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BUILDING PERMIT
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
09300
$I~~~
Date
3.;,'7-6JdJ
BUILDING
EL~AL
PL~
MEC~L
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcell.D. #
C'...~ fnJ\~
50'-t~ Go.1Cl .~,
Water Meter:
T.I.F. 's:
Zoning:
Description of Work
Energy Code:
L)cJ.Q ~~~
Radon Gas:
NO OCCUPANCY BEFORE C.O.
FINAL 3-' I ~ - <:J a
DATE
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
,'.------ Jnspector
.. ~
"
DATE
City License Registration # J d.S
State Certified License# C Be A- J / ~ I a....
Permit Fee
Valuation or
Contract Price
t13~~<2Q..
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BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
SLB
Tub Set
Water
Sewer
Final
Breakurs
Ducts Insl.
Compressor
Final
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($ 25.001 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.
OWNER'S NAKE V HS f2.EAL::tY
OWNER'S ADDRESS 777 .D612HAvV\ <3T:
JOB ADDRESS 501-8 GA~ gvO.
'---'1\ '))
0- \.\0.1 . \ iJ1-' 0
.. 10') 11~ IJ R.--D
,Il // ;v-) "'at-
PHONE 181-~28-77'O
CANTON . MA.. 0202-1
I
APPLICATION FOR PERMIT
CITY OF ZEPHYRHILLS
BUILDING DEPARTMENT
LEGAL DESCRIPTION: LOT(S)
B~SUBDIVISION
PARCEL I. D.'
(OBTAIN FROM PROPERTY TAX. NOTICE)
WORK PROPOSED:_New Construction _Addition ~teration -Jepair ~Install
~Sign -'love _DeJIOlish
PROPOSED USE: _Single Faaily _KIF _' of Units _K/B
_~.J:~ercial _Indust. _Swill. Pool _Other
_Restaurant & B<<:alth Departaent Approval
DESCRIPTION OF WORK:_' f\J ~ALL WALL- ~L~
BUILDING SIZE:
x
Square Feet,
Beight
RESIDENTIAL :
COMMERCIAL :
A'lTACB (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
A'lTACB (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORKS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
5~5.0o
PERKITS REOUESTED
_BUILDING
$
Valuation of Total Construction
_ELECTRICAL
AMP Service
Florida Power Corp.
W.R.E.C.
--1IECllAllICAL
$
Valuation of Mechanical Installation
_PLUMBING
GAS
ROOFING
SPECIALTY
TYPE OF CONSTRUCTION: _B1ock _Fraae _Steel
Other
FIlIISBED FLOOR ELEVAITONS:
FT.
IS PROJECT IN FLOOD ZONE AREA?
******************************************
BIITT .DER
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Signature
COKPANY
State Cert. or Regist. .
City License Registration .
******************************************
F.T.F.CTRICIAN
COKPANY
State Cert. or Regist. .
City License Registration .
******************************************
SignAture
PLUMBER
COKPANY
State Cert. or Regist. .
City License Registration .
******************************************
Signature
MECHANICAL
COKPANY
State Cert. or Regist. t
City License Registration .
******************************************
Signature
OTRF.R
COKPANY
State Cert. or Regist. t
City License Registra~~.~
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. PERMIT OFFICER.
Signature
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APPLICATION APBIlOWD....., ....~ ....i,...,
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CONDITIONS OF PERMIT AFFIDAVIT
A. 'NOTICE OF DEED RESTRICTIONS
The undersigned understands that this perlit lay be subject to "deed restrictions" which lay be .ore restrictive than City
regulations. The undersigned assUles responsibility for cOlpliance with allY applicable deed restrictions.
B. .. UNLICf;NSf;D CONTRACTORS AND CONTRAC'l'On RESPONSIB.IL.lTIES
If the owner has hired a contractor or contractors to undertake work, they lay be required to be licensed in accordance with
state and local Jegulations. ..If the contractor is not licensed ~s required by law, both fbe-OIOIer and contractor .y be
cited for a'lisdeieanor violation under state law. If the owner or int~nded ~ontractor are uncertilnrts .to ~t licensing
requirelents lay apply for the intended work, they are advised to contact the City of Jepbyrbills ~llding Departlent, (BIl)
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 OIOIer sign as the contractor,
you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wisbes you to sign
as contractor that lay be an indication that he is not properly licensed and is not entitled to p8IIitting privileges in the
City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
{
"
D. CONSTRUCTION LIEN L~W (CHAPTER 713, FLORIDA STATUTES1 AS AMENDED)
I certify that I, the applicant, bave been provided with a copy of .Florida's Construction Lien Law - HOIeOWDer's Protection
Guide" prepared by the Florida Departtent of Agriculture and ConsUler Affairs. If the applicant is 8OIeOR8 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 this application is accurate and that all work will be done in cOlpliance with all
applicable laws regulating construction, loning, and land developlent.
I
Application is hereby lade to obtain a perlit to do work and instailation as indicated. I certify that DO worl or
installation bas cOllenced prior to issuance of a perlit and that all work will be perforted to Jeet standards of all laws
regulating construction, City codes, loning regulations, and land developlent regulations in the jurisdiction. I also
certify tbat I understand that the regulations of otber goveInlental agencies lay apply to the 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 11lited to:
t Departtent of Environaental Regulation - Cypress Bayheads, Vetland Areas and EnviroDlentally Sensitive Lands,
Vater/Vastewater Ireattent .. .
t Southwest Florida Vater "anagetent District - Veils, Cypress Bayheads, Vetland Areas, Altering Vatercourses
t ArlY Corps of Engineers - Seawalls, Docks, Kavigable Vaterways
t DepartJent of Health & Rehabilitative Services, BnvirODleDtal Health Unit - VeIls, Vastewater Treattent, Septic Tanks
t US EnvirODlental 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 .cOlpeRsating volOle" will be sublitted which is prepared by a professional engineer registered in the State of
Florida prior to per.it. issuance.
. A perlit issued shall be construed to be a license to proceed with tbe work and not as authority to violate, cancel alter, or
set aside any provisions of tbe technical codes, nor shall is~u~ce of a per.it prevent the Building Official frOl thereafter
requiring a correction of errors in plans, construction, or violations of any code. Ivery peIlit issued shall beCOlB invalid
unless the work authorized by such perlit is cOllenced within sil IOnths of issuance, or if work autboriled by the petlit is
suspended or abandoned for a period of sil IOnths after the tile the work is cc.enced. One 90 day IItension of tite, .y 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 sil IOntb period, or the project will be considered abandoned.
VAMIKG TO OWKER: YOUR FAILURE TO RE A KOTlCB 0' COIQIEKCBIIIlKT HAY RHSULT IK YOUR PAYlKG BICB FOR IMPROVIIIIIrS TO YOUR
PR IITIlfD 100BrAI .IIAIIC ltG, COMULT V,rH\YOUR LBKDER OR All ATTORItB' BEFORE RlCORDIKG YOUR MorICI OF
C UNDER $2,5 IK VA DO KOT KBED TO RBCORD AND POST A "NOTICE OF COKKENCKMEKT". .
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SIGKATURB: COKTRACTOR
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STAlE OF FLORI~
COUKTY OF t44f'-er-
The foregOing instrument was acknowledged
before me this ,.;2 -,~ , .1-9-~{l() by
':pft~1 L/t-lA
who is personally known to me or who has
produced ---
identification who did/did not~
y' 0 h~
(Si~ature) .
r;. mAQk lA) I L '-F~
(Name Typed, Printed or Stamped)
NOTARY PUBLIC
CD' . MYCOMM==95 flCIlIRES
i : . December a. 2003
.. lOIllEl) 1MIIU lIl<WMIN lIlIUUIlQ, INC.
STATE OF FLOR~
COUNTY OF ~
The foregOing instrument was acknowledged
before me this ,7 - d ('; , ~() by
..,.-. '.
;-~ANe I-~ J~ - LIIJel2
,!ho is personally known .tILme or who bas
produced
as identification and who did/did not
~~~~
(~tu~. ~.
~"\- tt LU!0E 1/
(N e Typed, Printed or Stamped)
NOTARY PUCi) ~_~
. . tltCOMMtSStON';95 ..
: i : . December a. 2003
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February 22, 2000.,
T40931
Apple Sign & Awing, Inc.
1640 Land O'Lakes Blvd.
Lutz, FL 33549
Dear Sir/Madam,
This letter shall serve as formal authorization for Kenneth Hicks, D/B/A Kyokushin Karate to
install signage depicted on the attached layout at our property at 5046 Gall Blvd, Zephyrhills,
Florida. ParcelID# 112621000001400/1500. Legal description is attached.
If you have any questions, please do not hesitate to contact me at (800) 225-9702, extension
6007.
d$;(~
~Mumma
Director of Real Estate
County of Norfolk
On this 22nd day of February, 2000, before me personally appeared the above named James
Mumma, Director of Real Estate for VSH Realty (a division of Cumberland Farms, Inc.) 777
Dedham Street, Canton, Massachusetts 02021, acknowledged the foregoing in rument to be his
free act and deed before me, and the duly authorized act of the orporation.
My Commission expires: 3/31/06
A Division of Cumberland Farms, Inc,. 777 Dedham St. . Canton, MA 02021-9118
(781) 828-7790
.02/17/2000 11: 37 8139482403
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FEB 17 '00 10:53
APPLElKLINER
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8139482403
PAGE 02
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PAGE. 02
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A strip of land, 200 feet in width; i.e. 100 feet on each side of
the centerline of the roadbed of the Seaboard Coastline Railroad
being more particularly dMcribed as follows: From the corner formed
by the North boundary of South Avenue and the West boundary of
Seventh Street proceed along the West boundary of Seventh Street
North 24057'45" West, 502.18 feet for a POINT OF BEGINNING: Thence
continue along said 'boundary North 24057'45" West, 100 feet; thence
""South 65002'15" West, 200 feet; thence South 24057'45" East. 100
feet; thence North 65002 '15" East 200 f~et to the 'Point of Beginning;,;
SUBJECT TO Restrict"ions, reservations and easements (if recora;'- "".
AND
That J;XJrtion of the vacated SF>aboard Cbastline R:l.ilroad right-of-way in
Section, 11, 'Ibwnship 26 South, Range 21 Fast, Pasa:> County, being
described as follows: Cbrrrte1cing at the intersection of the Southerly
right- of -way line of 4th Aver1ue and the Easterly right-of-way line of
. U. S. Highway 301, per plat of CITY OF ZEPHYRH:ILrs, as recorded in Plat
Ebok 1, page 54, Public Records of Pasco O:nmty, Florida, nm S. 24057'15"
E., 419.82 fe<-?t for a POINT OF BEX;INNlNG: thence run N. 65002'15" E.,
200.0 feet to the Weste:rly right-of-way line of 7th Street, as per S;>~d
plat of CITY ('if' ZEPHY'RHILLs, thence s. 24 "57' 45" E., 50.0 feet along
said Westerly right-of-way lLe of 7th Street; thence run S. 65002'15"
W., 200.0 feet to the said Easterly right-of-way line of U. S. Highway
301; thence N. 24057'45" W., along the said Easterly right-of-way line
of U. S. Highway 301, 50.0 feet to the POnn: OF BEGINNnl:;.
· s. <STO~AC::JE" AN \00)"5,
" 210'-0")
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