< V LOT 2A: That part of Lot 2 of LAURELWOOD AT SILVER OAKS .. par the map or plat thereof .. racorded ln Plat Book 32, Paqes 110 and III of tha Public Record. of Pasco County, Florida, described a. fOllow.: . Commence at the Southwest cornar of .ai4 Lot 2; run thanca HIO-26'42"W, .long tha Wa.tarly boundary of .ald Lot Z, A distance of 39.36 faat to thePOl!ft' OP lIOIJllrIJIG; tbence continua RIO.Z6'4Z-W, along .a14 ".t.rll boundary, A distance of 50.17 te.t to tha IOr~.t cornar of .aid Lot 2: thence 989-52'27"1, .10ng the .orth boundary of .aid Lot 2, A dl.tance of 85.17 faat; tbaoce .72-31'53"1, .long the Horth boun4ary of ..1d Lot a, A diatance of 3'.1' f.at to the North.ast cornar of "14 Lot 2, M1dpoint being Oft , curve, concave to tha la.t, baYing A dalt. of 15-09'58" and A radius of 50.00 teet; thence 8outhe.atarly, .1oav ~ arc ~f .a14 curve, an arc distance of 13.23 f.et (ehord bearing ~24"5S'06"E, chord cU.tance of 13.20 faat) to tba end of .a1d curve: thence S49-32'36"W, A distance of 52.56 faet; thance S79-33'18"W, A distance of 82.67 feat to tha POIN'!' 0' 8IQIHNING. Unl.s. it bears'tha signature and tha original rat.ad ...1 ot A FlOrida Hcansed surveyor and mappar this drawln'1,aJletch, Plat or map is for informational purpo.a. Only and 1s not "aUd. o , REVISION DATE JOB NO Df.sCRIPTION fa PG ".,s.., ""- ~<4 DII r Z-Sl It CEllTInr."1JDl TIllS IS TO CER1'If'Y TIIAT A SIJIMY or TIll ABOVE DEsCRIBED PRoPf:Rl'Y 'AS IlADt: UNDER MY SUPERVISION AND THAT THE SkETCH HEREON IS A TRUE AND ACCURATE Rf:PRESEHTAnON THEREof' AND THAT SAID SURm nETS mE 1I1NIIIUII TECHNICAl. STANDARDS AS SL'I' FoRTH BY THE rt.oRIllA BOARD or PIQtSsJOHAL lAlfJ) SURVEYORS III CHArTER 8tCt7-6 0' TlfE fLORtOA AIlIllIIlSTRAnvE CODE. PURSUANT TO lItCTJON 472.027, noRlDA STAMtS, ~ ^,0~L JOlIN H. rr.t:rciiER . PRorl:ssJONAL MND SURVEYOR NO, 2696 .Job7 H. Flefd.er - noRIDA REGISTERED LAHD suamOR P,O. BOX 2lSS urn. rLoRlDA 33549-2IM PHONE (1113) 949-2204 8AIt VILLA&E aU....p~1It5.. IN t... DAn: /6. "/~-ff DRAIH: .I.rE't( SCAU:/;~o' JOO, "S"ss8 CIlK, o3It? f'.8 .~, PC L TICD TITLE . , ~; PREPA~D BY: ONE ~'IGAGE CORPOrWrION ~ ' 3922 COCONUT PAI1-1 DR., STE 106 TAMPA FL 33619 RE:l'lJRN 'TO: TEL:8139490436 Dee 28 95 14:45 No.009 P.05 1111111111111111111I11 1111I1111111111 1111111111111 95337246 ,I )~. ","IC,' ,'A"l'. ~ ,.: . :;~';'''''; .~ ...',. H~Pt; 458~6 12;211950.00 151~, N, Dale M<lbry IFf I Suite 101 LUTZ, FLORIDA 335 . STATE OF FLORIDA Rf~! 10.50 T. 0.00 _ Dpty Chrk NOTICE OF COMMENCEMENT COUNTY OF PASCO JED PIlTMAN, PASCO COUNTY CLERK 12/21/95 ~1143p. 1 of e OR BK 3513 PG 1089 The undersigned hereby gives notioe that improvement will be made to oertain real property, and 1n aocordanoe with Chapter 713, Florida statutes, the following information is provided in this Notice of Commencement. 1. Oesoription of PrQPer~Y_t _ XXXX LAURELWOOO DRIVE SEE EXHIBIT' A" ATrACHED HEl:WIQ AND ZEPHYRHILLS, FL. 33541 IN:OOPORATED HEREIN LOT 2 UNIT A SILVER OAKS General description of improvement: SINGLE FAMILY DWELLING BAY VILLAGE BUILDERS, INC. 18505 PUTTERS PLACE TAMPA, FL. 33647 2. 