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BUILDING PERMIT N~
Permit
CITY OF ZEPHYRHILLS
(813) 788-6611
. 62fi9~
Date /0 - ;l1-?b
'/0, eTV
BUILDING
_'?-S --.. t.TV
ELECTRICAL
....5-S " (,-'i[)
PLUMBING
;;Lei. &.7i)
MECHANICAL
Sewer Conn f 0-0 ' c.TZ>.
Water Conn: r:fI..o-z>, Lr[)
Water Meter; / b.5""', c:Jl)
T.LF.'s: ,9 'r J. o-D
~opertv Owne' ~1t!& ~
Job Address: 3 P-z a-c... ~
Parcell.D. # / y.-gG -;;)./ - 0/" 0 . O?J 0 CJ 0 - CJ / ~
Zoning: ,-~_erjY Code:
Description of Work J11 ~ .P ~?7
$-.p~ ~ /I-d-b-?f- m~ 8-:/0 J101
NO OCCUPANCY BEFORE C,O,
Radon Gas:
JJ7
Permit Fee
Signature
Company
Address
Telephone#
FINAL
C,O,
Complete Plans, Specifications and Fee Must Accompany Application,
All work shall be performed in accordance with City Codes and Ordinances,
Inspector
Valuation or
Contract Price
City License Registration #
State Certified License#
vd-~/u:' o~
>>;~ d-d.2-
~/ltAA'~ g.~...V'
PLUMBING
Y~~(d~
. /7.2Y
MECHANICAL
BUILDING
ELECTRICAL
Breakers
Ducts Insl.
Compressor
Final ) /- I q - q f4 &f)
SLB
Tub Set
Water
Sewer
Final /1,.20 - 9(p t3lbf3
Tp, Serv,
Rough In
Meter Can /0 cJ.9-P.6
Const, Pole
Pool
Pre-Meter
Final II ~ I c( ....q, ~ -.& $
Ftr,
Pre SLB
Lintel
FRM,
Insul. CL
WL
Driveway
lLb-Wf Ji-' 1, q~ Jdl
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($15,001 shall be made for each triP. for each trade: -I .
U 7f t. / tJ -cJ..'7-7'-b
a, Wrong Address ~....f' y :.i-h 1<'
b, Condemned work resulting from faulty construction. 2. ~ / Y b
c, Repairs or corrections not made when inspection called, IJ.-J II .... b -
d, Work not ready for inspection when called, F >
e, Permit not posted on job site,
f, Plans not at job site,
g, Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
OWNER'S NAME
/119-/(010 A11,rrle.s
~ lWl/f,Q W$~
JOB ADDRESS S &- tJ 'IV ~~'-"Z!."",,-L~
I ;)... BLOCK
PHONE
:7F3" bO't?
OWNER'S ADDRESS
PARCEL L D,'
SUBDIVISIONJ/.AfV! A.t.i?JLvI'1In
- €J 1.,/
LEGAL DESCRIPTION: LOT(S)
WORK PROPOSED:
____Addition ____Alteration ____Repair ____Install
_Sign
PROPOSED USE: ~ngle F8IIily
-"ove
_Deaolish
____KIF
____, of Units
I'
~/H
_ec-ercial
_Indust,
_Swia. Pool
_Other
____Restaurant Ii: Health Department Approval
DESCRIPTION OF WORK:
BUILDING SIZE: d.l..f X l(o, 960 Psquare Feet,
Height
RESIDEIITIAL:
COMKERCIAL :
ATTACH (2) PLOT PLANS Ii: (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
ATTACH (3) SETS OF BUILDING PLANS Ii: (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
~UILDING
rCAL
~~CHAlJICAL
--..LPLUMBING
$
/ ~OO C)
Valuation of Total Construction
;)....00 AKP Service
Florida Power Corp,
W.R.E.C.
$ /o~
10-& GAS
Valuation of Mechanical Installation
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fr_e _Steel
Other
FIlJISHED FLOOR ELEVATIONS:
FT,
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BUILDER ~~ COMPANYS~
State Cert. or Regist. ,
Signature City License Registration ,
******************************************
r<1Bttl1:9 4.l E [Jf)/ If ;-8
COMPANY
State Cert, or Regist. t
City License Registration ,
******************************************
J
PlDIBp ~ C COIlPANY :i.''''/'' J... t/n"S'/4/i.
