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BUILDING PERMIT NO
CITY OF ZEPHYRHILLS Permit.
Gu j;;f (813) 788-6611
- -613111
Date
9-3 (J '-7' b
BUILDING
cJ.o - ,IV
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner: i a..d -f' ~ ~..14~ /lj( # LJ ~ j;;;
Job Address: >' L? ..5'7') . ~ ;.f"
Parcell.D. #
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
~y Code:
elL -C~_-
Radon~as:
~~'!L f'- ~ T .1L~1 n AJ~
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
FINAL
C.O.
DATE
NO OCCUPANCY BEFORE C.O.
DATE
Inspector
City License Registration #
State Certified License#
~r9
Permit Fee
Signature
Company
Address
Telephone#
Valuation or
Contract Price
:li9. tJP-D. .rD
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O-jJ>>, 1/;)..
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM. jO-J'!',.. q~ $,f.$
Insu!. CL
WL
Breakers
Ducts Ins!.
Compressor
Final
Tp. Serv. SLB
Rough In 1.0 -jf'"- 'fJII ~15 Tub Set
Meter Can Water
Const. Pole Sewer
Pool Final
Pre-Meter
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.
APPLICATION FOR PERMIT
CITY OF ZEPHYRBlLU)
BUlLDIRG DEPARTKERT
/J~
lJ)~vJ ~/9~
l1/1 j
1
OWIIER'S ADDRESS
OWRER'S
JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
B~SUBDIVISION
PARCEL I.D.'
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:~ew Construction ----Addition J..,Alteration -.Jtepair _Install
_Sign
-Ilove
_D~lish
PROPOSED USE: _Single Faaily
-----1t/F _' of Units -----1t/H
_~rcial
_Indust. _Swia. Pool _Other
-.Jtestaurant Ii: Health Departaent Approval
DESClUPTIOII OP WBK. /{tJ.(! ~J) J. Ai, LI ~ ~ S1P~~r
BUlLDIRG SIZE: X ,7t Square Feet, Height
RESIDERTIAL: ATTACH (2) PLOT PLARS Ii: (2) SETS OF BUILDING PLARS Ii: (1) SET ENERGY FORMS.
COHKERCIAL: ATtACH (3) SETS OF BUILDIRG PLARS Ii: (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
~UILDIRG
$ 2t?...60C:l4.;J.
Valuation of Total Construction
RT.RcrRI.CAL
AIIP Service
Florida Power Corp.
W.R.E.C.
--lIECIIAlIlCAL
$
Valuation of Mechanical Installation
.-PLUtlBIRG GAS ROOFIRG
SPECIALTY
TYPE OF CORSTIlUCTIOR: ---Block _Fraae _Steel
Other
FIRISHED FLOOR ELEVAnOIlS:
FT.
IS PROJECT IN FLOOD ZORE AREA?
YES NO
..........................................
R.IT' .DO
SO
nt'Signature
mRTRA=~ ~ __' ~~
State Cert. or 1legi.~(2 .:>131t.
City License Registration . ;t4~
..........................................
0'11= _g ~ COMPANY f_
1}) /':..~ State Cert. or Regist. t
sj - m m :' } ~City Lie....... lleaistration .
~.L. ~~ " -. ..................::.................
./" State Cert. or Regist. .
S' eV. .-' City License Registration .
" .... ..........................................
COMPANY
State Cert. or Regist. .
City License Registration .
...................................~......
0TRR1l COMPANY
State Cert. or Regist. t
Signature City License Registration t
..........................................
APPLICATIOR APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
fbe undersigned understands that this perlit laY be subject to "deed restrictions" wbieb laY be lOre restrictive than City
regulations. fbe undersigned asSUles responsibility for COIpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner bas hired a contractor or contractors to undertake work, they uy be required to be licensed in accordance with
state and local regulations. If the contractor is not ,licensed as required by law, both the owner and contractor laY be
cited for a lisdeJeanor violation under state law. If the owner or intended contractor are uncertain as to wbat licensing
requirel8Dts laY apply for the intended work, they are advised to contact the City of Zepbyrbills Building Departlent, (813)
788-6611.
