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Home My WebLink About00-9616 ;)5.~ MECHANICAL Date 7 hs/ (}o ~ 1~4.J o 9 616 & 11./00 IliJV BUILDING PERMIT 9'). o~ BUILDING ')5.0.:: ELECTRICAL CITY OF ZEPHYRHILLS (813) 788~6611 ;)5, QQ PLUMBING Permit Sewer Conn Water Conn: / D Property Owner: TDu..;..'\ V, ~~ P\ed: c,,- Ur+ S Le..,.kJ' I ~r .t"u sAipwatef Meter: Job Address: '?7~fo + "'S761'f fI'lec/:,-cd A-,k Co(,lc+ T.I.F.'s: Parcell.D. # sY-)) - J 1- 000<.')- 0 () SOc) , OD g '2 Zoning: Descriotion of Work Energy Code: 'T..,+e,rr'LV (2~ '''',dP ( Radon Gas: NO OCCUPANCY BEFORE C.O. FINAL '~ '~ C.O. Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances. DATE Inspector Sf:. ~~"" dy j)OIi. BUILDING J ~~ r:.- ,j. ( Ii'. S 5 ELECTRICAL ( Y Co ~ ~:~;t Fe~o - ~ c:J com~ Address ./ Telephone# 3 C; 2.. - S~,? - 7Cj9z II" sfy I S PLUMBING I ')tf " Valuation or Contract Price J 5", 1)00. c"!;.' I City License Registration # State Certified License# ~o";'\y I ~ MECHANICAL Job Ftr. Pre SLB Lintel FRM, 1-2 LJ- neJ ~~ Insul. CL WL Tp. Serv, Rough In Meter Can Const. Pole Pool Pre-Meter Final SLB Tub Set ~ Water Sewer Final Breakers Ducts Insl, Compressor Final '8/1/0 i) 5R Driveway f. rq;. \ ~J-1/()" <;f 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. APPLICATION FOR PERMIT CITY OF ZEPHYRHILLS BUILDING DEPARTMENT DATE RECEIVED 7 h 2/ ;D PLANS REVIEW FEE ,. (!enler OWNER'S NAME---rDuJi\i.euJ M~c;lico..l/\rk^Po..f+ner6~'lp PHONE ~r~-/~~-;)15q_ JOB ADDRESS ?.il'b\O -\-~, '8\L\ tv\ed,ell\ Wh ~oo.rt L.ep~1" l-\d\~ ,FL.. LEGAL DESCRIPTION: LOT(S) A-H-o..ch.eol BLOCK SUBDIVISION PARCEL ID # 31.\- ';}. 5 -? \ - O(){)O~ 062/:x)- coB;;)., (OBTAIN FROM PROPERTY TAX NOTICE) WORK PROPSED: []NEW CONSTRUCTION [] ADDITION tiaALTERATION [] DEMOLISH [] REPAIR [] INSTALL [] SIGN [] MOVE PROPOSED USE: []SGL FAMILY DWELLING IXl COMMERCIAL []MULTI-FAMILY [] INDUSTRIAL []# OF UNITS [] SWIMMING POOL, o MOBILE HOME []OTHER c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL 1 n~e('"ior ~eMoGl'et SQUARE FOOTAGE ~ \ 000 DESCRIPTION OF WORK BUILDING SIZE HEIGHT RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. PERMITS REQUESTED ...~ BUILDING $ ,I ~ Odd VALUATION OF TOTAL CONSTRUCTION ~ ELECTRICAL AMP SERVICE ~ FLORIDA POWER [] W.R.E.C. f:J. PLUMBING 'fJ MECHANICAL $ 3~ VALUATION OF MECHANCIAL INSTALLATION [] GAS o ROOFING o SPECIALTY 0 OTHER TYPE OF CONSTRUCTION: 0 BLOCK o FRAME o STEEL o OTHER FINISHED F~OOR ELEVATIONS IS PROJECT IN FLOOD ZONE AREA[] YES [] NO SIGNAT COMPANY j~J J)€i!e{c'fl~re! (!~l1lf line STATE CERT OR REGIST # __ () _1!1..s23 CITY PROCESSING # ::1""5 S" rV'lecJ l.v c.. S "...,. 7 'i '7 7.. ************************************************* BUILDER SIGNATURE COMPANY h'rsf tla.t;..'1 Clec./-r,'c STATE CERT OR R~GIST # (:PO J/,L) / 7 , CITY PROCESSING '# ) ~ ~ ...' ~ vJG.." . * * * **** * * ** ** * * ** * **** * * ** * * *;;: I * I*,* ,** *-P) ~:~ *'*b**':; "" COMPANY ICv--S T'1 S I ~rn- 1-1 o . . nO (\ I. ^- . ~.