HomeMy WebLinkAbout01-0526
BUILDING PERMITti~
OS26
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
Date 9/7 / 0 (
7' dO
,;,0. .-
BUILDING
ELE~CAL
PLU~ING
MEC~NICAL
Sewer Conn
Property Owner: G L.. r: ~ l? u ( r
Job Address: ~ <7 7( 1 M~oIc l,../ :.OC)
Parcel I. D. # I ~ - 2 ~ - 1 ,- D I c.{ (). (;) a 0 (!) U -
Water Conn:
Water Meter:
Lt'
o Ja
T.I.F.'s:
Zoning: Energy Code:
11.0' Of i..J'
Description of Work _ .-\ ~
Radon Gas:
de.. ~ ^ I,'" k .f-e YI c.e
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.
City License Registration #
State Certified License#
Permit Fee
X Signature
Company
Address
~ Telephone# ( f?f)) '.2..~' ~ -!;;oi"J ~
Inspector
Valuation or , 70. go
Contract Price
. L I (..1'\ <:1 c.. F~ lf1 C'".,.
BUILDING
ELECT ICAL
PLUM NG
MECHA CAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
Tp. Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
SLB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Twenty Five and 00/100 Dollars ($25.00) 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.
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 Sth STREET ZEPHYRHILLS, FL 33540 _
Phone:S13-7S0-0020 Fax:S13-7S0-0021 / /
DATE RECEIVED r _0 /) LO (
PLANS REVIEW FEE' I
OWNER'S NAME ;11 It Q. All S
JOB SITE ADDRESS 39 ?;-;F)
6u{) t?
PHONE CONTACT ~ - 9~ ~
LEGAL DESCRIPTION: LOT(S)
i/V( 'i tIS- 0 Ot l.<.I C-' con
SUBDIVISION
/0 Or)
,
BLOCK
_ 0 I t.I 0.. CJt::>000'-
~ () (OBTAIN FROM PROPERTY TAX NOTICE)
PARCEL ID #
WORK PROPSED: [JNEW CONSTRUCTION
o SIGN
o MOVE
o ADDITION
o DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
o COMMERCIAL
[JALTERATION
o REPAIR
o INSTALL
DMULTI-FAMILY
0# OF UNITS
o MOBILE HOME
o INDUSTRIAL
o SWIMMING POOL
o OTHER
DESCRIPTION OF WORK 0)
0~-
f-i
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
(
L-, ~ J{
C' ,-/1. Ii, >U
BUILDING SIZE
SQUARE FOOTAGE
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
[J BUILDING
D ELECTRICAL
AMP SERVICE
VALUATION OF TOTAL CONSTRUCTION
D W.R.E.C.
D PLUMBING
D MECHANICAL
$
D FLORIDA POWER
o GAS
o OTHER
VALUATION OF MECHANCIAL INSTALLATION
o ROOFING
o SPECIALTY
TYPE OF CONSTRUCTION: [J BLOCK
D FRAME
FINISHED FLOOR ELEVATIONS
padw~~s JO pa~u1Jd 'padA~ am~N
4uawDpaTMou~oe DUl~e4 uosJad JO aJn~~UDTS
q~~o U~ a)[~~ ~ou P1FO P1P[J OqM pu~
(u01~~o1J1~uap1 JO adA~)
pa::mpoJd s~q oqM [J
JO 'am o~ UMOU)[ ATT~uosJad s1 oqtJ
(paDpaTMou~o~ uosJad JO ameu)
Aq
-:- 61 I JO Aep- s1q~ am aJoJag
pafipaTMou~o~ S~M ~uamnJ~SUT DUloDaJO~ aQili
D STEEL
D OTHER
IS PROJECT IN FLOOD ZONE AREAD YES D NO
padm~~s JO pa~u1Jd 'padA~ am~N
~uamafipaTMOU)[O~ DU1~~~ uosJad JO aJn~~ufi1S
'q~~o U~ a)[~~ ~ou P1P[J P1P DoqM pu~
(U01~~o1JT~uap1 JO adA~)
paonpoJd s~q oqM D
JO 'am o~ UMOU~ ATTeuosJad sT oqMD
(paDpaTMOU)[O~ uosJad JO am~u)
Aq
--e;1 I JO A~p - s1"q~ am aJolag
paDPaTMouxo~ S~M ~uawnJ~SUT fiUTODaJO~ aQ~
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 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 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 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 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 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 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 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
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
STATE OF FLORIDA
COUNTY OF
-,ii--~'r"',,;"""ay~ ~1-'o.....:~;..c~-.;f~/';~.....;~.'.:~"l-'i~~ .-':-f'~-"'--~""'.t ..~.'_e""""'-'~'" ..,"r.,.;~,. !"__~ .j&:~, ,~#.:/#,,'...\..,...~,;,~..,;.ft1ii,~~ ~~._
'--
II MEMBER
~' - Suncoasl
--'" e" BeUer (;
· Busmess
:. Co
:t,....--:II. --
MEMBE
- (~A
EIN #59-2617794 ...
