HomeMy WebLinkAbout99-9062
BUILDING PERMIT
BUILDING
7 6 ~ 73
ELECTRICAL
CITY OF ZEPHYRHILLS
(813) 788-6611
{,O ~
.
PLUMBING
Permit
09062
12/blq~
'f~ 7. ~
Date
S s: !!E
MECHANICAL
Zoning:
l5r:"" k
L..'-'.f!..
'0- (')0
T.I.F.'s:
I] ..., '"8. ~
1{,o.~
lio.'3e
Sewer Conn
Water Conn:
Job Address:
Parcell.D. #
Radon Gas:
I,. 24
DescriPtion of Work
NY J~~' - (jl 10' C
FA... ~., r? /I...:/S-t)/) //.j}cJAr\. A I ~j)F/
NO OCCUPANCY BEF~RE C.O. ~~ .
\
Complete Plans, Specifications and Fee Must Accompany Application.
All work sh~1 b.~ p~rformed in accord.~ anc,' Wi~hJ'~it~e~ ~~inances.
'7":J.(,'-0C?~ p:'L .c:2-:1/56rT~ t::1 (/JI1L- ...1 Inspector
64 ~~ ~~ t7J-LJ,6~/h1~ ~~?../t;rlJ~A4$5JI{.
q ~atc;'~"~f'sf~~o <;;; ~.~ P.'~~(~ ~~
Contract Price I ~ r;l . _ Slgh..tt.... ~ ~. . -,
Company
Address
" Telephone# 7g d.--'ff 3~ (jY 7R .,2..-D'e I ~
FINAL ~ 00
8/'1/00 DATE
C.O.
DATE
City License Registration #
State Certified License#
5gf
~"':",k &rrrl,;lIJ ~(~. Se"',:c.f' Pluwo.L:J. ~ S~O~C~
BUILDING ELECTRICAL t:;b PLUMBING ,UD
Ftr, JZ..u>-&f9 ~ Tp. Serv, SLB I-IO-C!K!J r;:;;;;)
Pre SLB J.. 21.{ ,L!)(J)7:21!IJ Rough In a..2P-5..&a J/C Tub Set L .3-'1.... ~ Ie-
Lintel .L:2../aJ ~~ &8/2 Meter Can Water
FRM, v.3- >- DCJ .$(( Const. Pole l!t1"2~/l./- 9c4ijJ Sewer Z ""24 - 00 :;;c
Insul. CL Pool Final
WL,;;;"'/ .:5-e:JCJ.J$"e Pre-Meter i.!...2S"--clD ~
Final
Driveway -'t-/7"'~bge t?.~Z-P.... 9CJ(2;jjJ
~ Z~2:?~O(!)9R- P~p;;:;C
~ Go. ~ r \, fropt;. -r Ii> r I
.4,,"
MECHANICAL
Breakers
Ducts Insl.~~ d $V'Z
Compressor
Final
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($ 25.001 shall be made for each trip for each trade:
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.
lAt<)-k A~>t"\~~.
~. FCt:J
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
2. /-//
. /
STATE CERT OR REGIST # C.(\ C.o <; 7"1 YtF
CITY PROCESSING # /7
SIGNATURE
*****, *****************************************......*....*..*..
OTHER COMPANY
STATE CERT OR REGIST #
SIGNATURE CITY PROCESSING #
.***.****.*********.*******.***************....*.*...............
~
~
COlJ))jTLUN~) Of PJ~ilJ'~J'r }\VfllJlWIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" which
may be more restrictive than City regulations. The undersigned assumes responsibility for
compliance with any applicable deed rest.rictions.
B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILI'l'lES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be licensed in accordance with sLaLe and local regulaLions. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to 'what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(sl sign portions of the "Contractor Sections" of this application for which they
will be responsible. If you, as the owner signs 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 may be an indication that he is not properly licensed and is
not entitled to permitting privileges in the city of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "owner" prior to corrunencement.
E. CONTRACTOR' S/OWNER' S AF'F'IDAVIT
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as in~icated. I
certify that no work or installation has corrunenced prior to issuance of a perrott and that
all work will be perforrned to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certi~y, that I understand that the regulations of other governmental agencies may apply to
the. intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Envirorunentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
. *U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "A" or "A,etc.", it is
understood that a drainage plan addressing a "compe,nsating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance.
