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BUILDING PE,RMIT
Permit 7 437~
Dat. /- ~ 9- CjyJ
CITY OF ZEPHYRHILLS
(813) 788-6611
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Sewer Conn
Property Owner:
Job Address:
Parcell.D. #
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Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
DescriPtion of Work
NO OCCUPANCY BEFORE C,O,
FINAL ~ 2 1r
DATE
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
C,Q,
DATE
Inspector
g,
Valuation or
Contract Price
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Permit Fee
Signature
Company
Address
Telephone#
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City license Registration # 7 ()
State Certified license#
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MEC/',ANICAL
Ftr.
Pre SlB
lintel
FRM,
Insul. Cl
WL
Tp, Serv,
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 ($+!r.O'O) shall be made for each trip for each trade:
0lS: IT'D
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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SUN STATE AlU1VnNUM', INC.
37528 State Road 54 West
ZEPHYRHILLS, FL 33541
(813) 788.7308
SOLD BY
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AMOU~T
CUSTOMER'S ORDER NO.
NAME
ADDRESS
OTY.
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TAX
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TOTAL
RECEIVED BY
All claims and ~'gOOdS
MUST be accompanied by t~ISblll. Y7ll".j).q l&if;'
.'/ PIlOOOCT610 I~ 1~. ~'UAllt(J 9t}
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PARCEL I.D~
SITE PJ...M.I
(Rf.SIDENTlAL USE ONLY)
SEe TWl' RNG SUllU BLOCK
I'ROPEHTY HEASUREHENT ~( .71 e;.;~ r6/,uy-.
CUlmENT OWNEHS CJ71'{ t1111?://J lJ^TE
LOT
All drawings sball be drawn to scale for all parcels or lots five acres or less.
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PLA~r:. k~VIEWED
DATE / /2-8/97
BUILDING DEPT, APPROVED
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SHOw fiLL EXISTING AND PROPOSED STHUCTURES CfVIJiG DIHE.NSIONS Mm S!~TBACL<;. L
/-!\'Y HOlJJJ:S Of ""hTEr: 1,/;'0 ROA])i,'I,)"'. (HKumniC.; t,','..,f'j!..'.C;',i I...i,.,.',,/,(.;].'.h"j" I, SO,
., ., TO THE i'poPUny.
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08
HiD 1 C^ TE
JI.'!1TChTE
APPLICATION FOR PERKIT
CITY OF ZEPBYRBILLS
BUILDING DEPARTMENT
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OWNER'S NAKE
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PHONE
OWNER'S ADDRESS
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JOB ADDRESS
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL 1. D.'
(OBTAIN FROH PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration _Repair _Install
_Sign
_Hove
_Deaolish
P~POSED~E: _Si~leF~ily
_H/F
_' of Units ---.Ji/H
_<=<-ercial
_Indust.
_Swim. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK:
70 I ~5 77'Iz.,C-
r:'x/O,
k IbJcm,<
?if YtV h~'? ~
BUILDING SIZE:
~ 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.
_BUILDING
$
//<g(P
PERMITS REOUESTED
. cJO
Valuation of Total Construction
_ELECTRICAL
AKP Service
Florida Power Corp.
W.R.E.C.
_MECHANICAL
$
Valuation of Hechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _Block _Fraae _Steel
Other
FllUSHED FLOOR ELEVATIONS:
F1' .
IS PROJECT IN FLOOD ZONE AREA '1
******************************************
YES NO
BUILDER
Y C/ A.J s 77ff€.
State Cert. or Regist. .
City License Registration .
******************************************
COMPANY
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Signature
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RT.RCTRICIAN COMPANY
State Cert. or Regist. .
Sianature City License Registration *
******************************************
PLUMBER COMPANY
State Cert. or Regist. .
Signature City License Registration .
******************************************
MECHANICAL COMPANY
State Cert. or Regist. ,
Signature City License Registration f
******************************************
OTRRR COMPANY
State Cert. or Regist. ,
Signature City License Registration #
******************************************
APPLICATION APPROVED BY PERMIT OFFICER.
CONDITIONS OF PElrnIT AFFIDAVIT
A. NOTICE OF DEED HES'l'HIC'l'IONS
The underiiigned underBLands Lhat Lhis perlii lay besubject to "deed restrictions" "bich .ay be lOre restrictive than tity
regulations. The undersigned assllIes responsibility for cOlpliance "ith any applicable deed restrictions.