--- STATE CERT OR REGIST # SIGNATURE -v'-A.JJ}f).UjL'0""'~ - - ~ CITY PROCESSING # "''-.'1f) , . OK... ** * * * ** * **.** * ** ** *** * ** *** * ** * * * * ** *** * * **~** * * * **** *,j:;; * -.I; * ***** COMPANY: L... (/ ""J,. ""v. STATE CERT OR REGIST # a'w\ tJ>GJ I ~ 4 /r; ,~ ~ CITY PROCESSING # ~o~ . ********************************************************~~~***** ELECTRICI PLUMBER MECHANICAL OTHER COMPANY STATE CERT OR REGIST # CITY PROCESSING # SIGNATURE ....~.'~l. .,..,~_...t'..:, .;"" *****************************************r******~*****~*~******** l~~ '.' ,.'. .\ . ,:'f! j~ EXI-IXBXT 99A 99 Legal Description The East 90.05 feet of the following described property: For a Point of reference commence at the Southwest corner of Lot 3, TOWNVIEW MEDICAL ARTS CENTER, as per plat thereof recorded in Plat Book 29, page 68, Public Records of Pasco County, Florida; thence N 89 58'40" W, along the North boundary of SPANISH TRAILS VILLAGE and along the Westerly extension thereof, 360.00 feet for a POINT OF BEGINNING; thence continue N 89 58'40" W, a distance of 224.64 feet; thence N 00 07'42" E, a distance of 182.33 feet; thence 47.95 feet along the arc of a curve to the right (said curve having a radius of 25,00 feet, Delta of 109 53'48", chord bearing and distance of N 55 04' 39" E, 40.94 feet); thence S 69 58'40" E, a distance of 98.48 feet; thence 84.47 feet along the arc of a curve to the left (said curve having a radius of 242.00 feet, Delta of 20 00'00", chord bearing and distance of S 79 58'40" E, 84.05 feet; thence S 89 58'40" E, a distance of 15.59 feet; thence S 00 04'30" W, a distance of 157.00 feet to the POINT OF BEGINNING. SUBJECT TO road right of way for MEDICAL ARTS COURT EXTENSION as indicated on the site plan and to be described by a certified survey which will become part of this exhibit. @~' .. R8tIJtn to: (seJUNl......AIj stamped envelope enclosed) R'.... Sandy Development Company, Inc. t 12303 Hwy 301 \! Dad.CIty, FL 33525 This lnatrument Prepared by: Sandy DeYelopment Company, Inc. 12303 Hwy 301 Dade City, FL 33525 Property Apprai8ers Pan::elldentiflcatlon Number 34-26-21~OOO~0300~82 A IN / 1111111111111111111111 UIIIIIIIIIIIIIIIIIIIII" 1111I 11111111 2000087541 Rcpt.: 42716!5 OS: 0.00 07/13/00 Rec: 10.50 IT: 0.00 Opty Clerk i~91~~~~"'~ : rc.s;o fOUNT:,. C~ERk OR 81< 4402 PG 1962 NOTICE of COMMENCEMENT State of Florida County of Pasco The undersigned hereby gives notice that Improvements will be made to certain real property, and In accon1ance with section 713.13 of the Florida Statutes, the following Infonnatlon Isprovtded In this NOTICE of COMMENCEMENT. Legal description of property: Attached Contractor Mailing Address: Surety Name: Surety Mailing Address: Lender Name: Lender Mailing