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BUILDING
BUILDING PERMIT ~
,CITY OF ZEPHYRHILLS Permit N · -: ~ 5872 /3-
(813) 788-6611 4
Date S - 02 R- - /-b
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PLUMBING
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MECHANICAL
Sewer Conn
9(/?), ~
ELECTRICAL
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Parcell.D. # /,/-;1.6'-;2)- 0/60 - 0 O/!J 0 ~ - 03:2.. D
Zoning: _ ;p~rjY C~ej 'u Radon Gas:
Description of Work IJ1 ~ ~~ ~-~
WOl', CO"", ~tro. =
Water Meter: / t -5'- tT'D
T,I.F.'s; P;;2.... t7[)
d'P~weA- ~ t -6, - 9' h In. ,~ $"....) 0 ~/1 A IZf
NO OCCUPANCY BEFORE C.O.
Valuation or
Contract Price
I 7 tHY? ~
/
FINAL
C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
City License Registration #
State Certified License#
J/7
Signatur
Company
Address
Telephone#
~~AI~g L,~~
BUILDING
ffJt~ fo~~ ~
Ftr.
~ i?p,.dt?~ 1>- W
ELECTRICAL
--4~A./'; 0,- ?/)
PLUMBING
.~~L:..tZ.. IN1
MECHANICAL
Tp. Servo
Rough In
Meter Can . .r~-~
Const. Pole
Pool
Pre-Meter
Final
Pre SLB
Lintel
FRM.
Insul. CL
WL
b.lg
Breakers ~~
Ducts Insl.
Compressor
Final
b~L
SLB
Tub Set
Water -4P/~
Sewer
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 A/J ~...flst,,~/\:5---.;2J=-h
b, Condemned work resulting from faulty construction. j ;~ _ ~ I - yb
c. Repairs or corrections not made when inspection called. ~.S -
d. Work not ready for inspection when called. I
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 PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAKE ~ t'rY J.J, m.{jQ...-fes- S ('. PHONE 771- 3 cgS (p
OWNER'S ADDRESS P. o. 'i? () X: (;/).12 Zef' A'J'r h; Ur. ~/. ?J.:!J40
, /
JOB ADDRESS j ~DO 7 llJ...wdtJ diL ~iJ,o 7-e,.?AyrtdJy t:J. J3St/(!)
LEGAL DESCRIPTION: LOT(S) :q:J- BWCK SUBDIVISION LJ~YlJO-rdLJ/~J /lJ.J.I. J~.
I
PARCEL 1. D. , 1'1-). fE - 2/ ,- 0 /{~ () - () (Jo () {) - 03.J (!) (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction -^ddition -Alteration _Repair _Install
_Sign _Move _Deaolish
PROPOSED USE: ~ngle Family _M/F _, of Units _M/H
_C~ercial _Indust. _SwiRl. Pool _Other
_Restaurant &: Health Department Approval
DESCRIPTION OF WORK: S €--r- CAp {{J ob d-t_ ~IY\ ~
BUILDING SIZE: :l ft.'f-x ~11. I;). 72 Square Feet.
Height
RESIDENTIAL: ATTACH (2) PLOT PLANS &: (2) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS &: (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
_BUILDING
PERMITS REOUESTED
$ /7/ (;' Od) Valuation of Total Construction
fJ.-c,'l.1() NIP Service Florida Power Corp.
$--079"brt9D Valuation of Mechanical Installation
W.R.E.C.
_ELECTRICAL
_MEGHANlCAL
_PLUMBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
..........................*...............
YES NO
BUILDER
CONTRACTOR SECTION
COMPANY Su...t\1 t- t~ R JJo fJ..,S j ~
State Cert. or Regist. f f-I.. lllfl'i
City License Registration' J/?
............*..................*******.
~'
Signature
/-
'- COMPANY ~~I\Jr-I~.e Ilcl/~5'I~ff
State Cert. or Regist. f V Jt II L/ 1 g
City License Registration' 3/7
..*********.***...**....*****.***.
Signature
i/
MECHANICAL
Signature cfJ/.:L '::1~
COMPANY V 0 !p ~ I AJ 19, 'r J'j/( f~(?7 5'
State Cert. or Regist.' G~~~ 5'711?
City License Registration , ~ I
..........****.***...**.*..*....*.**.****.
~
OTHRR COMPANY
State Cert. or Regist. f
Signature City License Registration ,
*****.******.**********..*..*.*.**********
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. 'NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perJit .ay be subject to "deed restrictions" wbich lay be lOre restrictive than City
regulations. Ibe undersigned assUles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they .ay be required to be licensed in accordance lIith
state and local regulations. If the contractor is not licensed as required by lall, both the owner ~d contractor laY be
cited for a .isdeleanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirelents .ay apply for the intended work, they are advised to contact tbe City of Zepbyrbills Building Departlent, (813)
188-6611.
