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BUILDING PERMIT 0 -;."1,'4
CITY OF ZEPHYRHlllS Pe.m" N · . 595 'f:,)
(813) 788-6611 Date 1o-d.5'-9~
Property Owner:
Job Address:
Parcel I. D. #
P~' M~
~~ ?!~~,~1(a~ :i-
.-
#1J
~L.ECTRIC~
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
FINAL_..l t)/ I~--
DATE
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
Valuation or ~ ;) oJ
Contract Price " ~ /1 J /7, -
Permit Fee ~
Signature V'J
Company
Address
City License Registration # 77
State Certified License# {! ;61'10 .L/ 3 (, 33
~;1:t%~) .~.
'. ~ Ofiv0
~ ~I Fl'T~,~~';yI-/;& I
Ftr. 1.;-d-Qf, ~ Tp. Servo -'-. ..' SlB
Pre SlB Rough In ~ -10 ~ 9i:J B DB Tub Set
Lintel Meter Can Water
FRM. ~ ~ fa -q ~ 808 Const. Pole Sewer
Insul. Cl~ Pool Final
Wl ~ Pre-Meter
Final
Telephone#
l~'
PL G
E~---
M AL
Breakers
Ducts Insl.
Compressor
Final
Driveway
~~ ~~lo-~Io BoB
tJ~~~.-tq-'t~ e~
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.
APPLICATIOII FOIl pEBKlT
CITY OP zEPIlYBBIUS
BUILDDlG DBPARTtIEIiT
-/\,::;
~77?r / ~.' (.l
. ;'_/~-f~
'7~"Z-ll n
OIIIIIlll'S _ ~6Pj \-Io(lO-J K\f"=fA-RI<... I.PIIO"
OWER'S AD~ (dolL, \.J;ge- KOA:O
JOB ADDRESS (~J~ 'vJ ,is~~
LEGAL DESCRIPTIOII: LOT(S)
PAllCllL I.D.' (OBTAI' pM PIIOPPTY TAX IIOTlc'l
WOBJ( PBOpOSIlII:~ew Coa&tPICdoo ~ltioo hteratiOn ~palr _lnsta11
BLOClL---SUBDIVISION
--1iigu
~ve
---peaolish
PllOpOSED USE: ---1iinale Feaily
"//~ercial
~/P _' of units --1f/B
_I.ndu&t. --1iwia. pool _Other
~estaurant . Bea1th Departaent Approval
DESClUPTIOII OP WOK: H-~\::>~\\ 6~ t LCEy'\1uJA-k~J
(
BUILDDlG SUE: '\ 0 xl. <b . 2 ~ D JJ~uare Peet. Cf' Height
USIDEIITIAL: ATTACH (2) PLOT PLAIIS . (2) SBTS OP BU"lLDIIIG PlANS&: (1) SiT IU1I1lGY FOBKS.
COHKEllCIAL: ATtACH (3) SETS OP BUILDIIiG PLANS. (1) SET EIiERGY POlUlS.
PIlOPERTY SURVEY IlEQUIllED POll ALL HEW COIiSTllUCTION.
. pF.RKlTS 'RROIJESTED
~UILDDlG
.J lU.KcrBICAL
$ -z. '.11 '1,,00 valuation of Total Construction
/
~iSti N ~ AIIP Service
Florida Power Corp.
W.R.E.C.
~CAL
~UHBIIIG GAS BOOPDlG
TYPE !lP llOIISr&I/CTIOII:.-J1oc:k :; P"..e --1Iteel
,
FIJIlSBBD FLOOIl ELEVAfiOIlS: 7_ " .
$
ValuatiOll of llechanical Installation
SPBCIALTY
other
YES
L-
IiO
IS pBOJECI III FLOOD ZOIiB AIlBA'l
..........................................
Signature
~NTRA.CTOR SECTIOJi
lDIPAIIJ CttAJ.1IrdJ ;"/Mtl ~ fiUr.k"".
State Cert. or Regist. ._ -c. ~l::.3 ~
City License Registration' 17
....................................
COHPAIIY ~ A;JJJ t;LEC112J' ~
State Cert. or Regist. .