Address: Person within the State of Florida designated by Owner upon which notices and other documents may be served as provided by Section 713.13(1)(a)7., Florida Statutes. Name Not Applicable . Street address of property: DeSCription of improvements: Property Owner Name: Property Owner Address: Owner's interest In property: Fee Simple Title Holder Name: Title Holder Address: Contractor Name: Interior Remodel Townview Medical Arts Partnership 7335-2 Gall Blvd, Zephyrhills, FL 33541 OWner Same Sandy Development Company, Inc. 12303 Hwy 301, Dade City, FL 33525 None None Amt of Bond $ None N/A Address In addition to himself, the Owner designates the following person to receive a copy of the lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes. Name Address Expiration date of this Notice of Commencement: /1 This Notice of Commencement expireS in one year. er James H. Bingham Pnnted Signature of Owner I have relied upon the following identification of the Affiant: PeYSOI'1a.//r Knol,l../r} ii':Jil::--."iti~'d 0t1ly ~ C - 1,{,(,1)'L; ry I re PMlecI fIIolaty sogna.uUEUSI. Q. 8R~ Notary Public, State of F1ortd1 My comm. expo Sept. 28, 2003 Convn. No. CC870880 " OR 81< 4402 PG 1963 2 of 2 :-., EX!-IXBXT wWAWW Legal Description dst 90.05 feet of the following described property: For a Point of reference commence at the Southwest corner of Lot 3, TOWNVIEW MEDICAL ARTS CENTER, as per plat thereof recorded in Plat Book 29, page 68, Public Records of Pasco County, Florida; thence N 89 58'40" W, along the North boundary of SPANISH TRAILS VILLAGE and along the \Westerly extension thereof, 360.00 feet for a POINT OF BEGINNING; thence continue N 89 58'40" W, a distance of 224.64 feet; thence N 00 07'42" E, a distance of 182.33 feet; thence 47.95 feet along the arc of a curve to the right (said curve having a radius of 25.00 feet, Delta of 109 53'48", chord bearing and distance of N 55 04' 39" E, 40.94 feet); thence S 69 58'40" E, a distance of 98.48 feet; thence 84.47 feet along the arc of a curve to the left (said curve having a radius of 242,00 feet, Delta of 20 00'00", chord bearing and distance of S 79 58'40"E, 84.05 feet; thence S 89 58'40" E, a distance of 15.59 feet; thence S 00 04'30" W, a distance of 157.00 feet to the POINT OF BEGINNING. SUBJECT TO road right of way for MEDICAL ARTS COURT EXTENSION as indicated on the site plan and to be described by a certified survey which will become part of this exhibit. STATE OF FLORIDA COUNTY OF PASCO THIS IS TO CEIUIFY THAT THE FOREGOING ISA TRUE AND CORRECT COpy OF THE DOCUMENT ON FILE OR OF PUBLIC RECORD IN THIS OFFlp~~NESS MY HAND AND OFFICIAL SEAL THIS DAY OF -I 2 -'!J!1) N C ERK OF CIRCUIT COURT DEPUTY CLERK /{'_O \~\.~~. ~v . t5' '- ~~0\.-l 'b6V/i,l9f f:tVH'~'1 f ~ .Ieft -\: ' l ;~I\Ll~~ ~l IV' '31 ~ltO &-~'l1>llf ~j) (Vlf). c.+. . /> " ~~';{'1/(j.) SQ. FEET. PRICE MAIN OR LIVING AREA .. . OTHER AREA UNDER ROOF OTHER . ! . BUILDING: q"- .,:> " ":). ELECTRICAL: Z5,"'\:. PLUMBING: - CO L.':J MECHANICAL: ~ cu 2."7:;), RADON: 10IIT CREDIT: ,JIlt- QI4iy\ ') i. SEWER: WATER: TOTAL: ...... , -r0~ A b-U bb- ~t;SiGNtrllW T.I.F',S I. I. (j;rA-L -::::=- . /70 A~?b , 0.<.. I' M " tl\ .;t ~ : ;. ~ .> .; ~o.l . l(\_>$\ , o :;; '::b ~ ~ .~ ~ ~ ~ ~. ". .,.6. ~'6 ro.c=. :. " .. r 'il III' ~. "Of ~ . .J I :~ ,,' 0> . \))4 ~~ tip .I .' ~. ~ . " ~ " ( ~ . ~ V\ o o V, ." r- ,~'..... l' ~ z8 a,:""? (120 ot:: a........ tT1 C/) .. ~~ . .... (rt .' - m ~~ \i\.x -t o o' - () 6 '. - X .:.,. '.-' 'g~I.' \J\ . . l"ff7' !: . ", . . :\:;::-: .o,.:of, ~ . ~i.:". I ':2 oiL '~... ~ . \.:, 'So" t. ''';0' . .... ........~ '. '0- . .-, "'.'" " ~ "~~'~'.: l',,'~~~::-:r' , . . " ;}'" !.: ''!.'l!.:.....,... ..... ., . . ....,.-....... -. .... .... .. .' ,:-..... . ""t. I. . . .0' ... . :. . . ' '" ~od '. J DONALD F. ZAHN. A.I . ARCHITECT 726 TMOEWlkOS ORIV BRANOON. FL 33511-62 6' tll,,) 6110047113 ( '.~ -- () ;. r~ '.~.: 6 '. , ~ ~ ~ ~ ~ .[). ~ ~ ~. ~ ~ t ~ ~. ~ ct 5 i '1. 02 BUILDING BUILDING PERMIT 09618 CITY OF ZEPHYRHILLS Permit (813) 788.6611 Dale 7/; '1/00 ~q.~ (,S'. ~ PLUMBING "JS.~ MECHANICAL Sewer Conn /27 j. ~ ..0 Water Conn: ~S-u.- Water Meter: I io, ~_6 ELECTRICAL Pmperty Owne, )uJ ~'~ ~'}2Je..u Job Address: , 'i? I- 0... ~ i . Parcel 1.0, # 02 - 2 b ,. J. 1 - ctJ I 0 . 0 '2 ~ 0 0" 00' 0 Zoning: Energy Code: Oo"';DI;on of Wo", ~).e 'I Y " ;~ . '2 Is 10 I B-t" e P 4:K , /,/'".ll.f Radon Gas: .., '71 ofl, - TIF~~I ~? 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 Valuation or Contract Price 13.q70.~ , Inspector 9 Permit Fee 2,0~, €;L _ Signature ~ lA, \5.w---. Company Address City License Registration # State Certified License# ~ f.' e II LSrc BUILDING 27 ~ 3 __ Telephone# ~13> 7'30 ELECTRICAL PLUMBING 20G Ftr 1~2~A!JCJ ~ ~ Pre' SLB cr, /<f...(6) Ie.. Lintel VI b -1:,.'lJO S ~ FRM, I?"/~- iJo 5/( Insul. CL WLZS: Driveway - I I:.. ~1/-1-~C>5R... SLB q... ~-GO 5?re Tub Set /2-/1J-dJt!J 5R... Water Sewer II- 9 -eo 5' ~ Final Tp, Serv, Rough In /2-/9_~t!J fj,f Meter Can Const. Polec.. Pool Pre-Meter 2' _r -C7 / 5" IC.. Final r~ ~ '!~29-DD~)L ~9,15--(!)t>tL Breakers Ducts Ins!. /'2.. -1'l-Dj)5.R 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. 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. Russell Brown 4745 Silver Circle Zephyrhills, FL35541 10-18-2000 Zephyrhills Building Dept. I request a license change on building permit # 9618, 9619 and 9620 from Dennis Tryznadellicense # ER 0607888 to Russell M Brown license # ER 0010551. \# oZ q/fJ Sincerely yours ~rvt.~ Russell M Brown . 6'ld ;;J 1 \i\. (2 d 68'~.5' \)C.. ry . I 'J APPLICATION FOR PERMI~l~/. /, CITY OF ZEPHYRHILLS nLq tf) '.. '7 7/00 BUIWING DEPARTMENT If TE RECEIVED PLANS REV'l:EW FEE NAME ~lli\ 0 1A. PHONE '7 ~- 2. J:S ~ Il-L-~ r--L, 53~<+o JOB ADDRESS L) \'-' \. (?_ \) '\ LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # 02-- 2t-. -2..\-Dnlo - O?~DO- 00\ 0 (OBTAIN FROM PROPERTY TAX NOTICEI WORK PROPSED: ~EW CONSTRUCTION o ADDITION DALTERATION o REPAIR o INSTALL Os I GN o MOVE o DEMOLISH PROPOSED USE: DSGL FAMILY DWELLING o COMMERCIAL IidM"ULTI-FAMILY o INDUSTRIAL fA..n OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER DESCRIPTION OF D RESTAURANT & HEALTH DEPARTMENT APPROVAL WORK D~PU~_;X 6. 'I- X 7 i . z " SQUARE FOOTAGE 2 13 '8/::2.1'7 So HEIGHT R ~ k"141/E$ BUILDING SIZE RESIDENTIAL: ATTACH (21 PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. .~ PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION. PERMITS REQUESTED WBUILDING [1:( ELECTRICAL g PLUMBING IR"'MECHANICAL $ ~ I ( 000 ~oO VALUATION OF TOTAL CONSTRUCTION AMP SERVICE 9" FLORIDA POWER o W.R.E.C. $ 5700 VALUATION OF MECIIANCIAL INSTALLATION o GAS I0"ROOFING o SPECIALTY o OTHER TYPE OF CONSTRUCTION: ~LOCK o FRAME o STEEL o OTHER FINISHED FLOOR ELEVATIONS IS PROJECT IN II3"'N 0 BUILDER SIGNATURE Q~ \'\1. <:K~ COMPANY r~U ~ ~t.~LL.1'V\ ~Q ~ STA'fE CERT OR REGIST # C-6:- z.o ~ I h LI CITY PROCESSING # 2. I t:l 3. Die SIGNATURE ****************************************************~****~*** ~ COMPANy.J)eVlIll,' 5 h.Ul~ -e-( -.J. STATE CERT OR REGIST # tJl.O{) 7 ~g>p CITY PROCESSING # 32"8 D ~ ELECTRICI ***************************************************** PLUMBER COMPANy:::r: 'M \4 \T I c-6 STATE CERT OR REGIST # r<. f l:'O s -, b 4- 0 CITY PROCESSING # 20q O~ MECHANI ******************************~******~******~******** COMPANY nl N S(;;'f C(- NT{? 14L ~ STATE CERT OR REGIST # (')OS'f-IL CITY mfESSING # I 'S L. ' * ** * * * ~ *** ** * ** * * * ** * * * ** * * * * * ** **kf!J;t; ~**>.t~1:;...t*~_.. COMPANY STATE CERT OR REGIST # CITY PROCESSING # OTHER SIGNATURE ***************************************************************** '" CONDITIONS OF PERMIT AFFIDAVIT 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 restrictions. B. UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES If the owner has hired a contractor or contractors to undertake work, they may be required to be licensed in accordance with state and loc~l regulations. 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 1 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 doculnent and promise in good faith to deliver it to the "owner" prior to commencement. E. CONTRACTOR'S/OWNER'S AFFIDAVIT I certify that all the information in this application is accurate and that all work will be done in compl~ance with all applicable laws regulating construction, zoning, and land development-. Application is hereby made to obtain a permit to do work and installation as indicated. I .", certify that no work or installation has commenced prior to issuance of a permit and that all work will be performed to meet standards of all laws regulating construction, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify -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 Environmentally 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 "compensating volume" will be submitted which is prepared by a professional engineer registerpd in the State of Florida prior to permit issuance. A permit 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 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 a period of six months after the time the work is commenced. 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 six 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, CONSULT 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". SIGNATURE: OWNER OR AGENT ~ M. c:g~ SIGNATURE: CONTRACTOR acknowledged , 19_ STATE OF FLORIDA COUNTY OF The foregoing in~ent w Before this ~y f by ~ PeL? L() STATE OF FLORIDA COUNTY OF The foregoing instrument was Before me this _ day of by \ (name of person acknowledged 1 Dwho is personally known to me, or nowledged ,H~ of identificationl take an oath. (name of person acknowledged) [1ho is personally known to me, or ~o has produced ~J.. ~ ~ c~ (type of identification) and who Ddid ~d not take an oath gment Dwho has produced (type and whoD did D did not Signature of person taking acknowledgement Name typed, printed or stamped ,.a,I\~I'II.<t Clerep.n M Brunty Na~,~~,,'re:l~n200e1'lNfB2' 5lt~, ,~t~=~ D..-. ~~",I;i . . '.. ......c. 10 -.......,. .. ~.~.tJ ~MY Commission CC74l1811 '~,..".J' Expires June 15, 2002 RUSSELL BROWN 6831 DAIRY ROAD SQ. FEET PRICE MAIN OR LIVING AREA 1,655 $ 40.00 OTHER AREA UNDER ROOF 518 $ 15.00 OTHER VALUATION $ 73,970.00 FEE SHEET $ 366,00 ADDRESS $ 20.00 DRIVEWAY $ 20.00 BUILDING: $ 589.00 CREDIT: $ - BUILDING LESS CREDIT: $ 589.00 ELECTRICAL: $ 89.88 PLUMBING: $ 65,00 MECHANICAL: $ 35.00 RADON: $ 21.73 TOTAL $ 800.61 SEWER: $ 1,278.00 WATER: $ 350.00 IRRIGATION: $ - TOTAL: $ 1,628.00 WATER METER:I $ IRRIGATION METER $ 180~00 I SUB-TOTAL $ 2,608.61 I T IF'S: $ 1,480.00 99% $ 1,465,20 1% $ 14.80 TOTAL: $ 4,088.61 , 986758 -= D PERFORMANCE BUSINESS PROOUCTS. INe, 813-71l1-8OO8 FAX 813-719-7111$ CITY OF ZEPHYRHILLS ZEPHYRHILLS, FLORIDA (JO - t.; {J 71 WATER ACCT, NO. DATE 7/1<,/ /00 ~~~ K4. 55 ell ~I"'CJ~" MAIUNG '-I) 4)' ./I), " vet/' z-efhy/' k:l/.$ I Pc SERVICE ADDRESS b g! I ~; '" y SHUT OFF SERVICE 0 TURN ON SERVICE if INSTALl. METER ~ READ METER 0 CHECK METER 0 OTHER 0 "31 ,{ " ~ j'vte~ WORK COMPLETED BY & DATE COMPLETED G '/' <-I{> 53 ~"f I ((d. ~TER o SEWER o GARBAGE ~ CITY o OUT CITY l ._ No, OF UNIlS ._ DEPOSIT AMOUNT ._ AMOUNT LAST BILL __ DATE __ MISC. CHARGE ORDER TAKEN BY 4~ Retain white form in office at aJllimes. Send pink & yellow forms to Water Service Oept Water Service Dept. to sign yellow form & return to office. \ t I I ( 1 i ! t i i i 1 t !