f,,:,i:;.',~ ~-4.\.....:4t__",-~~<~:>'j.:"'h
o GATE OPERATOR DALUMINUM
!OOD DVINYL C.L
, HAJN LINK Dpvc
REPAIR 0
" ""\. POSTS
--, IN lOUT fiN-LINE
WALK ~ES DRIVE GATES
I ,,~(~~ '
ROLL GATES LATCH TYPE
T(2r
DWOOD Dpvc
LENGTH HEIGHT
TYPE STYLE
PICKET SIZE STRINGER
TYPE TOP
0 o POINTED
0 o FLAT TOP
0 DOTHER
CHAIN LINK
LENGTH I ~(~HT I
llO
/' ~"'. GAUGE
--Cll1f2) 9 6
DIAM..:rOP R1L OIAM. GATE FRAME
~/~ I l )jr II
1-- ~ -IG
TOTAL VINYL SYSTEM 0 VINYL COLOR
VINYL WIRE ONLY 0
DIAM. LINE POST DIAM. TERM POH
I ':./~ rr 2 ');-:> 'I
, " ./
GAGE FRAMEWORK . nh\
# STRANDS BARB ARMS
0 3 6 IN OUT VERT.
o ALUMINUM DSTEEL
LENGTH HEIGHT
STYLE COLOR
SCREWS RESIDENTIAL XTRA
IN OUT COMMERCIAL
TAKE DOWN
LENGTH HEIGHT
OLEA VE ON JOB JOB CONDITIONS
o GOES TO BFC
o GOES TO DUMP
SEE DRAWINGS ON BACK
I~' TO BE SET TOP STRAIGHT
B TOP OF FEN.pE ~FOr.LO~
GROUND "', ) .....~
Note: Company not
responsible for any
underground sprinkler
lines.
Proposal - Contract
D 1900 - 34th Street South ~315 Hwy. 52
2102163
Contract
uncil St. Petersburg, FL 33711 Hudson, FL 34669
(Office Use only)
R Pinellas (727) 321-1669 dson (727) 857-1118 Candy Locale
Fax: (727) 327-2460 Fax: (727) 856-6774 Inv.#
AMERICAN Pinellas (727) 843-0155 Crew
FENCE Hernando (352) 688-3151 Start Date
ASSOCIATION
_. r... Zephyrhills (352) 780-1747 Complete Date
CUSTOME J)fr~ ~\rV
BLOCK# SUBDIVISION LOT#
STRE~1h f))Qrt1~ loJD PARCEl.# UNIT#
CIT? " (:~ sr::f ZI~r-. \'\4 ( ~ CITY STATE ZIP
'J - ')1 ~.) [}
JOBSITE LOCATION "3~r V1 L CITY PHONE I CONTACT
-~
QME PH?~JlJ I OFFICE FAX BEEPER "CAR
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FRONT
SPECAIL TY SERVICES ~TAL PRICE INCLUDES:
o VISA 0 MASTER CARD 0 DISCOVER DAMERICAN EXPRESS lERIAL DTEARQUT & HAUL
o FINANCE 90 DAY 0 SAME AS CASH 0 CHECK R o PERMIT
CHECK HERE IF CUSTOMER IS ACCEPTING RESPONSIBILITY FOR
GETTING PERMITS AND ANY RELATED FEES, FINES, ETC,
PLEASE :~~~~:~~~:~ ~~uP~~~ ~~ p::E~ V:d~O~~O~y~~ COMPLETE
UNDERSTAND THE TERMS AND CONDITIONS ,r-..'\ "'}[J
ON THE REVERSE SIDE BEFORE SIGNING Authorized; ')' Q . ( I c-' C~ ~
THIS CONTRACT. MANY OF THEM WILL BE Signature \ ( l' U.I .....it... ) lOt Y:. -" '6 -'Vi
IMPORTANT TO YOU. " . _IJL_I..,. -' _~ a e U ...