City License Registration' 141-, (
..........................................
JIITIDER
Slgnat.w:e
COHPAIIY_
State Cert.. or Regist. '-
City License Registration ·
..........................................
PLUMBER
SigDature
COHPAIIY
State Cert. or Regist. .
City License Registration .
..........................................
tJRr.lWlIGAL
Signature
COHPAIIY
State Cert. or Regist. .
City License Registration ·
..........................................
9TRR'R
APPLICATIOII APPBOVED BY
PlUlHIT OPFICER.
, CONDITIONS OF PERMIT AFFIDAVIT
. A. . llOTICE OP DEED RESTRICTIONS .
IIIe ~gaecJ lIIIlIers~ lIIat tills petalt Ii, be "'jl<t to 'deed roatrictioDa' nidi Ii, be .,.. ,eatrieti,. lIIao ell
regulatlODS. rJle underSIgned i88U1e8 respcmsibilitr fOl COIpliance Idtll any applicable deed restrictiODS. 'J
B. UNLICE~SED CONTRACTORS: AND CONTRACTOR RESPONSIBILITIES
If tile owner baa bired ~ contractor or cootractOls to underta1e IfOIl, tbey lar be required to be UC8J18ed in accordance with
s~ate and local regulabODS. If tile contractor is not JiC8J18ed aa rlQUired by law botll the ClImer' and Contr tot be
Clt~ for a lisdelleanOr violati~ under state law. If tbe. OWDer or intended contr~tor are uncertain aa to :at l::Ui
requu8lellta lay apply for tile InteDded IfOrl, tlley are adVJsed to contact tbe City o( JepbyrJaiUs Buil"'.... DepartleDt (:13)
788-6611. , ' -.."
Furtlll!llOre, if tile owner haa bired a contractor or contractors, be is advised to bare tbe contractor(s) sign portiODS of tII
IContrac~. Sec~i0081 of tIIis appJicatloo for whiell tlley wiU be responsible. If you, as tile OIfDer sign as the contractor, e
you are IDcbcatlllg tbat rour ~a~ ~ tbe con~actor, are responsible for the worl. If tbe contractor wi_ you to sign
~ contractOl ~t lar be an indicatIon tbat be IS not properly licensed and is not entitled to peWtwg priVileges in tile
CIty of Zepbyrbdls. ,
I
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. .CONSTRUCTIO~ LIEN LAW <,CHA~TER 713, FLORIDA STATUTES, AS AHEHDED)
I ~er!lfy that I, tile apph~t, bav. been provIded WltII a copy of 'PIOlida's CODStructioo Lien Law _ ~er'a Protec:tioo
GUIde prepared by tile Flonda Departlent of Agriculture and Cooalller Affairs. If tbe applicant is 8OI8OIIe other tban tbe
lOIfJlerl,.I certify that I bave obtained a copy of the abore described docu8ent and prOliae in good faitll to deliver it to the
lownerl prior to COIIeDceaent.
E. CONTRACTOR' S/OWHER · S AFFIDAVIT
I certify tliat all the infollation in tIIis application ia accurate and tbat aU IfOrlwiU be done in COIpUance with aU
applicable law8 regulating construction, lOlling, and land developlellt.
Application is bereby lade to obtain a perlit to do IfOrk and instaUation aa indicated. I certify tbat DO IfOrl or
instaUatioo baa cc.enced priOl to i88uance of a pelIit and tbat all work wUl be petfOlled to leet standards of aU laws
regulating construction, City codes, loning regulations, and land develO(llel1t regulatiODS in tile juriadictioo. I al80
certify tbat I understand that tile regulations of otber go'erDIeIltal agencies IaJ apply to tbe intended work, and that it is
IY responsibility to identify what aetiODS I IUIt tab to be in COIpliance. Suell agencies include but are not luited to:
t Depart.ent of InvirOJlleJltal Regulation - Cypreai lIIybeada, Metland Areas and IIlvirOlllellWly Sensitive Landa,
lIater/llastewater Ireal:lent
t Soutl1weat Florida "ater Hanageaent District - ileUs, Cypresa Bayllead8, IIeUand Areas, Altering lIatercour888
t Ally Corps of Engineers - Seawalls. Docb, lIavigable lIaterways
t Deparl:lent of Health' Rebabilitati,e Services, InvirllUl8Dtal Health Unit - ileUs, Ila8te1hlter rreal:lent, Septic lanb
t US InvirOllleDtal Protection Agency - labeat08 abateaent
I also certify that, if flllaaterial is to be used in Flood lone IAI or IArete. I, it is under'toad tbat a draiDage plan
addressing a lCOIpeD8ating vol_I will be saitted whiell is prepared by a profeaaional engineer registered in the State of
Florida prior to perlit i88uaDce.
