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BUILDING PERMIT 7035
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1/
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Date
/0 .- ~- /,~
BUILDING
GCT~~
Pmperty ow:e/7;t/ c1?~
Job Address:
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Parcel 1.0. #
Zoning: Energy, Code: Radon Gas:
Descriotion of Work (> ~~""t.~ '?~
N'/? E C-- / 0 -;J.,:S .. ~ > ~ ~ .' ~ /l ftt
NO OCCUPANCY BEFORE C.O.
FINAL
o - El -
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Inspector
Permit Fee
Signature
Company
Address
Telephone#
/ -!:> - uiJ
O.~
Valuation or
Contract Price
4*
City License Registration #
State Certified License#
() ~JJ I [?-7
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Con st. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
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 ($~) shall be made for each trip for each trade:
~--;tJ'Z)
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.
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APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
LOT
OWNER'S NAME E mela ~o; ("\t e Curp PHONE~~g -~l~,
OWNER'S ADDRESS 31lP O"d--. Arne -t- hy s-t Gc, y
JOB ADDRESS ~ A, I\\.e.....
LEGAL DESCRIPTION: LOT(S) ~ I L.( \( BLOCK SUBDIVISION
PARCEL 1. D. #
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:____New Construction ____Addition ____Alteration ____Repair _Install
____Sign
~ove
____Demolish
PROPOSED USE: ____Single Faaily
____M/F
_' of Units _M/H
____COI8ercial
_Indust.
_Swia. Pool _Other
____Restaurant & Health Department Approval
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet,
Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDING
$
Valuation of Total Construction
~ELECTRICAL
100
AMP Service
Florida Power Corp.
W.R.E.C.
____MECHANICAL
$
Valuation of Mechanical Installation
____PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: ____Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
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CONTRACTOR SECTION
BUILDER
Signature
COMPANY
State Cert. or Regist. ,
City License Registration ,
******************************************
::::IAN~~~ COMPANY,^- t:2a- a~ xL etIf
State Cert. or Regist. ,f::.-SOOOcc' /
u e ><. J (,;2~JY City License Registration' ) g 7
******************************************
PLUMBER COMPANY
State Cert. or Regist. ,
Signature City License Registration ,
******************************************
MECHANICAL COMPANY
State Cert. or Regist. ,
Signature City License Registration t
***********~******************************
OTHER COMPANY
State Cert. or Regist. ,
Signature City License Registration ,
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perJit lay be subject to Ddeed restrictionsD which lay be lOre restrictive than City
regulations. The 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 laY be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building DepartJent, (813)
788-6611.
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 which 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 he is not properly licensed and is not entitled to perlitting 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 Law - HOIeowner's Protection
Guide" prepared by the Florida DepartJent of Agriculture and ConsUler Affairs. If the applicant is sOleone 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 cOllencelent.
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 developlent.
Application is hereby lade to obtain a perlit to do work and installation as indicated. I certify that no work or
installation has cOllenced prior to issuance of a perlit and that all work will be perforJed to leet standards of all laws
regulating construction, City codes, zoning regulations, and land developlent regulations in ~e jurisdiction. I also
certify that I understand that the regulations of other goverDJental agencies lay apply to the intended work, and that it is
IY responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not lilited to:
t DepartJent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater TreatJent
t Southwest Florida Water Hanagelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable.Waterways
t DepartJent of Health & Rehabilitative Services, EnviroDlental Health Unit - Wells, Wastewater TreatJent, Septic ranks
t US EnviroDlental 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 volUle" will be sublitted' which is prepared by a professional engineer registered in the State of
Florida prior to perlit. 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 is~uance of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Every perJit issued shall becOle invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of six .ontbs after the tile the work is cOllenced. One 90 day extension of tile, JaY be
allowed for the perlit 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.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOnCE OF COMHENCEMEHf MAY RESULT IN YOUR PAYING TWICE FOR IHPROVEHEHfS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIH FINANCING, CONSULT WITH YOUR LENDER OR All ATTORNEY BEFORE RECORDING YOUR IIO'fICB OF
COMHENCEHENT. JOBS UNDER $2,500 III VALUE DO NO'f NEED TO RECORD AlID POST A 'NO'rICB OF COMMENCEMENT".
SIGIIATURE: OVHER OR AGEIIT
SIGIIATURE: COIITRACTOR
STATE OF FLORIDA
COUN'lY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
COUIITY OF
The foregoing instrument was acknowledged
before 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 known to me or who has
produced
as identification and who did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC