HomeMy WebLinkAbout00-9915
BUILDING PERMIT
'~
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
0991~
II h J /OV
Date
t&>. ~
BUILDING
..,r 00
.,L'.:>.-
JS-,'~
PLUMBING
;)~,~
MECHANICAL
ELECTRICAL
- l'"l€
Sewer Conn 1~ 6.
~&t'
Water Conn: ~, "
Property Owner: WG."cJ CA $"e.t (
Job Address: <;19. ~~ j ~ pP. E'
Parcell.D. # 11-2(,- 2., - 0010.... Iq~ 00,' 00 II
Zoning: Energy Code: Radon Gas:
DescriPtion of Work ,I\1:~~\hr ~~ ~
~l_e~ei"" 12../1'1/__ F. P.3: 03 fA Lo t.,'Se
Water Meter: ,.., """'.
T.I.F.'s: '''T..lJ<~
'"
"j
~?
~ ~
'- ':1
V~
~
~
'(
~
~
FINAL
NO OCCUPANCY BEFORE C,O,
Complete Plans, Specifications and Fee Must Accompany Application. C.O,
All work shall be performed in accordance with City Codes and Ordinances.
DATE
Valuation or ~ 2 r
Contract Price .) , 7 )
Inspector
Permit F~
.... Signatu~ t ~ '---/'Y}&tn-
Company
Address
-Te
City License Registration #
State Certified License#
r'br-
BUILDING 2lo
Ftr. JI,2.(!)-OD 8.f5
Pre SLB
Lintel / /,. '2,-oofl:!#)
FRM.
Insul. CL
WL
ELECTRICAL
PLUMBING
MECHANICAL 4)'.
Breakers
Ducts Insl.
Compressor
Final
SLB
Tub Set
Water
Sewer
Final
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
F~ e~ 11-2.o-C1C) I3B
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Fifteen and 00/100 Dollars ($ 25.001 shall be made for each trip for each trade:
a.
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.
00. ~ ~
p.. ,))t v- \,
\b-' cA
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
//-&, - tlO
DATE RECEIVED .
PLANS REVIEW FEE <=
OWNER'S NAME AN'M'
JOB ADDRESS
r~ ~~L PHONE
.3"p~ )/t/ ~AlJlEI 2H~-..~
?rI"~-J>~~
3M1'/i>
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID # I/-';t '';/''Oe>/P-/''"'-P&>//
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ~EW CONSTRUCTION
DSIGN
PROPOSED USE:)nsGL FAMILY DWELLING
o COMMERCIAL
o ADDITION
OALTERATION
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
DMULTI-FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
..
DESCRIPTION OF WORK /AJ"'~
.::P~ ' 1>" J '/9'
BUILDING SIZE .;1v t:I ~'/7
bt:;A I'IJ'JJv~ ~ at! ~,~
SQUARE FOOTAGE d IP~
HEIGHT
/~/
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT
ATTACH (3) SETS
PROPERTY SURVEY
:!2l BUILDING
~ELECTRICAL
)9- PLUMBING
~ECHANICAL
$ ~~ptIV
,2 t>t?
PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS,
OF BUILDING PLANS & (1) SET ENERGY FORMS,
REQUIRED FOR ALL NEW CONSTRUCTION'(j) '--J7..t2-J- NcJ~
./ (
'" If II ~.~
PERMITS REQUESTED (J)...6../ (J&1<<L.>r5~~~
~v~~~~.
VALUATION OF TOTAL CONSTRUCTION V
AMP SERVICE 0 FLORIDA POWER 0 W, R, E. C.