A pe,t'lit 188ued sbaU be construed to be a license to proceed with tile work and not aa authority to violate, cancel alter, or
6et aaideany provisions of the tecJlDjcal codes, nor sbaU i88uance of a penit prevent the Building Official fro. thereafter
requiring a correction of errOlS in plana, COIl8truetion, 01 violations of any code. Iverr penit i88ued aball becote inralid
unless the worl autborbed by suell perlit is ('~DCed ..ithin aillOllths of isauance, or if worl autboriled by the penit is
suspended 01 abandoned for a period of sillOllths after tile tile the IIOll Is COMenced. (g 90 day utenaion of tile, laY be
aUowed for tile perlit ..ith fee cbarge of '15.00. lbe utenslon aball be requested in ..citing to the Building Official. An
approved inspection IUIt be logged during eaell sblOllth period, 01 the project wiU be COIIidered abandoned.
IIlRIIIJIG TO~: YOUR FAILUU ro RICOID A DICK or aIIIIIIICIIfIn IIY USULI III YOUI PAYIJIG I'll FOI IIP1DIIlIIr8 ro YOUI
PROPERlY. IF YOU 111'110 ro OB'lllll FIUlCIIIG, . (DBULI IIIrD lOUI LIIDIR 01 All AnoRIIY IIIG lID JIOIICI OF
aHIIICIIIII!. JOBS UIDIi .2,500 II VILUI 00 lOr DID 10 BICOIID lID POSf lIOflCl OF I.
/~
SI : AGm , ~<it
srAr. OF FLOII~
COlImOF '-r~
The for~going instrument was acknowledged
before lie tbis h - / r , 197...t- by
SIAD OF FLOBI~
coum OF .-L~
Tbe foregoing instru.ent was aCknowledged
before IDe this h - / p- , 19~ by
wbo ~pers~own to _ or wbo bas
produced
as identification and wbo did/did not
take an OiJtb.~ a ~~~
(Signature) ~.o ~ 11 ~ "let-
(Nue Typed, Printed (or Stuped) 1
NOTARY PUBLIC
wbo i per~onal own to .e or wbo bas
produc
as identification and wbo did/did not
tate an oatho'-!1 c1 J1r~
(Signature) /V ~ Aa./
_ d It c: Y ;If- __#'-.7 )'
(NUle Typed, Printed or StUlped)
NOTARY PUBLIC
..~~Ill'~'~ NIncy A. Moody
{~ ".'f~ MY COMMISSION , CC534806 EXPIRES
~~'. ~ FebnIIIy 21. 2000
"'-J,f.'Q;"~ BONOEDlMRUTRO'fFAlNINSURANCE.INC
",."fli
...,UH'", Nancy A. Moody
....)~y Pltl~"!
~11. .-it
tw' ~~ MY COMMISSION * CC534806 EXPIRES
c 'J.~. : j February 21. 2000
':~Rf.:r..~'" BONDED THRU '!ROY FAIN IIfSURANCE.INC,
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IH& ~IPICATIQoI 1& FeR &TRUCTURAI. IlEGIlIIlEt1:NT6
feR cafl.IANai WI &ECT IQoI 1i<>>.OO ct= THE &accl.
TANOARD eIlllDING CODE Of ~~ . &ECTlON 1205.00 Of T11E
6CCt, &TAI'lOARD 6UflOlNG CODE OF 1Il9' AND DOE& !'lOT
TO AN'r DUf'LICA TIOI'l. REPRODUCTION OR HODIfICA TION
nll6 PLAN. nll& CERTlfICA rlON 1& NOT TO 1Hf'L'r TIlA T CEN1lUL
& I Ci<I GR:lllP ~ lw.v I t( eRl [lOR 16 THE AU TIleR ct= THE&E
LAN!. W1NOLOAD CALClL4T1ON& ARE 6A&ED ON me REQUIRE.