3. Owner information: (a) Name and address: (b) Interest in property: Fee Simple (c) Name and address of fee simple titleholder (if other than Owner) : 4. Contraotor: 5. Surety: (a) N~me and address: (b) Amount of bond $ BAY VILLAGE BUILDERS, INC. 18505 PUTTERS PLACE TAMPA, FL. 33647 6. Lender: One Mortgage Corporation 3922 Coconut P~lm Or., suite 106 Tampa, Plorida 33619 7. Persons within the state of Florida designated by Owner upon whom notices or other doouments may be served as provided by Section 713.13 (1) (a)7, Florida statutes: 8. In addition to himself, Owner Designates: One Mortgage Corporation 3922 Coconut Palm Dr., #106 Tampa, Florida 33619 to receive a copy of Lienor'S Notice as provided in Section 713.13 (1) (b), Florida Statutes. 9. ~~~"" .', ..... Expiration date of notice of commencement (the expir~tion d~ee is , one year from the date of reoording unless a differ~nt da~~ is specified. ,,' ',~ .)... ...._. t; INC. Sworn to and SubscriDed before me this 1~TH day of OWNER nlir'l'MRm , 1995. PmSONALLY AI? EA~ lIDBER'I' A. KELLY, JR., PRESIDENr OF BAY VILI..J\GE BUILDERS, N: ., A F ~' , WHO IS PEQSONALLY ~ 'IO ME. 4.~.._. ... . My commission Expires: '1r HERRVM. NEWGE,W AL) STAli OF flORIDA Comm, fJlpIr. OCT 27. 1~3 TE OF F(ORfQA COUNTY O~PASCO" '~~. 'm:;; t;; H) ComFY -THAT T~F. fOlftGMJ11S ^ lrn'r. Nfll~.~O~llF.CT COPY OF .f"~I~I~;~>'II' \ ;, ~ii.~ or,.; l'U~lI'."_IN tNIS ~':,;;,:: '.!' flaw AN~IOr"CJjl ~!Al. tHIS" ""; :.,; .."..~.~..~f;. - 18 , .lriD .:'lrr~A~'}~ll'Of . ijr{I;,::-~; Ell( c:.2~" . t...... :,i;~~, TICD TITLE TEL:8139490436 , Fl'.E NAME: BVlONE MOR'fCAGE ~~~~.~ w " Dee 28 95 14:46 No.009 P.06 FILE # 9511.21 EXHIBIT "A" OR BK 3513. PB 110910 2 of 2 LOT 2A: THAT I)ART OF LOT 2 OF LAURELWOOD AT SILVRER OAKS AS PER THE MAP OR PLAT THEREOF AS RECORDED IN PLAT BOOK 32. PAGES 110 AND 111 or THE PUBLIC RECORDS OF PASCO COUNTY. FLORIDA. DESCRIBED AS FOLLOWS: COMMENCE AT THE SOUTHWEST CORNER OF SAlD LOT 2: RUN THENCE NORTH 10026'42u WEST. ALONG TIlE WESTERLY BOUNDARY OF SAID LOT 2, A D1STANCE OF 39.36 FEET TO THE POINT OF BEGINNING: THENCE CONTINUE NORTIf 10026'42'1 WEST, ALONa SAID WESTERLY BOUNDARY. A DISTANCE OF SO.l? FEET TO TIlE NORTHEAST CORNER OP SAID LOT 2: THENCE SOUTH 89052'27" EAST, ALONG THE NOR"" BOUNDARY OF SAID LOT 2. A DISTANCE OF R6.67 FEET; THENCE NORTH n039'S3" EAST. ALONG THE NORTIi BOUNDARY OF SAID LOT 2. A DISTANCE OF 39..98 FEET TO THE NORTHEAST CORNER OF SAlD LOT 2. SAID POINT BEING ON A CURVE. CONCA VB TO THE EAST. HAVING A DELTA OF 15009'58" AND A RAmus OF 50.00 FBBT; THENCE SOUTHEASTERLY. ALONG THE ARC OF SAID CURVE. AN ARC DISTANCE OF 13.23 FEET (CHORD BEARING SOUTH 24055'06" BAST, CHORD DISTANCE OF 13.20 FEET) TO THE END OF SAID CURVE: THENCE SOUTH 49032' 36" WEST, A DISTANCE OF 52.56 FEET; THENCE SOUTH 79033'18" WEST, A DISTANCE OF 82.67 FEET TO THE POINT OF BEGINNING. Department of Community Affairs SN: 5235 FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION FORM 600A-93 Residential Whole Building Performance Method A CENTRAL PROJECT NAME: SILVER OAKS VILLAS #:BUILDER: BAY VILLAGE BUILDERS AND ADDRESS: C'Ib 7 d:,., ~. I> ,"--;J : PEF.:M I TT I NCi : CL I M?'\ TE ~ ZEPH~[~IDA:OFFICE: CITY OF ZEPH:ZONE: 4:_: 5:_: 6:_: Dl"'NEr.;;:: : PERM I T NO '.5-=s-z; y 6: JUP I!:m I CT I ON NO. G 11600 CI< 1. New construction or addition 2a Single family detached or Multifamily attached 3. If Mul t i f am i I y..,..No. 0 f un its 4. If l'1ultifamily, is this a WCljrst case (YE.!s/no) 5. Conditioned floor area (sq. ft.) 6. Predominant eave overhang (ft.) 7. Porch overhang length (ft.) 8. blass area and type: a. Cl E?a'( Gl a';:;;s b. Tint, film 0'( ~;:;olat' SC'jreE'n 9. Flooy type and insulation: a. Slab on grade (P-value, perimeter) 10.Net Wall type area and insulation: a. Exterior: 1. Concrete (Insulation P-value) b. Adjacent: 2. Wood frame (Insulation P-value) 11.Ceiling type area and insulation: a. Under attic (Insulation R-value) 12.Air distribution systems a. Ducts (Insulation + Location) 13.Cooling system 14.Heating System: 15.Hot water system: :I. C. Hot l,.,la t E?lr Cy ed its: (Hr';;:"-HE::at I::::ec over- y, DHP-Dedicated Heat Pump) 1'7. In f i 1 t I" at ion p r ac tic (,?: 1, 2 or 3 :l.8.HVAC Credits (CF-Ceiling Fan, CV-Cross vent, HF-Whole house fan, RB-Attic radiant bEH j" iE'\", 1'1Z .....Mul t i zone) 19.EPI (must not exceed 100 points) a. Total As-Built points b. Total Base points 1. New Construction "_. Multi"-Fc:imily r~ ..:J a .0::. 4. No 5. 11 '35. 00 6. 1.00 7. O.()() Single Pane 8a.168.0sqft Bb. O.Osqft Double Pc.1ne O.OOsqft O.OOsqft '::Ja.P:::: 0.00 , 116.00 ft 1 Oa..... 1 F.:= 4.30, 10b"-2 P:::::11.00, 740. OOsq ft__ 78. OOsq ft '___ 11 a. 1::::::::: 19. 00 , 11 ':35. OOsq ft ,_ 12a. R= 6.00, uncond 13. Type: Central A/C SEER: 10.00 14. Type: Heat Pump HSPF: 7.00 15. Type: Electric EF: 0.. '30 H:o. 17. 18. 1 1 '3. 1 ':~a. 1 '3b. '34.49 21800. ':=-j5 23()7~"2. 31 -.-.------------------....----.------..-..----.----------.----------------...----.-----..-----------..------.--.------.--.- --..-----------------.-..---.-.---.----.-----.--.---.---------"------------------------..-------.--.-.--- Peview of the plans and specifications covered by this calculation indicates compliance with the Florida Energy Code. Before construction is completed this building will be inspected for compliance in accordance with Section 553. '308 F. S. I Hereby certify that the plans and specifications covered by this calcu- lation are in compliance with the Florida Energy Code. PPEF'I;F::ED BY: A - ~ C DATE: \. '2._ - 2- \ -- q ~ ~~~ I hereby certify that this building is in compliance with the Florida Energy Code. OWNE01;~: U"fr1~ DATE: __ tf7 /.2-dJg-9<: - BUILDING DFFICI'4~?6' -;(7. DATE:__ ..tA,U...-&.1 ******************************************************************************* SUMMER CALCULATIONS ******************************************************************************* ::::::::::::::: BASE :::::::::::::: :::::::::::::: AS- BU I L T :::::::::::= ----------------------------..-.----.---------------------------.-----..-----.-.-----.------- ------------------.------------------------.--------------------..--------.-----.-----.--.-- GLASS---------------- ORIEN AREA x BSPM::::: POINTS : TYPE SC ORTEN AREA x SPM x SOF :::: POINTS --....---.--...-...---.,.---...--.-----...--..--....--..........N.__....__...._._.___....___..__.__.___..