$
.2 ,QD~
.
o VALUATION OF ME(C~~ :S:~O:~ '#~tnU
OTHER v~, 'If - cr'l/5:-"
;a. FRAME 0 STEEL ~--aQTH~R "."..!}______.---
IS PROJECT IN FLOOD ZONE AREAO YES ~ NO
o GAS
o ROOFING
o SPECIALTY
TYPE OF CONSTRUCTION: 0 BLOCK
FINISHED FLOOR ELEVATIONS
SIGNATURE
A 7J~
^J
******************************************************************
/',
(~
U?/LIUL , ___'
COMPANY fj ft'1t ~.rr"krl;..J
STATE CERT OR REGIST # G.8-ePS'7/d/.;!L
CITY PROCESSING # ~~ (iU
v' ,-
BUI:LDER
SIGNATURE
COMPANY /hAt/'U ~e~r";c.-
STATE CERT OR REGIST #
CITY PROCESSING :/;t~fL.. ~K
******************************************************************
ELECTRICIAN
S I GN.P-.TURE
/;J~
~
~1uLC
COMPANY owner
STATE CERT OR REGIST #
CITY PROCESSING #
PLUMBER
'"
**~~********************************************~*~*****~** .
....CllJ\NICAL~ ' COMPANY ~.-h.e 'll,"n_;.z" ~1Mi~
/ -
> STATE CERT OR REGIST #
SIGNATURE _ 'm.._ ~ t, t-f L ~L>~A:iTY PROCESSING 111Sr'I-
* * * * * * * **** * * * * * * * * * * * * * * ** * * * * ** * * * * * * * * ** * ** * * JI'.. * * * * * * * * * * *'* * *
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictipns" w~ich
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 local 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 aqvised to have the
contractor(s) sign portions of the "Contractor Sections" of this application for which the:
will be responsible, If you, as the owner signs as the contractor, you are indicating thai
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 i:
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 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 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 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 tc
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 Bayhe'ads, 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 registered 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 ofsi~ 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".
J:1~ 7-1~
SIGNATURE: WNER OR AGENT
A 1J~
SIGNATURE~CONTRACTOR
STATE OF FLORIDA~ STATE OF FLORIDA -:\ , '
COUNTY OF \J~~t!. D COUNTY OF rt'\.~~ b
The foregoing instrument was acknowledged The foregoing i~Jument was~knowledged
Befor~ this day of ('\.t;'V' , ~t.-tt> Before me th~. )('~ dalhof ~ .t...,y , X~
b ' by b '~C-~ .:bq g;~
y (name of erson acknowledged) ~. (name of per on acknowledged)
~ho is personally known to me, or ~o is personally known to me, or
Dwho has produced
(type
and whoD did ~id not
of identification)
take an oath,
o who has produced
(type of identification)
~id not take\an oath
Name
ledgement
Betti- ~-,JYtiV..K~ Tt ~~
'3 ~q Eft ~ (l..() A v,
/UD'()G~
'.
SQ. FEET PRICE '
MAIN OR LIVING AREA $
OTHER AREA UNDER ROOF '~1>~ $ t~~
OTHER
VALUATION $ 3/,~/5. oc.-
.
BUILDING: $
o.>:;)V
~~
ELECTRICAL: $
,,- aJu
,?
CREDIT: $
Nfl'
PLUMBING: $
-- C....
Z-~~
MECHANICAL: $
-- e>t:.
Z~ <
GD~~
~
RADON $
11111111111111111111111111111111111111111111111111111111111I
2000142248
state of _F\ 0 y- \ J 0-
NOTICE OF COMMENCEMENT
County of YClSC D
TUB tmOERSIGNED hereby gives notice that improvement will be made to c~rtain
real property, and in accordance with Chapter 713, Florida Statutes, the
following information is provided in this Notice of Commencement:
1. Oeser iptiol1 of Property:
~ 3r-J
(Lega descr~pt~on 0 t
2.
General Description of
fVl{)du IOJ
Rept: 4!54418
DS: 0,00
11/13/00
Ree: 6,00
IT: 0.00
____ Dpty Clerk
3.
Owner Information: Name ~tl ~\L.p /<neJ{
Address 3"f{1'iCp 6",1 Aile city ~1L~r)\' ((S
Interest in Property: rcwn fir
State +1.
