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BUILDING PE.RMIT 7357
Permit
CITY OF ZEPHYRHILLS
(813) 788--6611
6
Date
/;}.-dl-?J
BUILDING ~~ PLUMBING
Property Owner: ~ LI.I 17~
Job Address: ~,.:::t- /~ ~
Parcell.D. #
Zoning: M ~9Y.Code:
DescriPtion of Work ~ ~
'?TR E=- c... /-d.--9 1" ~ n "1
NO OCCUPANCY BEFORE C.O.
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T.LF.'s:
Radon Gas:
FINAL
f
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
15>
fRY
Permit Fee
Signature
Company
Address
Telephone#
~ ':. cro
()~~
Valuation or
Contract Price
/I /Jr
City License Registration #
State Certified License#
IZJL-
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
Wl
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
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 ($ 't-&:-e6) shall be made for each trip for each trade:
~'. t7V
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 ZEPHYRBILLS
BUILDING DEPARTMENT
JOB ADDRESS
LOT -
OWNER'S NAKIL-J:: t1'\ -e r 1I I J
.~ ~ <.:..:::> ~
~ A Vl'\ -e-
IS ~
Pt:7i n;-'<..... G u(' ro.
AN\~+,^y st
PHONE
'f""") <t?-)(. .J..\ "f r
OWNER'S ADDRESS
Wdy
,
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.'
(OBTAIN FROK PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction ~ddition -.Alteration ~epair _Install
_Sign
----.Kove
_Deaolish
PROPOSED USE: _S ingle Faraily
----.KI F
_, of Units _H/H
_Comaercial
_Indust.
_Swia. Pool _Other
_Restaurant 1& Health Department Approval
DESCRIPTION OF WORK:
BUILDING SIZE:
x
Square Feet.
Height
RESIDENTIAL:
COHHERCIAL :
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS 1& (1) SET ENERGY FORMS.
. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERKITS REOUESTED
_BUILDING
~ELECTRICAL
---"ECHAIIlCAL
$
Valuation of Total Construction
100
AKP Service
Florida Power Corp.
W.R.E.C.
$
Valuation of Kechanical Installation
_PLUKBING GAS ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FINISHED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BUILDER
COKPANY
State Cert. or Regist. t
City License Registration .
******************************************
Signature
::~:~~~
.
COKPANY")( ~ a~ r C(ff
State Cert. or Regist. t l;:o-So~Oc~ 'i
City License Registration . ) & 7
******************************************
PLUKBER COKPARY
State Cert. or Regist. .
Signature City License Registration ,
******************************************
MECHANICAL COMPANY
State Cert. or Regist. #
Signature City License Registration .
***********~******************************
OTHER COKPANY
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 peClit lay be subject to "deed restrictions" 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
requireJents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Departlent, (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
RContractor SectionsR 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 - HOJeowner's Protection
Guide" prepared by the Florida DepartJent of Agriculture and ConsUler Affairs. If the applicant is sOleone other than the
Rowner", 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 couenceJent.
E. CONTRACTOR'SjOWNER'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 perfoCled 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 goverDIental agencies lay apply to the intended work, and that it is
.y responsibility to identify what actions I lust take to be in cOlpliance. Such agencies include but are not liaited to:
t DepartJent of EnvironJental Regulation - Cypress Bayheads, Wetland Areas and EnvironJentally Sensitive Lands,
Water/Wastewater TreatJent
t Southwest Florida Water Managelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable,Waterways
t DepartJent of 'Health & Rehabilitative Services, EnvironJental Health Unit - Wells, Wastewater TreatJent, Septic Tanks
t US Environlental Protection Agency - Asbestos abate.ent
I also certify that, if fill aaterial 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 peClit issued shall becOle invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authorized by the perait is
suspended or abandoned for a period of six IOnths after the tile the work is cOllenced. One 90 day extension of tile, aay be
allowed for the peClit 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 Ta RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF
COKKENCKMENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
SIGNATURE: OWNER OR AGENT
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
before me this , 19____ by
STATE OF FLORIDA
COUNTY 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)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC