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Home My WebLink About98-7366 -;;rV F /~. .<fR BUILDING PE,RMIT 7366 13 Permit CITY OF ZEPHYRHILLS (813) 788-6611 ~~01) Date /~ 6 -7 r BUILDING ;)..!> -. .7i/ ELECTRICAL PLUMBING MECHANICAL Sewer Conn Water Conn: "'operty Own." t1./l~ ~ ~ Wet., M.t." Job Address: ~~0-:.s'- ~___ T.I.F.'s: Parcell.D. # /I-X --;;1./- 0'" / 0- 0 O.;J..O 2) - 6J I <30 - ? Zoning: Energy Code: ~ Radon Gas: Description of Work ~J~ ~ ~ ~~ 4- b ~;Z-~ /?~ City License Registration # State Certified License# ;;ld-~ '-I Permit Fee Signature Compa Addres Tele FINAL C.O. <j 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. DATE Valuation or Contract Price J ~ H-V , O'TC ~A~ BUILDING fJ7 ~ Y~~P? dl/)'s 7J ELECTRICAL PLUMBING MECHANICAL Tp. Servo Rough In Meter Can Const. 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 ($ ~I shall be made for each trip for each trade: tdJ....~-: tTV 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. ()o APPLICATION FOR PERMIT ~~ ') / r CITY OF ZEPHYRBILLS Cf>'6~ /l7K r -. oV..Jt "'7 BUILDING DEPARTMENT rf/ . r J \ I ~ /1 ~ 5 . I'd-- OWNER'S NAME L\f'c..\L \~ S+00e...S \ ~ . PHONE ~\~- [pa\- 55~<3 OWNER'S ADDRESS 5~J:; D ~ ('e..c...\::..e.v('\d\~ Pc-<-$. Df'l $<L J ~M.~ ,-t\ ~3tcJD JOB ADDRESS l!/"J =~C ~ 0....\\ e:, 0 \.l\ ~U~ ~ Z:... <...{)" "\ y" h \ \ \<) ) ~ I 0 ll\ d 0.. ~~-S- LEGAL DESCRIPTION: LOT(S) I ~ - I S BLOCK d" SUBDIVISION -:c LP).,'1f'k.I/J s . 1'\ - ~ 4 "\ PARCEL 1.D.' J I. .;}l. -al -00 I b -oC>~co - 0/10 ",,' (OBTAIN FROH PROPERTY TAX NOTICE) l ) - a I. - 3-\ - 00 ll> .. <) 6 ~ CO - t::> 1 G\ 6 WORK PROPOSED:_New Construction _Addition --Alteration _Repair _Install _Sign _Hove _Deaolish pmPOSED~E: _Si~leF~i~ ~eo..ercial _H/F _' of Units _H/H _Indust. _Swia. Pool _Other DESCRIPTION OF WORK: I tVska...\\ , X )0 , 'So,\ _Restaurant & Health Departaent Approval Vc:..~r ~~IO-v ~'.l ~ \ I BUILDING SIZE: J D 100 Square Feet, ~'l Height RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. ....:::&..BUILDING '/... ELECTRICAL ~CIWIlCAL dLPLUMB~NG / g-J L7cX'. t!)::) , ~ /ao AMP Service $ $ GAS _Fraae _Steel IS PROJECT IN FLOOD ZONE AREA? TYPE OF CONSTRUCTION: _Block FlBISBED FLOOR ELEVATIONS: FT. PERMITS REOUESTED Valuation of Total Construction ~FIOrida Power Corp. W.R.E.C. Valuation of Mechanical Installation ROOFING SPECIALTY R,.....J. ,(>..~ IO~ Other ****************************************** YES NO CONTRACTOR SECTIO~ .:::::... n- c. c:, ('0\.1 ? JZ.1"" \Co e.",:> . '\. COMPANY ~f.R\~~\<..~ oL.. 6;d~1^.u...\~P. E4rec:J State Cert. or Regist. t Pc. - c.o5~3 t.-- City License Registration t ~ /).~...... J ..........::::..;C?~ JPc State Cert. Regist. j V City Lice Registration , B-...l s-n ******************************* BmlJ>l!R /J !-e~j-/. SignatureJ'~( -( J, PLUMBER Signature COMPANY State Cert. or Regist. . City License Registration . ****************************************** MECHANICAL Signature COMPANY State Cert. or Regist. . City License Registration . ****************************************** OTRRR Signature COMPANY State Cert. or Regist. . City License Registration t ****************************************** APPLICATION APPROVED BY PERMIT OFFICER. CONDITIONS OF PERMIT AFFIDAVIT A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this per.it .ay be subject Lo "deed restrictions" which aay be lOre restrictive than City regulations. The undersigned assWles responsibility for co.pliance wiLh any applicable deed restrictions. B. UNLICENSED CONTRACTORS AND CON'l'RAC'l'On RESPONSIBILI'l'IES If the owner has hired a contractor or contractors to undertake work, they .ay 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 .isde.eanor violation under state IaN. If Lhe ONner or intended contractor are uncertain as to what licensing requiru.ents .ay apply' for the inLended Nork, Lbey are advised to contact the City of Zephyrhills Building Departlent, (813) 788-6611. , Further.ore, 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 OIIDer sign as the contractor, you are indicating that you, rattler than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that .ay be an indication that he is not properly licensed and is not entitled to per.itting priVileges in the City of Zephyrhills. C. TRANSPORTATION IMPAC'r FEES AND UTILI'ry CONNECTION FEES ,,~ D. CONSTRUC'l'ION LIEN L1\W (CHAPTER '113, FLORIDA STATUTES I AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Law _ HOIeOWDer's Protection Guide" prepared by the Florida Departlent of Agriculture and ConsUler Affairs. If tbe applicant is SOleODe other than the "owner", I certify that I have obtained a copy of the above described docu.ent and