Name of Fee Simple Titleholder:
(If other th~n owner)
JED PITT"AN~ PASCO COUNTY CLERK
11/13/00 b:2!pm 1 of 1
OR BK 447~ PG 1757
Address
City
State
~'Fi
Contractor: Name ~~e
Address ~'6 S Y vJ
~~-L' ~ B+ II (!()Jlslru~i/()~
. I~ State Fl. 33'5 q I
5. Surety: Name
City
State
Address
Amount of Bond: $
6. Lender: Name
City
State
Address
7. Persons within the State of Florida designated by Owner upon whom
notices or other documents may be served as provided by Section
713.l3(1)(a) (7), Florida Statutes:
NC1me
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.
Exp.l rnt ion d"t.e ot Not.lce or Commencement. (the explration date is 1 year
fr~m the date of recording unless a different date is specified.)
My Comiili s510n Expires:
SignatureOfowne~: \~~u~~ .
Sworn to and subscribed before me this r ~ day of jJ DV€m ber
ed-ODD. L
/7 j) /J/J STATE OF FLORIDA
Notary Publ ic : . C ~./JLA\- r-:ZaA .J-o 1/ Ypo COUNTY OF PASCO
THIS TS" to l;I:K II~Y I n~ I rf1~ POflll!GOll1lB 13 A
TRUE AND CORRECT COPY OF THE DOCUMENT ON FILE
N THIS OFFiCe, TNESS MY
L SEAL THIS - gAY QF
2 f.JrE)
ERK OF CIRCUIT COURT
DEPUTY CLi:f'lK
PC93053048
G) IUIMt NllIAlMUII
. NGfay NlIII:I." d.......
Mrec.-. .....bt ,.....
· Co........, . CC92S7...
... ....
./
,"_00_"
./
(
......
.L-.._'.
~
i
~
.i
.
I
~2
~
\\
'l:
-
'. '
.,
f'., .....
I
/
......
\
r
,
1
r
,
r
J
-
a..
'"
" '
-.
\
'-1
. ,
1-
.1
. )' , ' ,,' ''';,'.. ~. .
,,;... . .
. ..
. f. .'" .."
.~; :\:1
- ."
.. . ,...: '"
,r ~ ..;. -.. ~
. - ",
. "'''..J .
\
.....
. , ..
~
.' '" ~' "
~
....
...::1 I ~
..
M ~,
...... Q
...... , lV'I
, ~J..
. ',.
. ,.... -'
, .
I: "
"
.-{
...
. .
-
~~
WG:
>0
<tt;
~
'l).
~~
M
.'
1.
. ~ .. :
. .J
..' . .
r. .' ' " i,:' .
f . , -... ''''".f.''- '"
....-:.J.' ". ' ".'
. · ,:;....'/ :,'~; '.'r :.:
,;-, ... :;'t/~ ..:...ttt~ ;..7-". .
,.', . ".",;: '~:~~"~::~:"'"
,..", , ~:-:',~.r~'i!p."?J;!h""
". . .. . :, . _.... :. '/:,/...!~I\'r' .~~: ~~.: . _
. _.. -.. -" _.. -.. -.. -.. -" _.. - ,.- ,.._:..._1,_.. - "-1'-"-
S3IW^ Uo..wd ' M/tl 011McI:.-;.~ ~~:,~ :~:! ,
<d) 133~lS HI3 I iN3"!., ('j ). 13~1sL"'4~02 .
~ ;"<',1:' ;.:.... ~.t.~
.L~:.
.,
,
..
, . #
. ., "\',7.;: .
;Z .. , , "~:' "
1 -. '. .' ~ " . .'. . , .
~ s; I . -. ..~,.- "',' ..... .~
JI~."~'" . ' ~
.:- .~ D
f ' "110 . . .-. ,. . -I
. -,
~~
1-.-1
l-
e.=-
...1/'
n.Q:
:J.
3 ~8t',tO.OOS
" ,
1
1
r
r
r
J
r
r
r
r
~.t2
~'..........J:'81
J-+'91
r
.1.
r
,
I
r
al
:. (ID.O\ '.
o ,
....1
-
I-
o
...I
"-
o
Q:, . If) Q:
~.I"'" w
:z: ~
. i 1 i
L ~,j, ~
(d>Ot, .
