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BUILDING PE.RMIT 7557 'P
Permit
CITY OF ZEPHYRHILLS
(813) 788-6611
Date
~~~""-?f-
BUILDING
ELECTRICAL
~BI~
MECHANICAL
Sewer Conn
:::,~,:~os1-Y3.~~~\
Parcel 1.0. # b P
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
~
Description of Work
. Enz~ode:
~f'.l AO
Radon Gas: ~
_A"'~Z-~ _~_ .~. .
NO OCCUPANCY BEFORE C,O,
FINAL
Complete Plans, Specifications and Fee Must Accompany Application, C,O,
All work shall be performed in accordance with City Codes and Ordinances.
DATE
City License Registration #
State Certified License#
~o'7C:;
/
Inspector
Po'm;t Foo dL<'~ ~
Signature _ c::;;-~ ~_
compan~
Address
Telephone#
Valuation or
Contract Price
)' c3-P. o-u
BUILDING
ELECTRICAL
)Jf:l=r~~~
PLUMBIN 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 ($15.00) shall be made for each trip for each trade:
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 ZEPHYRHILLS I ,,'..... I ~ 1
BUILDING DEPARTMENT ~ \..(J U! .
OWNER'S NAKE Nor- ber.f-'t- A~~tA- Sltsk Ie w,'c- 2- PHONE 7CjO - 7 ::J.-wr::)
OWNER'S ADDRESS 55 Lf d- i: u. G eJJ e... D r
JOB ADDRESS f:tm.1
LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION.5 i'f. Av'L(}u~' 111~
PARCEL I.D.' IJ---~ (p - J.- 1- On ()-I?J-()OSJO - {)QXj (OBTAIN FROK PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ----A1teration ~epair _Install
_Sign _Kove _Deaolish .>C_~
. V<'H
PROPOSED USE: _Single Family _KIF _, of Units
_eo..ercial _Indust. _Swim. Pool _Other
Restaurant & Hea1t:h Department Approval
DESCBDTIOR OF WORK:~ PAlifti ""kffL', b ~ de<)11AJ/CflV~~
BUILDING SIZE: X Square Feet, Height
RESIDENTIAL:
COMMERCIAL :
ATTACH (2) PLOT PLANS 5: (2) SETS OF BUILDING PLANS 5: (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS 5: (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REOUESTED
_BUILDING
$
700.61)
Valuation o~ Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
_KECIIAHlCAL
~PLUKB~NG
TYPE OF ooNSTRUCTION: _B1ock _Fraae _Steel
$
Va1uation of Kechanical Installation
GAS
ROOFING
SPECIALTY
Other
FDUSBED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
CONTRACTOR SECTION
BIITI.DER
COMPANY
State Cert. or Regist. .
City License Registration .
******************************************
Signature
ELECTRICIAN
COMPANY
State Cert. or Regist. f
City License Registration ,
******************************************
SiOTUI ture
PLUMBER
COMPANY f!l iriwQ r Se.rv "Ct!~ ( ~
State Cert. or Regist. , LFC~I
City License Registration #I _ ':2-0' 7
*****************************
Signature
COMPANY
State Cert. or Regist. f
City License Registration #
***********~******************************
Signature
OTHF.R
COMPANY
State Cert. or Regist. ,
City License Registration #
******************************************
Signature
APPLICATION APPROVED BY
PERMIT OFFICER.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS ,
The undersigned understands that this perlit lay be subject to '"deed restrictions" which lay be lOre restrictive than City
regulations. The undersigned assWles responsibility for cOlpliance with any applicable deed restrictions.
B. UNLICENSED CONTRACTORS AND CON'l'RAC1'On RESPONSIBILll'IES
If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
state and locai regulations. If the contractor is not licensed as required by law, both the ONner and contractor lay be
cited for a lisdeleanor violation under state law. If the owner or intended contractor are uncertain as to what licensing
requirl!lents lay apply for tlle intended work, they are advised to contact the City of Zephyrbills Building Depart.lent, (813)
788-6611.
Furtherlore, if the ONner 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. CONSTRUC'l'ION LIEN UW (CHAPTER 713, FLORIDA STA'rUTES1 AS AMENDED)
I certify that I, the applicant, bave been provided with a copy of .Florida's Construction Lien Law _ HOJeOlfDer's Protection
Guide~ prepared by the Florida Departlent of Agriculture and ConSWler 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 COllenCl!lent,
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.
I \
Application is hereby lade to obtain a perlit to do work and instaifation as indicated. I certify that no worl or
installation has cOllenced prior to issuance of a perlit and that all work will be perforled to leet standards of all law8
regulating construction, City codes, zoning regulations, and land developlent regulations in the jurisdiction. I also
certify that I understand that the regulations of other goverDlental agencies lay apply to tbe 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 Iilited to:
t Departlent of Hnvirofilental Regulation - Cypress Bayheads, Wetland Areas and HnviroOlentally Sensitive Lands,
Nater/Nastewater Treallent
t' Southwest Florida Nater Hanagelent District - NeIls, Cypress Bayheads, Netland Areas, Altering Watercourses
t ArlY Corps of Engineers - Seawalls, Docks, Navigable Naterways
t Deparllent of Health & Rehabilitative Services, EnviroDlental Health Unit - NeIls, Nastewater Treallent, Septic Tanks
t US EnviroDlental Protection Agency - Asbestos abatelent
I also certify that, if filllaterial is to be used in Flood Zone "AR or "A,etc.., it is understood that a drainage plan
addressing a "colpensating volUJe" 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~u~nce of a perlit prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code, Bvery per.it issued sballbeCOle invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authorized by the per.it is
suspended or abandoned for a period of six IOnths after the tile the work is cOllenced. One 90 day eltension of tile, laY 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.
NARNING TO ONNER: YOUR FAILURE TO RECORD A NOTICE OF COHHENCKHBNT HAY RESULT IN YOUR PAYING TWICE FOR IHPROVEIIBD'S TO YOUR
PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICI OF
COKHENCKHENT. JOBS UNDER $2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COKHENCKHBNT".
SIGNATURE: ONNER OR AGENT
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregOing instrument
before me this
was acknowledged
, 19_ by
STATE 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
" .' (
Ui0U
f ~ 4:1- __!-3: - dl.? - ,)./ . DC :2/3 -Ocl5:J() - DOoO
~~W
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EXHIBIT "e"
WORK OUDti;R
(Singl>? Unit)
DAT~ 02/06/96 AOJOBT~R 14119
COngumliH- Plumbing Recov~ry Center.
CRANFORD FILE # 07004-000011466 CPRC C~M #509666
(CPRC) llli!nlby ;>ggiqllg thl? following property:
02
Owner: NORBERT AND ANITA JASKIEWICZ
Addrese: 5542 EUGENE DRIVE
ZEPHYRHILLS. FL 33540
Home Telephone :(517) 667-0670
Ot.her Telephone: ( ) 760 -7265
Mobile Home P~rlt or Subdivigion SIX AVENUE MHP
to bg n~plwnbgd by MIDWAY PLUMBING SERVICE (P-H-P
~CPVC
_COPPER _Other ~ppl'oved OYOt011l, Define:
(Contl"..ctor) with thlil following /llOltgrial: