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BUILDING PE.RMIT
7464
8
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Date
d - t-9'Y'
~ ELECTRICAL PLUMBING
p,"pertvOwne'4i.f:4<1 J:,'i~
Job Address: ~ -- .. y ~P
Parcel I. D. #
MECHANICAL
Sewer Conn
Water Conn:
Water Meter:
T,I.F.'s:
Zoning: Energy Code:
Description of Work ~ / L. L \.~~ ~
Radon Gas:
....
.' .A'..A..-7 . A1 ;'7...A
FINAL
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.
C.o.
DATE
Inspector
Permit FeeD. .....s [) - cJ-c> _
Signatu~ ~o~Q
Company
Address
Telephone#
Valuation or
Contract Price
~.~A
City License Registration #
State Certified License#
,/YlJ'Y\..b'-
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($1 g.OQ) shall be made for each trip for each trade:
~-; cTV
a.
b.
c.
d.
e.
f.
g.
Wrong Address
Condemned work resulting from faulty construction.
Repairs or corrections not made when inspection called.
Work not ready for inspection when called.
Permit not posted on job site.
Plans not at job site.
Work not accessible.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
CITY OF ZEPHYRHILLS BUILDING DEPARTMENT
~~Adl!--I D. GJn1G r
E33S ~~ J'T
OWNER
JOB LOCATION
PARCEL 1.D.'#
~p)vrA( lb-- Ft
, ,
3 "35",-/ (
SHOW ALL EXISTING & PROPOSED STRUCTURES GIVING DIMENSIONS & SETBACKS.
ALLEYWAY ACCESS FOR
GARAGE OR CARPORT -
15 FOOT SETBACK
REQUIRED.
UTILITY BUILDINGS
MUST SHOW SIZE &
FOUNDATION INFOR-
MATION.
(NOTE EXAMPLES 1 & 2)
?lc u.~--e
)
\
fl"~i \
~
,I
1
0~e.
, r \,0'\
I}.. 0..
"
l I ~
~ 7/0
--~-~ \
il
40 I - 0
i
If
,-'
FRONT PROPERTY LINE
STREET
5335 I./-rt. S"T
1. SETBACKS FOR R1f R2 ZONING
60'
2. SETBACKS FOR R3 ZONING
60'
10'
P E
R X
0 I
10' P S 10'
0 T 1 0'
S I
E N
D G
20'
FRONT PROPERTY LINE
10'
10' EXISTING 10'
PROPOSED
20'SGL FAM 30 ' DUPLEX
1 0'
FRONT PROPERTY LINE
APPLICATION FOR PERKIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTKENT
JOB ADDRESS
G },.., Te-r
sT
S''/
PHONE(6'/3) 7/5 '-/7..09
:2eph)lr-h( ))r 1" FL f3" 51.{ I
OWNER'S NAME ,$/ C)1t:J..e.! D.
OWNER'S ADDRESS 5335 L/ ~
5335 47'J,
CI"
/',
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL I.D.' (OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition _Alteration ~epair ~Install
_Sign
_Move
_DeJIOlish
PROPOSED USE: ~Single Faaily
_M/F
_' of Units _M/H
_eo..ercial
_Indust.
_Swia. Pool _Other
_Restaurant & Health Departaent Approval
DESCRIPTION OF WORK: :E?f7A /1 c At:{; ~ Lt' " k n. rr c e.. (~O'" + y~ <"Yi )
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
AMP Service
Florida Power Corp.
W.R.E.C.
_MECHARICAL
$
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
..........................................
CONTRActOR SECTION
Signature
~d~P~
COMPANY
State Cert. or Regist. .
City License Registration .
....******.**..***.*****************..*.**
BUILDER.
SiQflAture
COMPANY
State Cert. or Regist. t
City License Registration t
....*...****.*..............*..***...*..*.
RT.RCTRICIAN
Signature
COMPANY
State Cert. or Regist. .
City License Registration t
.*..*.....................................
PLUKBER.
MECHANICAL
Signature
COMPANY
State Cert. or Regist. f
City License Registration .
..........................................
OTHF.R COMPANY
~../ ~ ..., .k ",<.., State Cert. or Regist. ,
Signature//~~~ City License Registration'
..........................................
APPLICATION APPROVED BY
PERKIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
rbe under.igned und.r.t..d. that tbi. per.it sa, b. .ubj.ct le 'deed restriction.' .bieb sa, b. sor. restricti.. th.. City
regulations. The undersigned assUles responsibility for co.pliance wilh any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake wort, they .ay be required to be licensed in accordance with
.tat. and i'cal regulation.. if th. contractnr i. ..t licen,oa a. required by I.., loth the ...er aod contractor .., be
cited fer a .i.d......r ,i.lation u.d.r .tat. I". if tb. ....r .r intend.d contractor ar. ..certal. as to slot li....ing
requir....t. .a, apply r.r the Intend.d ourl, they ar. ad,ised tu conlacl th. Cit, .f Zeph,rbill. Building Deparbleat, (8Il)
188-6611.
FurtherlOre, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign portions of the
'Contractor SucUen.' .f thl. appllcatien for whieb they wm be respon.ibl.. If rou, as the lIIllIer sJ!lII as UIe CI8Ilraetor,
you are indicating that you, rather than the contractor, are responsible for the vort. 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 U'I'ILI'fY CONNECTION FEES ,."
D. CONSTRUC'I'ION LIEN L1\W (CHAPTER 713, FLORIDA STATUTES1 AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction Lien Lav _ HOIeOWDer'a Protection
Guide" prepared by the Florida Departlent 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 docu.ent and pro.ise in good faith to deliver it to the
"owner" prior to conence.-ent.
E. CONTRACTOR' S/OWNER' S AFFIDAVI'I'
I certify that all the inforlation in this application is accurate and that all vort viII be done in cOlpliance vith all
applicable laws regulating construction, zoning, and land developlent.
I
Application is hereby lade to obtain a perlit to do vort and instailation as indicated. I certify that no vorl or
installation has cOllenced prior to issuance of a perlit and that all vort viII be perfolled to leet standards of all lavs
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other goveCDIental agencies asy apply to the intended worl, and that it is
.y responsibility to identify what actions I lust tate to be in co.pliance. Such agencies include but are not li.ited to:
t Deparllent ot Bnvirofilental Regulation - Cypress Bayheads, Wetland Areas and EnviroDlentally Sensitive Lands,
Water/Wastewater Treallent
t Southwest Florida Water Hanage.-ent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docts, Navigable Waterways
t De artlent of Health & Rehabilitative Services EnviroDlental Health Unit - Wells, Wastewater !reablent, Septic !anks
t US EnviroDlental Protect!on Agency - Asbrstos abate.-ent
I also certify that, if fill .aterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "co.pensating vol Ole " will be sublitted whicb is prepared by a professional engineer registered in the State of
Florida prior to per.it. issuance.
. A per.it issued sball be construed to be a license to proceed with tbe vort and not as authority to violate, cancel alter, or
Bet aside any provisions of the technical codes, nor shall is~u~nce of a per.it prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Bvery per.it issued shall heCOle invalid
unless the wort authorized by such perlit is COllenced vi thin six IOnths of issuance, or if vork authoriled by the petlit is
suspended or abandoned for a period of sil IOnths after the tile tbe wort is couenced. One 90 day l!Itension of tille, lily be
allowed for the per.it with fee charge of $15.00. Tbe extension sball be requested in writing to the Building Official. An
approved inspection .ust be logged during eacb six IOntb period, or the project viII be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTlCR OF COHHRNCKHKNr HAY RBSULT IN YOUR PAYING l'IflCl FOR IMPROVIIIBIIIS !O YOUR
PROPERTY. IF YOU IITEND TO OBTAIN FINANCING, CONSULT WUB YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICI OF
COKMENCEHENT. JOBS UNDER $2,500 IN VALUR DO NOT NEED TO RRCORD AND POST A "NOTICE OF COHMBNCKKKlllw.
SIGNATURE: ONKER OR AGENT
SIGNATURE: CONTRACTOR
, I
STATE OF FLORIDA
COUITY OF
The foregOing instrument
before me this
was acknowledged
, 19_ by
STATR OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
was acknowledged
, 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