", . . 7.:,;'.',r
: '. ,-
, .. '.~ . .~.. , '.., '
, ~'. 1....::-". '. . .
, '. .
"
'u-,
/.....
~
, I .
(d )1 (4 >00 "06
, '. ., -..
II"" ~; :
'101.1
Xl
.
d
(II)
I-
o
...I
"-
o
Q:
~
Z
-
1 ~'
, Q:. ,
./. _(~X?t-.J
:u-,
I.....
nO
.....,
(d )Ot
, '
"'. .,..
This Warranty Deed
Made this ~st day of November A..D. 2000
b~. JOHN NESSELBAUF and PATRICIA E. NESSEL
his wife
UP,
I
hereinafter called the grantor, to
WANDA SUE KNELL, A SINGLE PERSON
whose post office address is:
Grantees' SSN:
hereinafter called the grantee:
(Whcnever used hcrein thc tcon "grantor" and "grantcc" includc all thc parties to this instrumcnt and thc
hcirs, lcgal representatives and assigns of individuals, and thc successors and assignS of corporations)
Witnesseth, that the grantor, for and in consideration of the sum of $ 10.00
and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises,
releases, conveys and confIrms unto the grantee, all that certain land situate in Pasco
County, Florida, viz:
Lots 1, 2, and 3, Block 199, City of Z~hyrhills, LESS the West
75 feet thereof as per plat recorded in Plat Book 1, Page 54,
Public Records of P~sco County,'Ylorida. .
SUBJECT TO covenants, restrictions, easements of record and taxes for
the current year.
Parcel Identification Number: 11 26 21 0010 199~'OOll
Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining.
To Have and to Hold, the same in fee simple forever.
And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple;
that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants
the title to said land and will defend the same against the lawful claims of all persons whomsoever; and lhat said land is
free of all encumbrances except taxes accruing subsequent to December 31, 2000
In Witness Whereof, the said grantor has signed and sealed these presents the day and year first above
written. ,
Signed, sealed and delivered in our presence:
ame:
~5, ~" ~ S~~Qf\~)
Name:
~rlA~
y
Name a Addrea:
US]
Name:
Name &: Address:
rm
State of
County of
Florida
Pasco
The foregoing instrument was acknowledged before me this 1s t day of NOvember
W, JOHN NESSELBAUF and PATRICIA E. NESSELBAUF, his wife
,2000 ,by
'.
who is personally known to me or who has produced
DRIVERS LICENSE
as identification.
WD-l
5/93
PREPARED BY: SUNSTATE
RECORD & RETURN TO:
Sunstate Title Agency, Inc,
13937 7th Street
Dade City, Florida 33525
File No: S-19229
~
Notary JSublic
Print Namc: '
My Commission Expircs:
09/18/00 13:28 FAX 727 726 7019
JACOBSEN HOMES
@001
. FORM 600A-97
FLORIDA ENERGY EFFICIENCY CODE
FOR BUILDING CONSTRUCTION
Florida Department of Community Affairs
Residential Whole Building Performance Method A
MOD093 '.5 Builder: JACOBSEN HOMES ";/
1J6utJ tsAR TOW - J ,"1'1 b) Arr Permitting Office: ~L. CITY ~",./;., I' tAr
ZEPHYRHILLS, FL ~ 11 ("f' I?_ermit Number: '7 '115'
SUE KNELL Jurisdiction Number: 611600
Central' -
Project Name:
Address:
City, State:
Owner:
Climate Zone:
I. New construction or existing
2. Single family or multi-family
3. Number of units, if multi-family
4. Number of Bedrooms
5. Is this a worst case?
6. Conditioned floor area (ft')
7, Glass area & type
a. Clear - single pane
b, Clear - double pane
c. Tint/other SC/SHGC - single pane
d, Tint/otller SC/SHGC - double pane
8; Floor types
a. Raised Wood, Post or Pier
b, N/A
c. N/A
9, Wall types
a. Frame, Wood, Exterior
b, N/A
c. N/A
d. N/A
e. N/A
10. Ceiling types
a. Single Assembly
b, N/A
c. N/A
II. Ducts
a. Sup: Unc, Ret: Unc, AH: Outdoors
b, N/A
c. Conservation credits
(HR-Heat recovery, Solar
DHP-Dedicated heat pump)
R=30.0, 2090,5 iF -;?"" 15. HVAC credits PT-C, PT-H
(CF-Ceiling fan, CV-Cross ventilation,
HF-Whole house fan, APPROVED [BY
PT-Programmable Thermostat,
RB-Attic radiant barrier,
MZ-C-Multizone cooling,
MZ-H-Multizone heating)
New
Single family
I
3
No
2085 it'
12. Cooling systems
a. PTAC and Room Unit
Cap: 54.0 kBtulhr ,/
EER: 10.00 -;.---
b. N/A
c. N/A.
13. Heating systems
a. Electric Strip
Cap: 20,0 kBtulhr
COP: 1,00
7.3 W
8.1 ft,
146.6 ff'
0.0 ff'
R=11.0,2085.0ff'
R=19,O, 1333.1 ff'
Sup, R=6,O, 238.0 ft
b, N/A
c. N/A
~
14, Hot water systems
a, Electric Resistance
Cap: 40.0 gallons V
EF: 0,88
b. NfA
29 11m
Glass/Floor Area: 0.08
PASS
Total as-built points: 27359.00
Total base points: 28092.00
I hereby certify that the plans and specifications covered 1
by this calculation are in compliance with the Florida
Energy Code,
PREPARED BY: aJ- '7 / <_J-J:?,..-t_
DATE: iT '1 - l )..- c J /'
i/ - ---
t hereby certify that'1his building, as designed, 1s in
compliance with the Florida Energy Code.
OWNE~AGENT~ ~
DATE: ~ - lS' - eo
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 with Section 553.908
Florida Statutes.
BUILDING OFFICIAL:
DATE: q-t&J-tPo
EnergyGauge@ (Version: FLRCNA-200)
(I
(~ t !
I i" "l" II
,I
;::
, I
, ~:
i i: I'
,
1 I
r'
;, >:I,!j
-,"j ','
~'.ij ,
"!I Ii I
. {i 1,", f'
t' j ,,: ; ~ i r i
/,
~ ~ -,._'-',---- - - '--- -, -- ----- ---..,. --~ --,-;-,''---
'ft
Ii
; ;
1 {
.! i
1 ;
J i,
: 11 I': 'J
I ,,- I . ~ 1
I'
:,;"1 1(:
: r 'j
(:
,;
;:.:1, 'I
II I
, ,
\ ,
.i
i j
" , '. , I
i , ,
, ::1' :" r I I
:1:"
ii h;
")
,1:, !
r!
J",J,I
'j
PASCO COUNTY. FLORIDA
Permit Nu, ,'1<:; /,
Date Permitted _ (t I, \' /00
,
Builder NamelOwner Name
~ ~ t\
(.' ',_,.' SJ .
"
County Parcel No.
",
., I
, , (.I
, ,
'"
AddresslLocation .--;;, "'\ q l.f (,
-
I' lf'
Subd.
.,ol." d I
Classificationffype of Use I '. ;.. ,~,..
j j
f-L ,'. ~
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Rate $
Zone No.
Impact Fee Amount $
Prepare,9.-B'y
/
C)€cked By
./
Sq. Ft/Unit
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted by the
Board of Pascq.,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
Gross Sq. Ft. (GSF)
Ratc ERl:
52,OO/Year
or $0.1.+2/Day
ERU ASSIgn No.
Assc,sTllcnt - (No Units) x ($01421
'( (No, Days)
Assessment -
(GSF) x (ERU) x (0,1'+2) x (No. Days)
100
TOTAL FEE $
TOTAL 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. but simply recclpt uf 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 l'SE ONLY
TRANSPORTATION REC. NO,
RESOURCE RECOVERY REC. NO,
DATE
DATE
BY
BY
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal :ce
r
PC93113094/D