__.---..-.-__......_.......__....N..._..._______.._________________________ N 108.00 50.00 82.2 82.2 8877.5 : SGL CLR 49::32. 0 : SGI... CU:;:: N 108.0 50.0 51.0 100.2 eCI uO..... 3800.5 2344.7 r~ ~) r~ ;:) . 3':;' --.-..-..--..-.---.--------------------------------.------.----.-----.-..-.-..--.----.-----.-.-.-.-.---..--------------- .15 x CONDo FLOOR I TOTAL GLASS:::: ADJ. x AREA AREA FACTOR GL,~SS == POINTS ADJ GL('\~:;S POINTS 13L,~~3S POINTS ..__..____.__R__________________.._...__.____._._._________________________________...._._._.._......_........__.__._.__.___.____ . 1:::; 1 , 1 ':;'5. 00 lE..8.0(> 1.0E.7 13, 80'3. E.O 14,734.35 : E..,145.20 ------------..-..----------------------------------.--..-----------------------.----.-------------- --------.-.-.-.--.------------------------.-----------------------------.---------.-------- NON GLASS------------ AREA x BSPM::::: POINTS: TYPE F::-"!./AUJE AREA x SPM::::: POINTS -------------------------.-.----.-....--.-.--.-.--.--.-----.--.--....-----------------------.--...--.----...-....--.----.....-..... WALLS---------------- Ext 740.0 1.0 {idj 78.0 .7 740. 0 E>.;t NormWtBIock In 4. 3 740. 0 1 . 14 843. E. 54. E., I~dj Wc,od Frame 1 1 . 0 78. 0 . 70 ~54 . (:; '3E. . 0 E>,;t Wood ~"2() .. (> ...,.. 2() 1,:+4. U I . 28" 8 (.1 d j Wood 1';:) (> on:r 40 '::1,3. w. a_ . a.. DOORS---------------- Ext 20.0 4.8 Adj 18.0 1.E. CEILINGS------------- UA 1195.0 .E. 717.0 Unde"r Attic 1 ':;' . 0 11 '35. 0 1.. 10 1314.5 FL OOF:S --" ...., .......... ,..., ..." ,'...... SIb l:f.E...O ",,31.. B --3E.88. 8 Sl ,"Ib ---on---I::ll" ad e .0 l1E...0 -31.90 -3700.4 INFILTRATION--------, 1195.0 10.9 13025.5 Practice #1 1195.0 13.80 lE.491.0 ===:========::::==================================================================== TOTAL SUMMER POINTS 25,707.45 : 21,,335.. -:;7() TOTAL ~/; SUM PTS ======================================:====:==============::======================= SYSTEt'1 MULT CODL I Nt3 : TOT r-IL PDINTS : COMPON x CAP x DUCT x SYSTEM x CREDIT = COOLING RATIO MULT MULT MULT POINTS --.--.....----..-.-----..-..-.--------.-...----..----------.--------------...------.----------.--.----------------- 25 f ~7()7 .. .:~5 .37 9,511.7E. : 21,335.70 1.00 1.100 . :340 1 . 000 7, ':37'3. 55 ================================:===================:~====::=====::================ ******************************************************************************* WINTER CALCULATIONS ******************************************************************************* === BASE === === AS-BUILT === ____________________________________0__._..___,__._____________________________________..______._____ ..--.------.-----..--.-..------------------.----.---.-.-------.--------------------------------------- OLASS---------------- ORIEN AREA x BWPM = POINTS : TYPE SC ORIEN AREA x WPM x WOF = POINTS ---.-.,-------------...--..--------------.--.-..--.--..-..-.---.--.--------------..------....--.---......-.-.-..-...---..--..-.-..---.----.---.---.-- 1\1 108.00 60.00 '-3.4 --;::;.4 '-3E 7. :2: : SOL CL.F.: -,,204. 0 : SCiL CU;;: N 10B.0 60.0 '3.6 -10. '3 1. :20 -. 13 12'::J.4.2 B5.0 r-. .::;> ,.... ;:> ....-..---..---...