FurtherlOre, if the owner has hired a contractor or contractors, he is advised, to have the contractor(s) sign portions of the
"Contractor Sections" of this application for IIhich they lIill 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 you to sign
as contractor that 'laY be an indication that be is not properly licensed and is not entitled to per.itting 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 "Florida's Construction Lien Lall - HOIeOWDer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If the applicant is SOIeOne other than the
"owner", I certify that I have obtained a copy of the above described docUleDt and prOlise in good faith to deliver it to the
"owner" prior to coaencelent.
E. CONTRACTOR'SjOWNER'S AFFIDAVIT
I certify that all the infor.ation in this application is accurate and that all work will be done in cOlpliance lIith all
applicable lalls regulating construction, loning, and land developlent.
Application is hereby .ade to obtain a per.it to do work and installation as indicated. I certify that no 1I0rk or
installation bas cOllenced prior to issuance of a per.it and that all work will be perforJed to teet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of otber goveIDIeDtal agencies laY apply to the intended wort, and that it is
.y responSibility to identify IIhat actions I .ust take to be in cOlpliance. Such agencies include but are not U..ited to:
t Departlent of Environtental Regulation - Cypress Baybeads, Netland Areas and EnviroDlentally Sensitive Lands,
Nater/Nastellater Treatlent
t Southwest Florida Nater Managelent District - NeIls, Cypress Bayheads, Netland Areas, Altering Natercourses
t Ar.y Corps of Engineers - Seawalls, Docks, Navigable Naterways
t Departlent of Health , Rehabilitative Services, Environtental Health Unit - NeIls, Nastewater Treatlent, Septic Tanks
t US EnviroDlental Protection Agency - Asbestos abatelent .
I also certify that, if fill .aterial is to be used in Flood Zone "A. or HA,etc.., it is understood that a drainage plan
addressing a "cOlpensating 'olUle" will be sub.itted whicb is prepared by a professional engineer registered in the State of
Florida prior to per.it issuance.
A per.it issued shall be construed to be a license to proceed with the wort and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor shall issuance of a per.it prevent the Building Official frOJ thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every per.it issued sball beCOle invalid
unless the work authorized by such per.it is cOllenced within six IOnths of issuance. or if wort authoriled by the per.it is
suspended or abandoned for a period of six IOntbs after the tile the wort is cOlleDCed. One 90 day eJtension of tile, laY be
allowed. for the perJit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection lUst be logged during each six IOnth period, or the project will be considered abandoned.
NARNING TO OIINER: YOUR FAILURE TO RECORD A NOTICE OF COMMBNCEIlBNT MAY RESULT IN YOUR PAYING TlfICE FOR IMPROVEIIBITS TO YOUR
PROPERTY. IF YOU INTEND 10 OBTAIN FINAlfCING, CONSULT WITH YOUR LENDER OR Alf AnORREY BEF RECORDING YOUR lIorICE OF
COMMENCEMEN'l. JOBS UffDER $2,500 IN VALUE DO NOT NBBD TO RECORD AND POST A "NOTICE OF C NCEMm" .
~ #/l/~:t
~N : OIlffIR OR AGENT
STATE OF FLORIDA n
COUNTY OF V ttiJ to
The foregoing instrument was a~knowledged
before me this '5... t S , 1 ~ by
STATB OF FLORIDA ~/i II
COUlffY OF wA:,Q
The foregoing instrument was ac)nowledged
before me this S-'IS , 19~ by
who i
produce
as identification and who did/did not
take an oath. A
Alv V\,
(Sign ture) c. G
O(lt.~ ".
(Name Typed, Printed
NOTARY PUBLIC
ersonally MO
,
to me or who has
who ~OnallY~ tor me or who has
pradu --
as identification and who did/did not
take an o~t~ AA.. A. 0
~rrture). (1 G / ~
~/\OO JtL-tA . ~ '
(Name Typed, Printed or amped)
NOTARY PUBLIC
()'\"';.~J':}8(" DEBORAH A GAY
.., ~'"- <' My Commission CC4~9
* JiiijJ * Expir_ Jun, 28,1999
"'--:, ~~... Bonded by HAl
r( Of fL\)~ 800-422-1555
~'\"~1j:'}18(" DEBORAH A GAY
.., ~'"- <' My Commission CC477Z19
* JiiijJ * Expir_ Jun. 28. 1999
~~ .~... Bonded by HAl
4r( Of fL\)~X 800-422-1555
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