ENT& OF &ECTlON 16006.00 Of T11E &ecCI.&tANOARD BUIlDING
OF 1914 AI'lO &EcTlON 005.00 Of T11E &ecc~ &TANDARD
m COOE 0 I':ISL nll& CERtfFlCA TlON DOE6 NOT EXTEND
o REYI&IO!'l& OR H ENT& HADE TO SAID &ECTlON& AFTER
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~ENTRALDE5IGN GROUP
100 ~I Cl! AYalUe
EUeTI&, ~LCRI04 J2126
(n2) 4U.IUl
FAX' In2) 4&J'~
I16R{IN CRlceR JR. , ltARXll2164
nue ~RTIFIc:AtlCtl Ie FCR etRIJelURAl. flEGlJI~Nt&
AND FCR C<H'I..IAHCl! 1)1 IECT ICtI I~.OO OF t~ leeel.
ItANOA/W eU1l.DIN<i cooe OF ln~ I &ECTION 1201.00 OF rue:
&eCC~ llTAHOJ../W eU1l.DIN<i cooe OF ~~ J..NO DOEll NOT
EXTEHP to ANY DUPlICATlOH,REPRODUCtION OR MODFlCATIOH
OF nll& PLAit nllll CERtlF1CA TION 1& NOT to IMPLY nu T CENTlUL
tEalei'( CRXlP I5Y tv.RYIN CRI~ 16 THE AUTIlat OF THEIl!
F't.AN&. II1HPl.0AD CALclL4 TlON& AR!! 6A&I:D ON me IItEGlUIRE-
HENTI Of' H:CTION ~o,.oo OF M! leeCl,6TANOARD eUlLDIN<i
COOE OF 19~4 ANO &ECTIOH 'O!>f.oo OF M &eccI. &TANOARD
BULDING coDe OF I9~L nllll ER rr.~A TION DOEll NOT EXTEND
TO REYl!lONe OR AHENON !\ KADE TO lAID IECTIOt!ll AFTER
TtE eaOUl DA tc.
DATE'
THI5 CERTIFICA
TO AN'T' DUPL.IGA 10
o MODIFICATIO 0
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FAX' In" <In-Of,C&
l1ARYIN CRICER JR.. 'AAr012184
TIlI& C%RfIPIc.4TICl'I 1& Fat eTRI.ICTUIW. FEGJJI~16
AND feR CGtfl.1ANCl! III &Eel ICl'I I~.OO Gf TIlE ellCCl.
&TAICARD ~UII..PIN~ COOE OF )'~ . &EcTlOH 005.00 OF n1E
&ecc~ STANDARD ~U1lDING CODE OF !!I'lll AHD DOE' HOT
EXTEHD TO AN'!" DUPLICATION, RfPRODUCTION OR HODI'lCA TION
Of' nll& PlAtt nlI& CERTlFICA TION 1& HOT TO t1Pl '!" nlA T CENTRAL
tE&l<i'C GA:lUP 8Y ~IH ~f[:E:R 16 tHE AUr~ Gf tHESE
P1..4N&. WINDLOAD CALClUTIOH6 .l.RE BA&ED ON THE REQUIRE-
HEtlt6 Ol'&ECtIOH ~,.oo Of' nlE & '. &t .l.NDARD BUIlDIHG
COOl OF In4 ANa &ECTION 00'.00 nlli &ecc~ &tANaARD
BUWING cooe OF "'llL nll& CERTlFlC !lON DOE& HOT EXWU>
TO REYI&IOH& OR AMENDMENt& MADl' 0 &AIO eECTIOH8 AFTER
nlli ea.ClIII DA TE.. \9~ 6
D4TE' ~ ]
THI& CERTIFICA 110 D . NOT EXTEND
to ANy DUPLICAtION' E RODliC1ION
OR MODIFICA lION OF, I PLAN
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