B. UNLICENSED CON'l'UAC'l'OnS AND CON'l'UAC'l'OH UESPONSIBILI'l'IES'
If Llle mmer has hired a contractor or contracLols-tounderlale lIork, tiley lay be required to be licensed in accordance with
state and local regulations. If the contraclor io not licensed as required by law, both the o"ner and contractor IIiIY be
cited for a lisdeleanor violation under state law, If Lhe owner or intended contractor are uncertain as to "hat licensing
requiryents lay apply for the intended Norl, I.hey are advised to contact the CiLy of Zephyrhills Building Deparl:8ent, (813)
780- 6611.
Further.ore, if the owner has hired a conLracLor or contractors, he is advised to have the contractor(s) sign portions of the
"Contractor Sections" of this application for IIhich they lIill be responsible. If you, as the OIIner sign as the contractor,
you are indicating that you, rat/ler than Llle contractor, are responsible for the Ifork. If the contractor wishes you to sign
as conLractor 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. TRANSPOHTATION IMPACT FEES AND UTILITY CONNECTION FEES
l
.'
D. CONS'l'UUC'l'ION LIEN L1\W (CIIAP'l'EH 713, FLOHIDA S'rA'rUTES, AS AMENDED)
I certiiy-tha~ihe applicant, have been provided "ith a copy of "Florida's Construction Lien Law - Hoteowner's Protection
Guide" prepared by the Florida Depart.ent of Agriculture and Conslller Affairs, If the applicant is sOleone other than the
"o"ner", I certify that I have obtained a copy of Lhe above described doculent and pro.ise in good (aith to deUver it to the
"o"ner" prior Lo co_encelent.
E. CON'rRACTOU' S/OWNER' S AFFIDl\VI'l'
I certify that all the in(or.ation in Lhis application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, loning, and land develop.ent.
I
Application is Ilereby .ade Lo obtain a per.it to do "ork and instailation as indicated. I certify that no worl or
installation has cOllenced prior to issuance of a per.it and that all work will be perfor.ed to .eet standards of all laws
regulating construction, City codes, lOlling regulations, and land develop.ent regulations in the jurisdiction. I also
certify that I understand Lhat Lhe regulations of oLher governlenLal agencies .ay apply to tbe intended work, and that it is
.y responsibiliLy Lo identify "hat actiOlls I .usL tale Lo be in cOlpliance. Such agencies include but are not UI1ted to:
t Deparltent of Environmental Regulalion - Cypress Bayheads, Wetland Areas and BnviroDlentally Sensitive Lands,
Water/Wastewaler !reallent
t Southwest Florida Water Hanagl!lent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t Ar.y Corps of Bngineers - Sea"alls, Docks, Navigable Waterways
* Departlent of Health & Rehabilitative Services, BnviroDlental Health Unit - Wells, Wastewater TreatleRt, Septic tanks
t US BnviroDleDtal Protection Agency - Asbestos abatelent
I also certify that, if flll .aterial is Lo be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "co.pensating volOle" "ill be sub.itLed which is prepared by a professional engineer registered in tbe State of
Florida prior to per.it. issuance.
. A per.it issued shall be construed to be a license to proceed "ith the work and not as authority to violate, cancel alter, or
set aside any provisions of the technical codes, nor shall is~u~nce of a perlit prevent the Building Official IrUl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery perlit issued shall beCOll invalid
unless the work authorized by such per.it is cOllenced within sil IOnths of issuance, or if work authorized by the perlit is
suspended or abandoned for a period of sill IOnths after the tI.e the work is cOllenced. One 90 day 81tension of tile, IIY be
allowed for the per. it with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An
approved inspection .ust be logged during each six IOnth period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COHKENCRHBNT KAY RRSULT IN YOUR PAYING twlCB POR IHPROVIMBIrS TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LKNDER OR AN ATTORNKY HEFOKl RECORDING YOUR MOIICI OF
IDlIIImJlRll'/. JOIIS ~~~~}X) ~ TO RRCOJlIJ ARll POSI A '''''l~,~~~;~~:=>
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sIfurn.t!!!!!i.JUfm:.OO:::AGHltT -SlGjjluRE: CONTRACTOR
STATK OF FLORIDA ~
COUNTY OF r If 5' .co
The foregoing instrument was acknowledged
before me this I / 2. / , 19$ by
. I
STATK OF FLORIDA ~
COUNTY OF r/tSZO
The foregoing instnpllent was aC~f"ledged
before me this I / 1.;2/ , 19 Z5 by
/ r
who is personally known to me or who has
produced .
as identification and who did/did not
take an oat~ff ~
(Signature) .
who is personally known to me or who has
produced
as identification and who did/did not
take an oat~ ~-,t:)
(Signature) .
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC