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BUILDING PERMIT .7894
;3
BUILDING
~~ tiV
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 788-6611
AFTER HOURS PHONE NUMBER
J~~)~-5262 ;J.!>..... ch>
PLUMBING MECHANICAL
Permit
Date
~-II-'1Y
ij' (/. lID
Job Address: '
Parcel I. D. #
Zoning: r. EnJrgy C.,e~~: f71 r--#-Radon Gas:
Description of Work %~ 111~. '~~
~E:P~ 9-11"-74" J/;iT/) ~ ~~ )1 YJt
NO OCCUPANCY BEFORE C.O.
L/I -
Sewer Conn 7 7 ~ 02.~,
Water Conn: ~~j;; 1..31-~
Water Meter: ~ / h ~ (J7;)
T.I.F.'s:
I FINAL
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances,
DATE
Inspector
)0
City License Registration #
State Certified License#
Permit Fee
Signature
Company
Address
Telephone#
t'f~~
Valuation or -
Contract Price :J -5. (/7.J'-cl . tJc.)
,
~-r
ELECTRICAL
Lt;tCr'f~
PLUMBING
c:l, p VS-
IJ:;:$~~ jJiJ
BUILDING
en. t2 / t-7
MECHANICAL
Breakers
Ducts Insl.
compresb-.r
Final 'ii 14 f~~
Tp. Servo
Rough In
Meter Can
Canst. Pole
Pool
Pre-Meter
Final '/2"'( 1 g to~
SLB
Tub Set
Water
Sewer
Final
8c1
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Driveway
F:.",,-\ &/~h~ t~b
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($~) shall be made for each trip for each trade:
a. Wrong Address ~thJ y~ ~ ~
b. Condemned work resulting from faulty construction. J f?.- I OJ. -18'
c. Repairs or corrections not made when inspection called. f' .q
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
BUILDING DEPARTMENT
OWNER'S NAME J/1;f 3' ~9Ti ~ Ch.- K:..J
PHONE
OWNER'S ADDRESS
JOB ADDRESS
1. ~-r 119
.
CO<j
f-J;rf
LCf (7.p
LEGAL DESCRIPTION: LOT(S)
PARCEL LD.' 2. <i-2~ -'4..1
BLOCK
SUBDIVISION
('/VO 0
- OO/OCl .- .//9
.
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPOSED:_New Construction _Addition ---^lteration _Repair _Install
_Sign
~ove
_Deaolish
PROPOSED USE: _Single Faaily
_KIF
_' of Units
~/H
_ec-ercial
_Indust.
_Swia. Pool
_Other
_Restaurant &: Health Departaent Approval
DESCRIPTION OF WORK: IJ; I? J<. #10 cd ~
BUILDING SIZE: /2. X y--z.., Y9~ 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.
--1IECIIAlIICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUC'l'ION: _Block _Fraae _Steel
Other
FIJIISIIED FLOOR ELEVATIONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
YES NO
******************************************
BIJTI.DER
CONTRACTOR SECTION
aMPAIIY ~ L?;.LI~
f'. I ~ State Cut. or Regist. .
1../lJ~p-~. . City License Registration . "1'"A L
**** ************************************
9~
Signature
PLUHBER
RT.RCTRICIAN COMPANY ~r -r ,
~ ~ State Cert. or Regist. .
Siorulture, ~ ~...... City License Registration .
*** *************************************
COHPAIIY C7'.~
~ State Cert. or Be ist--:-t
~~~ City License Registration'
*** **************************************
r'~
Signature
LJ7-
yy
Signature
COMPANY ..4 L e..
W ~ State Cert. or Regist. .
~ a City License Registration'
** *************************************** .
MECHANICAL
f"'~
OTlll1.R COMPANY
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 perlit lay be subject Lo "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 bired a contractor or contractors to underta1e wor1, 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
requirelents lay apply for the intended work, they are advised to contact the City of Zephyrhills Building Deparllent, (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
"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 wor1. 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'fILI'fY CONNECTION FEES l"
D. CONSTRUC'l'ION LIEN L'I\W (CHAPTER 713, FLORIDA STATUTES" AS AMENDED)
I certify that I, the applicant, bave been provided witb a copy of "Florida's Construction Lien Law _ HoIeoKoer's Protection
Guide" prepared by the Florida Departlent of Agriculture and ConsUl8r Affairs. If tbe applicant is SOleODe 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 cOllenCelent.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the inforlation in tbis application is accurate and that all work will be done in cOlpliance with all
applicable lals regulating construction, zoning, and land developlent.
I
Application is hereby lade to obtain a perlit to do lork and instailation as indicated. I certify that no wor1 or
installation has cOllenced prior to issuance of a perlit and that all work will be perfoIJed to lIet standards of all laws
regulating construction, City codes, loning regulations, and land developleDt regulations in the jurisdiction. I also
certify tbat I understand that the regulations of otber governaental agencies laY apply to the intended work, and that it is
IY responsibility to identify wbat actions I lust tale to be in cOlpliance. Such agencies include but are not liaited to:
I Deparllent of Environaental Regulation - Cypress Bayheads, Wetland Areas and BnviroDleDtally Sensitive Lands,
Water/Wastewater Treatlent
I Southwest Florida Water Hanagelent District - Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses
I ArlY Corps of Engineers - Seawalls, Docks, Navigable Waterways
I Deparllent of Health & Rehabilitative Services, EnvirODleDtal Health Unit - Wells, Wastewater Treallent, Septic Tanks
I US Environaental Protection Agency - Asbestos abatelent
I also certify that, if fill laterial is to be used in Flood Zone "A" or "A,etc.", it is understood that a drainage plan
addressing a "cOIpeDsating 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 lith 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 petlit issued shall becoIe invalid
unless the work authorized by such perlit is cOllenced within six IOnths of issuance, or if work authoriled by the perlit is
suspended or abandoned for a period of sillOnths after the till the worl is couenced. One 90 day utension of tiae, .y be
allowed for the perlit with fee charge of $15.00. The IItension shall be requested in writing to the Building Official. In
approved inspection lust be logged during each six IOntb period, or the project lill be considered abandoned.
WARMING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF CotUIENCRHENJ HAY RESULT IN YOUR PAYING nuCl FOR IHPROVIIIBIl'S TO YOUR
PROPERlY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN AnORlEY BEFORE RECORDING YOUR NO'lICE OF
COHMINCEHINT. JOBS UIDIR $2,500 IN VALUE DO NOr NEID TO RICaRD AND POST A "NOTlCR OF COtIHENCEHENJ".
SIGNAtURE: OWNIR OR AGENT
.' I
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument
before me this
was acknowledged
, 19_ by
STATE OF FLORIDA
COUIIY 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 bas
produced
as identification and wbo did/did not
take an oath.
(Signature)
(Signature)
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
CITY OF ZEPIIYRHILLS BUILDING DEPARTHENT
OWNER
JOB LOCA'l'ION
PARCEL 1. D .' #
SIION ALL EXISTING & PROPOSEU STRUCTURES GIVING DIHENSIONS . SBTBACKS.
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UTILITY BUILDINGS 1-
MUST SHOW SIZE & plPERTY
FOUNDATION INFOR-
MATION. FRONT LINE
(NOTE EXAMPLES 1 & 2) STREE'l' 1u
1. SETBACKS FOR Rl, R2 ZONING 2 . SE'l'BACKS FOR R3 ZONING
60' 60'
10'
P E-
R X
0 I
10' P S 10'
0 T
S I
E N
D G
20'
1 0'
,--
10'
10' EXISTING 10'
1. 0
PROPOSED
20'SGL FAM 30'DUPLEX
FRONT PROPERTY LINE
FRONT PROPERTY LINB
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PASCO COUNTY.. FLORIDA
Permit No. -Z r ? 't J1
Date Permitted _ ~- / / - Y Y'
Builder Name/Owner Name Jt1 r 1Y4.J-..-.
County Parcel No. ,;L'I-~ /:; - ~ () iJ;; 0 - () 0 I" 0- II 9'
~::::;':at;on/TYpe of U,e t1-of!7r.Yj!2~
Subd,
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Rate $
Zone No,
Impact Fee Amount $
Prepared By
Sq. Ft./Unit
The above impact fee has been established ant to the Pasco County ortation Impact Ordinance as adopted
by the Board of County Commission . his amount is payable PRIOR to the iss ce of a Certificate of Occupancy
structure.
RESOURCE RECOV
EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
I
Gross Sq. Ft. (GSF)
Rate/ERU - 52.00/Year
or $0. I 42/Day
ERU Assign No.
Assessment - (No, Units) x ($0.142)
x (No. Days)
Assessment -
(GSF) x (ERU) x (0.142) x (No. Days)
100
TOT AL FEE $
dO. a3
TOTAL FEE $
The above assessment has been established pursuant to the Pasco County Ordinance No, 89-07 and Resolution No. 89-197,
as commended.
THE ASSESSMENT WILL BE CALCULATED AT THE TIME OF ISSUANCE OF THE CERTIFICATE OF
OCCUPANCY.
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form. placing
the building permit owner on notice of this assessment and the conditions of payment for same.
Date
Received By
OFFICE USE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. NO.
rJ } A-- DATE
37:;) 73 g DATE
ry/~/ q Y'
BY ~
Byd~ /
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal:ce
PC93113094/