A permit issued shall be co~strued 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 issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for
pe'riod of six months after the time the work is corrunenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged during each siJ
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSUL'
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
~~~
acknowledged
, 19_
S'l'A'l'E OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____day of
by
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _____ day of
by
acknowledged
, 19-=-
(name of person acknowledged)
Dwho is personally known to me, or
D who has produced
(type of identificationl
and whoD did Ddid not take an oath.
(name of person acknowledged)
I:1hois personally known to me, or
D who has produced
(type of identification
and who Ddid OUd not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
..
1I111111111111111111111111111111111111111111111111
99151140
Permit No.
NOTICE OF COMMENCEMENT
Rcpt: 374421 Rec:
DS: 0.00 IT:
12/01/99
6.00
0.00
Dpty Clerk
State of FIori d.a.-
County of 'P~ Q. 0
THE UNDERSIGNED hereby gives notice that improvement will be made to certain
real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement:
1. Description of Property: Parcel No. I;;L c2~ d/ ()IOO ODCOO 00[/0
Lt f.12 Su..mmey 1-1,'11 SIA diVt'.s,'r5f1 (luna Dr (;iliAve ~ YnemCYi L.n Zf/;lls
(Legal descrlptlon of the property and street address lf avallab e)
2.
Gt::iteLal Dascl::i}?tion of In1pro"....~mcnt
C-DYlsfr u-c J- 11f.-{;U S /YLj I ~
.p 0-ft11"1J 10 I () c k. ho-m e .
~"'~"'.;'; .....~~~
R3.
Owner Information: Name G:,CVd@1 L. C1.Jtcl PO..-u.jc;.... D. T<l'1 Br" nlc-
Address 35.5.I:L Ck.J+cr Dr--, City Zephyr hi /ls State FL 335}1/
Interest in Property:
City
f~0i>~~~2~:COIC~rY CLERK
OR BK 4269 P6 1966
State
Name of Fee Simple Titleholder:
(If other th~n owner)
Address
4.
Contractor: Name (;l ()y dcYL
Address 35.5/;;. Ch.-e~ky Dr.
L. T-u1f3r,~/~Bn'^1c.f4ssO~0--+es
~
City 'Ze.p~~rhlll~ State Fe 33WI
5. Surety: Name
Address
City
State
Amount of Bond: $
6 . Lender: Name
Address
City
State
7. Persons within the State of Florida designated by Owner upon whom
notices or other documents may be served as provided by Section
713.13(1)(a)(7), Florida Statutes:
Name
Address
City
State
8. In addition to himself, Owner designates
of to receive a copy of the
Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
9.
gxpil.l1L LOll uttLe at Notico of CuuulIoncolllouL (tho expiration uate is 1 year
fr0m the date of recording unless a different date is specified.)
Signature of Owner: (~}/A..A cJ.-t:L ~~f"
Sworn to and subscribed before me this ~ ~ day of --1'J. C5l.)P.JV\l b~
19 qq.
,
Notary Public:
My Commission Expires:
87.05' North
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Department of Community Affairs
FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 600A-93 Residential Whole Building Performance Method A
PROJECT NAME: Model #1722 BUILDER: TenBrink and Associates
AND ADDRESS: .,oc)~ ,..,.~O/ y ~....~ PERMITTING '1 CLIMATE . 1
OFFICE: c.~ of 2eiAy, Zt#.1IE: 41 ~I 51_1 61_1
OWNER:Go,...d..... 7.e....,:J ' '- PERMIT NO.90€:.'7.. JURISDICTION NO. 6{f6()o
f)r, /I" CK
1. New construction or addition 1. New Construction
2. Single family detached or Multifamily attached 2. single-Family
3. If MUltifamily-No. of units 3. 0
4. If Multifamily, is this a worst case (yes/no) 4.
5. Conditioned floor area (sq.ft.) 5. 1215.60
6. Predominant eave overhang (ft.) 6. 1.30
7. Porch overhang length (ft.) 7. 0.00
8. Glass area and type: single Pane
a. Clear Glass 8a. O.Osqft
b. Tint, film or solar screen 8b. 83.5sqft
9. Floor type and insulation:
a. Slab on grade (R-value, perimeter)
10.Net Wall type area and insulation:
a. Exterior: 1. Concrete (Insulation R-value) 10a-l R= 5.00, 929.39sqft____
b. Adjacent: 2. Wood frame (Insulation R-value) 10b-2 R=11.00, 199.20sqft____
11.ceiling type area and insulation:
a. Under attic (Jn~111~+-~-- ~
12.Air distribution sye
a. Ducts (Insulat
13.Cooling system
14.Heating System:
15.Hot water system:
16.Hot Water Credits: (]
DHP-Dedicated
17.Infiltration practicE
18.HVAC Credits (CF-CeiJ
HF-Whole hOUSE
barrier, MZ-Mt:
19.EPI (must not exceed
a. Total AS-Built
b. Total Base poin
SN: 8132
CENTRAL
Double Pane
O.OOsqft
53.51sqft
9a.R= 0.00, 162.90 ft
..R=30.00 , 1215.60sqft____
t-J~
~ LGstJ"fr--r~
I
~
. R= 6.00, uncond
Type: Central A/C
SEER: 11.05
Type: Heat Pump
HSPF: 7.00
Type: Electric
EF: 0.88
~IL,
2
CF CV
81.78
21912.63
26794.65
-------------------------------------------------------------------------------
----------------------------------------~--------------------------------------
I Hereby certify that the plans and
specifications covered by this calcu-
lation are in compliance with the
Florida Energy Code.
PREPARED BY:
DATE:
Review of the plans and specifications
covered by this calculation indicates
compliance with the Florida Energy
Code. Before construction is completed
this building will be inspected for
compliance in accordance with Section
553.908 F.S.
I hereby certify that this building is
in compliance with the Florida Energy
Code.
OWNER/AGENT:
DATE:
BUILDING OFFICIAL:
DATE:
*******************************************************************************
SUMMER CALCULATIONS
*******************************************************************************
=== BASE ===
=== AS-BUILT ===
===============================================================================
~~~~;--~;;~-~-;;;;-:- POINTS I
TYPE
SC ORIEN AREA x SPM x SOF = POINTS
-------------------------------------------------------------------------------
E 51.12 82.2 4202.1 SGL TINT E 25.6 107.1 .90 2471.9
SGL TINT E 25.6 107.1 .90 2471.9
S 3.45 82.2 283.6 DBL TINT S 3.5 78.8 .64 173.8
W 82.44 82.2 6776.6 SGL TINT W 16.2 107.1 .90 1565.7
SGL TINT W 16.2 107.1 .90 1565.7
DBL TINT W 40.2 87.3 .93 3259.4
DBL TINT W 9.9 87.3 .83 714.2
-------------------------------------------------------------------------------
.15 x CONDo FLOOR / TOTAL GLASS = ADJ. x GLASS =
AREA AREA FACTOR POINTS
ADJ GLASS
POINTS
GLASS
POINTS
-------------------------------------------------------------------------------
.15
1,215.60
137.01
1.331
11,262.22
14,988.35 I
12,222.69
===============================================================================
NON GLASS------------ I
AREA X BSPM = POINTS TYPE
R-VALUE
AREA X SPM = POINTS
-------------------------------------------------------------------------------
WALLS----------------
Ext 929.4 1.0 929.4 Ext NormwtBlock In 5.0 929.4 1.00 929.4
Adj 199.2 .7 139.4 Adj Wood Frame 11.0 199.2 .70 139.4
DOORS----------------
Ext 20.0 4.8 96.0 Ext Insulated 20.0 4.80 96.0
Adj 17.6 1.6 28.2 Adj Insulated 17.6 1.60 28.2
CEILINGS-------------
UA 1215.6 .6 729.4 Under Attic 30.0 1215.6 .60 729.4
FLOORS---------------
Slb 162.9 -31.8 -5180.2 Slab-on-Grade .0 162.9 -31.90 -5196.5
INFILTRATION---------
1215.6 10.9 13250.0 Practice #2 1215.6 10.90 13250.0
===============================================================================
TOTAL SUMMER POINTS I
24,980.52
TOTAL X
SUM PTS
===============================================================================
22,198.57
SYSTEM =
MULT
COOLING I TOTAL
POINTS COMPON
X CAP X DUCT X SYSTEM X CREDIT = COOLING
RATIO MULT MULT MULT POINTS
-------------------------------------------------------------------------------
24,980.52
.37
9,242.79 I 22,198.57 1.00 1.100
.309
.860
6,488.95
========================================:======================================
*******************************************************************************
WINTER CALCULATIONS
*******************************************************************************
=== BASE ===
=== AS-BUILT ===
===============================================================================
GLASS---------------- I
ORIEN AREA X BWPM = POINTS TYPE SC ORIEN AREA X WPM X WOF = POINTS
-------------------------------------------------------------------------------
E 51.12 -3.4 -173.8 SGL TINT E 25.6 -2.0 .48 -24.4
SGL TINT E 25.6 -2.0 .48 -24.4
S 3.45 -3.4 -11.7 DBL TINT S 3.5 -11.0 .74 -28.1
W 82.44 -3.4 -280.3 SGL TINT W 16.2 -2.0 .48 -15.5
SGL TINT W 16.2 -2.0 .48 -15.5
DBL TINT W 40.2 -3.6 .84 -121.2
DBL TINT W 9.9 -3.6 .61 -21.8
---------~-----~---------------------------------------------------------------
.15 X CONDo FLOOR / TOTAL GLASS = ADJ. X GLASS =
AREA AREA FACTOR POINTS
ADJ GLASS
POINTS
GLASS
POINTS
-------------------------------------------------------------------------------
.15
1,215.60
137.01
1.331
-465.83
-619.96 I
-250.83
===============================================================================
NON GLASS------------ I
AREA X BWPM = POINTS TYPE
R-VALUE
AREA X WPM = POINTS
-------------------------------------------------------------------------------
WALLS----------------
Ext 929.4 1.1 1022.3 Ext NormWtBlock In 5.0 929.4 2.90 2695.2
Adj 199.2 1.8 358.6 Adj Wood Frame 11.0 199.2 1.80 358.6
DOORS----------------
Ext 20.0 5.1 102.0 Ext Insulated 20.0 5.10 102.0
Adj 17.6 4.0 70.4 Adj Insulated 17.6 4.00 70.4
CEILINGS-------------
UA 1215.6 .6 729.4 Under Attic 30.0 1215.6 .60 729.4
FLOORS---------------
SIb 162.9 -1.9 -309.5 Slab-on-Grade .0 162.9 2.50 407.3
INFILTRATION---------
1215.6 4.1 4984.0 Practice #2 1215.6 4.10 4984.0
===============================================================================
TOTAL WINTER POINTS I
6,337.14
9,095.93
TOTAL X
WIN PTS
===============================================================================
SYSTEM =
MULT
HEATING I TOTAL
POINTS COMPON
X CAP X DUCT X SYSTEM X CREDIT = HEATING
RATIO MULT MULT MULT POINTS
-------------------------------------------------------------------------------
6,337.14 1.10
6,970.86 I 9,095.93 1.00 1.100
.484
1.000
4,842.67
===============================================================================
*******************************************************************************
WATER HEATING
*******************************************************************************
=== BASE ===
=== AS-BUILT ===
===============================================================================
NUM OF
BEDRMS
x
MULT
=
TOTAL
I TANK VOLUME
EF
TANK
RATIO
x MULT x CREDIT
MULT
= TOTAL
-------------------------------------------------------------------------------
3
3527.0
10,581.00 I
40
.88
1.000 3527.0 1.00 10,581.00
===============================================================================
*******************************************************************************
SUMMARY
*******************************************************************************
=== BASE ===
=== AS-BUILT ===
===============================================================================
COOLING
POINTS
+
HEATING
POINTS
HOT WATER
+ POINTS =
TOTAL I COOLING
POINTS POINTS +
HEATING
POINTS
HOT WATER
+ POINTS =
TOTAL
POINTS
----------------------------~--------------------------------------------------
9242.8
6970.9 10581.0 26,794.65 I
6489.0
4842.7 10581.0 21,912.63
===============================================================================
*****************
* EPI = 81.78 *
*****************
ENERGY GUIDE
For detailed information
of the EPI rating number
or for any ITEM listed,
ask your Builder for
DCA Form 600A-93
or Form 600B-93
EPI= 81.8
o 10 20 30 40 50 60 70 80 90 100
I--------------------------------x--------I
The maximum allowable EPI is 100. The lower the EPI the more efficient the home
RESIDENTIAL ENERGY PERFORMANCE RATING SHEET
ITEM
HOME VALUE
Low Efficiency
High Efficiency
WINDOWS..................... Single Tint
SINGL CLR DBL TINT
I------x--------------I
INSULATION. . . . . . . . . . . . . . . . . .
ceiling
R-Value......... 30.0
R-10 R-30
I--------------------xl
R-O R-7
I--------------x------I
R-O R-19
Ix--------------------I
Wall
R-Value......... 5.0
Floor
R-Value......... 0.0
AIR CONDITIONER.............
SEER. . . . . . . . . . . . . . . . . . . . .. 11. 1
10.0 SEER 17.0
I---x-----------------I
HEATING SySTEM..............
Electric HSPF............ 7.0
6.8 HSPF 12.0
Ix--------------------I
WATER HEATER................
Electric EF.............. 0.88
0.88 0.96
Ix--------------------I
0.54 0.90
1---------------------1
0.40 0.80
1---------------------1
Gas EF.............. 0.00
Solar EF..............
OTHER FEATURES..............
. . . . . . . . . . . . . . . . . . . . . . . . . . . .
I certify that these energy saving features required for the Florida
Energy Code have been installed in this house.
Address:
Builder
Signature:
Date:
City/Zip
Florida Energy Code for Building Construction - 1993
Florida Department of Community Affairs
FL-EPL CARD93
-t~"'\'i'k~O-\I'P~ l' !\'))DL.
5 D'~} 'K ,ItA. t)...n'\-~ L,...N:
SQ. FEET PRICE
MAIN OR LIVING AREA /215. b 4D,v~
.
OTHER AREA UNDER ROOF so' + - .:>~
b. I ') ~
OTHER
BUILDING:
ELECTRICAL: 1b,/j 2
PLUMBING: roo ~ o'U
MECHANICAL: 3"; o=>
::>.
/71-L ~Q~ ~. RADON: /7. 1-'-
~
CREDIT: fJ/rr
SEWER: ~-r~MD
WATER:
TOTAL: J ,.,
I
T.I.FSI I; /frO,"'" I
l I)
rl
~. : f
1 \ ~
i:
"
, ~ i' If'"
;.':1
, i i j t
~.cd
,k
i "'~_\ "
"~
..~_..J
"j-..';:,) (i,j-V
!; j! !
: "j
: d ;,.
'" !
i"j'-;t',
il!'li 11'
,{
, I
,
i'l!
!;
i.,'
--- _ _ ...i!L.- --. -- _I
'II I
I ;1 I
! I
'"Ii
\1
'It,
'I
! i
1_.
PASCO COUNTY, FLORIDA
PermIt No. ~ G 2
Date Permitted _ !:: I tIe? q
Builder Name/Owner Name ~f I,:. , B / . /\ k.
f '';
County Parcel No. \
" .'
" l,
/."
,r .
,J I u U. O!". () OJ v - Q (J S ( )
AddressILocation
".
....;U(j~
/
l'1i,..... () ,'. <j
f.. t") .
Subd.
.n' .',,1 ~ )._ t-" J~ f\ "
Classificationffype of Use
::::.. " ,
. Ii"
~ r-
~
r f~... ~.-\
I "
>M
'U.Jf{1 :/'S
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Rate $
Zone No.
Sq. FtlUnit
Prepared By
Impact Fee Amount $
Checked By
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted by the
Board of Pasco County Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or
utilization of the permitted structure.
RESOURCE RECOVERY ASSESSMENT
EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
I
Gross Sq. Ft. (GSF)
Ratc ERL:
52.00/Year
or $0.142/03Y
ERU Assign No.
A~~c~~fllcnt
( ~ 0 U nit s) .\ ($0 I 42 )
.\ (No. D3Y~)
As~essment -
(GSF) .\ (ERLJ) x (O.14=~) x (No. Days)
100
TOTAL FEE $
TOT AL FEE $
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED VNTIL THE AMOUNTS LISTED
HA VE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowledgement below does not imply acceptance of concurrence. hut Simply rccclpt of 3 copy of this form. placing
the huilding permit owner on notice of this assessment and the conditions of payment for same.
\ " -
.- r:
.,,',..~
,
( C.,
Date
,r")!..
~.t.,),_,~..". ,;:-~-::"'.
Received By
I" . l
y . t ., J ' A
-' , '~,.~
. .I
----- ------------------------------------------------------------------------------------- -
- -------------------------- -
- --------------------------
OFFICE L'SE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. NO.
. t
DATE
DATE
BY
BY
White
Applicant
Canary
Trans/Finance
Canary
RR/Fmance
Pink
Office
Green
Bldgllnsp
feecalce
PC93113094/D