FurtheIlOre, if the owner has bired a contractor or contractors, he is advised to bave the contractor(s) sign portions of the
"Contractor Sections" of this application for wbieb they will 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 perlitting privileges in the
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, the applicant, bave been provided with a copy of "Florida's Construction Lien Law - HOIeOlOler's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsDler Affairs. If the applicant is sOJeOne other than the
"owner", I certify that I bave obtained a copy of the above described dOCUJeDt and prOlise in good faith to deliver it to the
"owner" prior to COll8llCel8Dt.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforaation in this application is accurate and that all work will be done in cOlpliance with all
applicable lad regulating construction, zoning, and land developlellt.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas ~ed prior to issuance of a perlit and that all work will he perfoIJed to Jeet standards of all laws
regulating construction, City codes, zoning regulations, and land developleDt regulations in the jurisdiction. I also
certify that I understand that the regulations of other governJental agenCies lilY apply to the intended work, and that it is
If responsibility to identify wbat actions I lUSt take to be in cDlpliance. Sueb agencies include but are not lilited to:
* DepartJent of BnviroDJeDtal Regulation - Cypress Bayheads, Wetland Areas and BnviroDJeDtally Sensitive Lands,
Water/Wastewater freatlent
I Southwest Florida Water Managel8Dt District - Wells, Cypress Baybeads, Wetland Areas, Altering Watercourses
t AIIY Corps of Engineers - Seawalls, Docks, Navigable Waterways
I DepartJent of Health i Rehabilitative Services, BnvirODJeDtal Health Unit - Wells, Wastewater freatJent, Septic lanks
I US BnvirODleDtal Protection Agency - Asbestos abatl!ll!llt
I also certify that, if fill laterial is to be used in Flood ZOne "A" or nA,etc.", it is understood that a drainage plan
addressing a .cDlP8DSating VOIUlen will be sublitted wbieb is prepared by a professional engineer registered in the State of
Florida prior to perlit issuance.
A perlit issued sball be construed to be a license to proceed with the work and not as authority to violate, cancel alter,.or
set aside any provisions of the technical codes, nor sball issuance of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perlit issued shall beCOJe invalid
unless the work authorized by sueb perlit is COIJeIlced within slllOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of, six IOntbs after the tile the work is co.enced. One 90 day extension of tile, laY be
allowed for the perlit with fee ebarge of $15.00. Ibe extension shall be requested in writing to the Building Official. An
approved inspection lUSt be logged during eaeb six IODth period, or the project will be considered abandoned.
WARNING fa (MINER: YOUR FAILURE 10 RICORD A NOIICE OF C<llMDCEMElI'I MAY RESULI IN YOUR PAYIKG !VICE FOR IMPROVIJIEKIS 10 YOUR
PROPERlY. IF YOU IHUD !O OB'l'IDf FIIWfCIKG, COKSULI WlfH YOUR LBKDIR OR II AnomY BEFORE RECORDING YOUR KOliCH OF
d~;:2'~O IIVM OOD_ro~~si~-"
SfAfB OF FLORIDA P
COUM!Y OF 0... oS C. 0
The foregoing instrument was acknowledged
before me this Se.vJ' 1..3 , 19q & by .
60b A. \ ocl~
who IS persona y own m r who has
pro uc
as identification and who did~id no~
tak'XitoaIllJ () I . ~-
~Afll . 7<f hva
(Si~ture) LJ
\ ~..... ~. r 1 ,'^ "'r.cJ,..s
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
SIAR OF FLORIDA C'.
coum OF t- o....S c. 0
The foregoing instrument was acknowledged
before me this SfZ..pt. 1 3> , 19 ~ by
c...~o e.-
who i ersonally known to me or who has
produced
as identification
take an oath..
(S~ature)
-l,J ~t'\"'t..~. H"J\I""c./'5'
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
""Ill "II _
." ,6"'<'t> UENEE J HINRICHS
*W* My ool11ll1inion 00449109
Expir-Mw.28.1999
, ~.. Bonded by HAl
~ IIF f~fI>"" 800-422-1555
,"" ~,,~ DENee J HfNRICH8
*ji" My Com..........., CC4481C>>
* Expiree Mw. 28, 1~
~ , II" Bonded by HAl
.,~., nO. 800-422-155&
J~ODUCTIO'l
Date / Ini tal
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