State Ce t, or Regist, , '7o/J
Signatur ~ City License Registration , '- 1/
****************************** *********** /'
KECHANICALet-. , ~ @ffi.~ COMPANY e ~
, . State Cert. or Regist, f
Signature () "p LC ,,-t;A~ City License Registration t
*":A**..*~***~******************************
~ L.-- ~
OTRRR COMPANY
State Cert, or Regist. ,
Signature City License Registration t
******************************************
APPLICATION APPROVED BY PERMIT OFFICER,
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perJit lay be subject to .deed restrictions. which Jay be lOre restrictive than City
regulations, fhe 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 lay 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 JaY be
cited for a lisdl!leanor violation under state law, If the owner or intended contractor are uncertain as to wbat licensing
requireJeDts JaY apply for the intended work, they are advised to contact the City of Zephyrbills Building DepartJent, (813)
788-6611,
FurtberJOre, 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 which they will be rl!.$ponsible. 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 he is not properly licensed and is not entitled to perJitting 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, bave been provided with a copy of .Florida's Construction Lien Law - HOJeOWDer's Protection
Guide" prepared by the Florida DepartJent of Agriculture and Conslller Affairs, If the applicant is sOlleone other than the
.owner", I certify that I have obtained a copy of the above described docUlent and prOlise in good faith to deliver it to the
"owner" prior to COJJeDceJent,
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, zoning, and land develop.ent,
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation bas cOllenced prior to issuance of a perJit and that all work will be perforJed 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 goveIDJeDtal agencies JaY apply to the intended work, and that it is
IY responsi~ility to identify what actions I lust take to be in cOlpliance, Such agencies include but are not liJited to:
t DepartJent of EnviroDJeDtal Regulation - Cypress Baybeads, Wetland Areas and EnviroDlentally Sensitive Lands,
WaterfWastewater TreatJent
t Southwest Florida Water ManageJent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
t DepartJent of Health & Rebabilitative Services, EnvirODJeDtal Health Unit - Wells, Wastewater Treablent, Septic tanks
t US EnvirODJeDtal Protection Agency - Asbestos abateJent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc,", it is understood that a drainage plan
addressing a .cOlpensating volOle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to per.it issuance,
A perlit issued shall 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 shall issuance of a perJit prevent the Building Official frOll thereafter
requiring a correction of errors in plans, construction, or violations of any code, Every perJit issued sball beCOle invalid
unless the work authorized by such perJit is cOJJenced within six IOnths of issuance, or if work authorized by the perJit is
suspended or abandoned for a period of six IOnths after the tile the work is co.enced, One 90 day extension of tile, Jay 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.
WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMDCEMEN'l MAY RESULT IN YOUR PAYING 'NICH FOR IMPROVEmfS TO YOUR
PROPERTY, IF Y ND TO OB F~, CONSULT WITH YOUR LINDER OR AN BREY BEFORE RECORDIHG YOUR HOTICH OF
ClIIIIIICIDIERr. JOIIS 0 R $2. 00 R ~ IDl RIRD to IlICOIlII AIIIl PCSI A' Ie Of >> ~
STATE OF F~IDA
coum OF { ~A~D
The foregoing instrument was acknowledged
before me this DCl--r JS-~ 19..1lL by
STE.PU,;.J ~S~
who is Jlersonally known to me or who has
produced
as identification and who did/did not
t~~
(~:~ -
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
STATE OF FLORIDA
coum OF p~~O
The foregoing instrument~as acknowledged
before me this De.T (S ,19~ by
S 76(11-/ b-.:) (J. (l.OS.)
who is personally known to me or who has
-
produced
as identification and who did/did not
t~ke~ o~~. 6Z ~~
(S1 tu ~ c;:r
uG Ie ~J~
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
~"lC~~..~.:."l'.i:"""" ANGEUauE R, WAY
$~ ::-l ''$'~ llV COMMIS8ION , cc ............
f*: V',: :*i 1ft, VIU#fIU
,~,~:.'<'C~ EXPIRES: July 29, 2000
......~8r.lth~~~~'. Bonded 11uu NotIry PubIc ........
..!; l~~:~:;'~:' ANGL~IQUE R, WAY
:! ~'f i"i MY COMMISSION' CC 5729lIO
J[!~ :/ EXPIRES: July 29, 2OlIO
" ... ~:".. !londed TlIIU NoIllry PublIc ........
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C E N T R ALP E R M I T TIN G
F'A~::;CO CCK.lN TY, FLOF\ I DI~
DiYIE: ll/0<:/9{~
P{~(3E:: t OF~ :l
cu('n r:;':?\CTOP# ~
NAME: HAROLD MOATES
ADDR: 38040LAWANDA LOOP
C/:;T: i~/I.'llLL
1:::;:::;UE OF-FleE; D
RECEIPT NUMBR: 00301990
OFFICE: DADE CITY
F ()F<; :
CHECi<. oft ij.;::::02
CITY Z /1.1 ILL:::;
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8450 _H' 363(}(){:r ... ..:,
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COMPNV ACCOUNl CENTER
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