pro.ise in good faith to deliver it to the "owner" prior to couencu.ent. E. CONTRACTOR' S/OWNER' S AFFIDAVI'l' I certify that all the infor.ation in tbis application is accurate and tbat all work will be done in cOlpliance with all applicable laws regulating construction, laning, and land developlent. I Application is hereby .ade to obtain a per.it to do work and instailation as indicated. I certify that no worl or installation has cOllenced prior to issuance of a per.it and that all worl will be perfoCled to teet standards of all laws regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. I also certify tbat I understand that the regulations of otber goveInlental agencies aay apply to the intended wort, and that it is .y responsibility to identify what actions I .ust take to be in co.pliance. Sucb agencies include but are not 11Ilted to: t Deparltent of EnviroDlental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands, Water/Wastewater Treatlent t Southwest Florida Water Hanagetent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses t ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways t De arltent of Health' Rehabilitative Services EnviroDlental Health Unit - Wells, Wastewater !reattent, Septic rants t US EnviroDlental Protection Agency - Asbestos abatu.ent I also certify that, if fill .aterial is to be used in Flood Zone "An or "A,etc.", it is understood that a drainage plan addressing a "cOlpensating volute" will be sub.itted whicb is prepared by a professional engineer registered in the State of Florida prior to per.it. issuance. . A per.it issued shall be construed to.be a .license to proceed with tbe work and not as authority to violate, cancel alter, or set aside any provisions of the technical codes, nor shall is~u~ce of a perlit prevent the Building Official frOt thereafter requiring a correction of errors in plans, construction, or violations of any code. Bvery peIlit issued shall beCOle invalid unless the wort authoriled by such per.it is cOllenced within sil IOntbs of issuance, or if work authorized by the peIlit is suspended or abandoned for a period of sil IOnths after the tile the worl is cOllenced. One 90 day IItension of tite, l8y 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 .ust be logged during each sil IOntb period, or the project will be considered abandoned. WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTlCH OF COHHHNCHHHNT HAY RHSULT IN YOUR PAYING fIIlCE FOR IHPROVIIIHIIS TO YOUR PROPIRTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDIR OR AN ATTORNEY BEFOHI HlCORDING YOUR HorlCl OF COHHENCKHKHT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECOR~MIl POST OF ~. i1 _ .,~I(/1/~ SIGNATURE: OIflfER OR AGENT SIGNATURE: COJlrRACTOR , I' srArl OF FLORIDA . h COUNTY OF ' / b JfOU The foregoing instr nt .,was acknowledged before me this 19 q1 by ~ imown to:Jil, or who has produced- - as identification and who did{did not~ ~A(M:iViIttn. ( ign ture) . ~mtl fJ. .A{tUUVlI/ID (Name ped, Printed or Stamped) NOTARY PUBLIC STATE OF FLORIDA COUNTY OF D ~ Z The foregOing in~t~~nt was aCknowledged before me this 'K- lk~ ::bu.q..,.i~19 en by b ~+- 1::.~ luc who is ally kno produce as identif.1CatiOD an~ ~did not t~~(~1t~. J 1j))1/b/lJ1);_ ~'-l ' Ii>. VjJ/~jnl("; b, /illflnJoll /u (Name yped, Printed or Stamped) NOTARY PUBLIC ....~~~~.~' VIRGINIA B. MANSOLlLLO f.'f \;; MY COMMISSION /I CC450799 EXPIRES ~: :..E April 4 1999 '~;;f.R"l'rl..~~ BONDED THRlI TROY FAIN INSURANCE, INC I 'ltH' 9955 NW 116 Way Miami, Florida 33178-5129 305,882,8200 Fax 305.882.1200 ASSOCIATES INC. ~ 9--5-/ POWER OF ATTORNEY Qualifier's Affidavit KNOW ALL MEN that l~obC?\'+ ~ \J~~ ~ do hereby constitute and appoint 'Sk.NN:")~ S'Lef~e...-- my t and lawful attorney-in-fact to receive from the City of Zephyrhills Building Department to sign for the plans and permits for the Circle K Facility located at 5855 Gall Blvd. in Zephyr . ls~ Florid~ _ J / ,!~!/N~, L Signature of Quali ler State of Florida, County of DA-\;:JE. Sworn to and subscribed before me this 5-day of~ I.t "'(-' 1998, by ""R 'b ~e.A'-\- E, u who is personally known to me. ignature, Not u ic -State of Florida A2.u c.~ ~ 2- Soia Printed, Name of Notary AZUCENA Z. SOTO Notary Public, State of Florida My Comm. expires Aug 3,1998 No. CC397557 (seal) Affidavit I, S~c...r1'1C,l" ~.~ -ef~ am the duly authorized attorney-i Power of Attorney as stated above. State of Florida, County of UAt'le Sworn to and subscribed before me this '5 -S, .\-K~ who' , 04NI.JI~~-Y, 1998, by 'S~ r\ r,,..., ersonally known to me, o SoicJ AZUCENA Z. SOTO Notary Public, State of Florida My Comm. expires Aug 3, 1998 No. CC397551 (seal)