-------...-.-----.--.--.-.--.....---.-.-.-...........--..---.,.-.....-..-.,....--..-.-..-..-.-.....-----.-..--..,...--.-----.-------.---.-.---....- .15 x CONDo FLOOR I TOTAL GLASS = ADJ. x AREA AREA FACTOR GLASS POINTS ADJ GLASS POINTS GLASS POINTS -------.-----.-------------------------------.-----------.-.------.------------------------------------ . 1 ~5 1 , 195. 00 168.00 1.057 ,-,,571.20 ...,EO':;!. 45 : 1,32'3.18 ----.-------....-----.-------.---..--.-.------------------------------------------------------------------ -...-----..--.....----.....-.-------....-.-..-..--..------------------------------------------------------------- NON GLASS------------ AREA x BWPM = POINTS : TYPE P.......,ALUE APE?"i ," WPM ::: POINTS ._.....__._..___.......'....N...._______________.__..._._.____._.____..__._________._____........________._._...___.._...___...._._..___.______._._______ WALLS---------------- Ext 740.0 1.1 Adj 7B.0 1.8 814.0 140. "t Ext NormWtBlock In i~dj ~kll:::,d F.r' ame .:~. u ~3 740.0 78.0 3.21 11.0 1.80 237'3. 1 140.4 DOORS---------------- Ext ~u.u 5u1 Adj 18.0 4.0 102.0 72.0 E:..;t Wood Adj \;Jood 20. 0 -, 60 11::"-:' 0 / . ..J..:... 18. 0 c:- '30 106. ..J. .1.- 1 '3. 0 1 1'35. 0 1 . 00 1 1 '35. 0 . 0 1 16. 0 2.50 2'30. 0 1 1'35. 0 E... 20 740'3. 0 CEILINCiS------------- UA 11'35.0 .6 717.0 Undel" At tic FLOORS---------,,----- SIb 116.0 -1.'3 -220.4 S1 ab'-on-(3r ade INFILTRATION--------- 1195.0 4.1 48'3'3.5 Practice #1 ======================================================================:~======== TOTAL WINTER POINTS ~5, '31::'j. 0:75 : 13,000.E-lB ==============================:==:================================================== TOTAL :i; WIN PTS SY~:;TEM MULT HEATINI3 : TOTAL POINTS : COMPON x CAP x DUCT x SYSTEM x CREDIT = HEATING RATIO MULT MULT MULT POINTS .-.--.-.-.-.-.-.--.------...-------.---....----------.---.---..--.--.---..----.-----------.-..--..--......---.-------------.-- 5, '315. 05 1 . 10 6,506.56 : 13,000.88 1.00 1.100 .484 1 . 000 6, '321. E,7 ==============:::=:=::================================================================= ******************************************************************************* WATER HEATING ******************************************************************************* === BASE === === AS-BUILT === --------------------------.-----.------------------------------------------------------ .----.----------------------------------------------------------------------------- NUM OF BEDRMS A MULT TOTAL : TANK VOLUME EF TANK RATIO x MULT x CREDIT MULT = TOTAL 2 3527.0 7,054.00 : 40 .90 1.000 3449.7 1.00 6,899.33 --..--...----.....--.----.----------.----.---------------.---.----.------------.----------------.--.-----..----- -..----..---.-..---..------.---.--......-......-.-.-.----.-.-----.--.---.---.-.-.--....------.----....--.--------.-----.-----------.--.....--- ******************************************************************************* SUMMARY ******************************************************************************* === BASE === === AS-BUILT === ...-----------------------------.--------------------.------------------.----.--------.-----------.-- ----------____._.________R_________________________________.____________.~______.____._______.__ COOLING POINTS + HEATING POINTS HOT WATER + POINTS - TOTAL COOLING POINTS : POINTS + HEATING POINTS HOT WATER + POINTS - TOTAL POINTS ----..---.-.-.----...---.-..-.-----..-----.-.--------.._-----_...__._.._._-_._-----_.._....._.._-_._-_._--~-..---.---------..-..--.-..--.- 9511.8 6506.6 7054.0 23,072.31 7979.6 6921.7 6899.3 21,800.55 ----.--------------.-.----.--.---------------------------.--..----...-------.--.-.----...------.---.--- -----..--------------..-------..-------------.-------------------------.---..-..---.....-.--.--.-----.-.------- ***************** * EPI ~ 94.49 * ***************** ENEPGY GUIDE For detailed information of the EPI rating number or for any ITEM listed, ask your Builder for DCP, Form GOOA"'''':33 or FOlr m GOOB--':j3 EPI== '34.5 o 10 20 30 40 50 60 70 80 90 100 ~---_._----_._--_._---------_..._-----------_.,._._---...-..---...----X......---: The maximum allowable EPI is 100. The lower the EPI the more efficient the home PESIDENTIAL ENEPGY PEPFOPMANCE PATING SHEET ITEM HOME VALUE Low Efficiency High EfficiEmcy WINDOWS.....................Single Clear SINGL CLR D8L TINT :X------------------ INSULATION. ............. .... R-l0 R'-30 Ceilin!;J P-Value......... 19.0 :----------x-----------.-: R---O P"",7 t.-Jall R-Value......... 4.3 :-.------------x-----.-----: Floor R-Value......... 0.0 R-'"0 :X----------------- P.....l'3 AIR CONDITIONER............. 10.0 SEEF.~ 17.0 SEEI:;::. . . . . . . . . . . . . . . . . . . . .. 10. 0 :x--------------------: HEATING SySTEM.............. G.8 HSPF 12.0 Electric HSPF............ 7.0 :x--------------------: WATER HEATER................ 0.88 O. '3E, Electric EF.............. 0.90 I V , I--....--A-.----------------, 0.54 O. '30 13as EF. . . . . . . . . . . . . . O. 00 I , I--------.----........--------------.J 0.40 0.80 ~301 al'- EF . . . . . . . . . . . . . . I I .-----------...------.--------) OTHER FEATURES........ ...... I certify that these energy saving features required for the Florida Energy Code have been installed in this house. Builder .d ~ ~ Addre'5s: /76~/ ;&.<'t/c,c ~. tJOtVN5 Siqnatw'e: ~~ - / Florida Energy Code for Building Construction - 1'393 Florida Department of Community Affairs D ate: .I.,}....J-&= -9.) City/Zip //1>>1 ~!J FL,..EPL. CAPD'33 't - ..4!4'<11i\~4~,JJJ '''':'~'~'l~.''''" .... ",,':c.,\ ....f!l. '\ County Parcel No. E',.... PASCO COUNTY, FLORIDA Permit No. " .i Date Permitted Builder Name/Owner Name Location ? r' Subd. Classification/Type of Use ~ ~. TRANSPORTATION IMPACT FEE CALCULATION EXEMPT D ~ Rate $ .-.."--- ...,.."~".- Zone No. :',t Sq. Ft.lU 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. '.1" 'f' No. Units / / Gross Sq. Ft. (GSF) RESOURCE RECOVERY ASSESSMENT EXEMPT D RESIDENTIAL NONRESIDENTIAL 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. Date Received By 1 I ! I I ! I I .~ 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. White Applicant Canary Trans/Finance Canary RR/Finance Pink Office Green Bldg/lnsp OFFICE USE ONLY TRANSPORTATION REC. NO. RESOURCE RECOVERY REC. NO. DATE DATE BY BY feecal:ce