By signing this proposal, Customer is authorizing
Burton Fence, Inc. to do the proposed work, and is Customer
accepting the prices and specifications shown Signature X Date
above, and Burton Fence, Inc:s standard terms 1-
15 which may be on the reverse side, attached, or ***010 YOU RECEIVE WARRANTY PAPERWORK?
not attached. Customer may request a copy of
terms 1-15 by calling Burton Fence, Inc, Upon Print Name
acceptance and signing by customer, this becomes Clearly
a binding contract.
Total ~7n I
25% Deposit
Balance
o Repeat Customer
o Yellow Pages
o Referral
o Other
..... -_;~_-.g;~."'",,,,,i\'
TERMS AND CONDITIONS OF CONTRACT
1. Please understand that any representation by Burton Fence, Inc. regarding an installation date is for the Customer's convenience and is an approximation
only. The installation schedule changes daily due to circumstances both within and beyond Burton Fence, Inc. control including, but not limited to: weather,
permits, easement agreements, progress on prior scheduled jobs, etc.
2. We all want the fence to be located where the Customer wants it. Therefore, the Customer will be responsible to indicate to the crew the proper location of
the fence and will provide Burton Fence, Inc. with an accurate survey of the property. All of the property pins will be located and exposed by the Customer. If
not found, the crew will attempt to help the Customer find the property pins but the Customer, and not Burton Fence, Inc. is responsible for the proper
location of the fence.
3. The crew will need room to work in order to do a good job. The Customer agrees to have two feet on both sides of the proposed fence lines clear of
obstructions, i.e.: trees, bushes, debris, etc. If the fence line is not clear when the crew arrives, the crew may clear the fence line and the Customer agrees to
pay $45.00 per man-hour for this service. This will keep the crews working and help to avoid extra trip charges.
4. Sometimes where a Customer wants their fence is the same place the cable, sprinkler or utility company wanted their lines. Because of this potential conflict,
even if these lines are marked, frequently unseen underground lines are hit and damaged during the fence installation. Because these lines cannot be seen,
the breaking of these lines cannot be attributed to negligence or carelessness. If a line(s) is broken, the Customer agrees to indemnify and hold Burton
Fence, Inc. harmless for any related damages. If appropriate, the Customer agrees to apply to their homeowner's insurance policy for coverage.
5. All measurements shown on the front are approximate. The actual measurements of the fence may vary.
6. The property to be fenced may have deed and/or Homeowner's Association restrictions or city or county planning or zoning restrictions. It is the responsibility
of the Customer to look into this before ordering the appropriate fence from Burton Fence, Inc..
7. Upon providing Burton Fence, Inc. with their credit card number and expiration date, Customer is requesting that Burton Fence, Inc. charge both the deposit
and the final balance due to that credit card.
8. This contract anticipates that once the work is started, Burton Fence, Inc. will be allowed to complete the entire scope of work without any interruptions or
stoppages by the Customer. Any such interruptions or stoppages may result in additional trip charges that the Customer agrees to pay.
9. Any Customer requested changes or deviations from the above specifications or quantities involving extra costs will be an extra charge over and above this
Proposal-Contract.
10. Any cancellation request must be made in writing. There are many costs incurred during the various phases of processing this order. To offset some of these
costs should the Customer choose to cancel, 15% of the contract amount, in addition to any direct costs such as special materials and permit services, will
be charged against the Customer's deposit. The balance will be promptly returned to the Customer.
11. The permit charge shown on the front is for standard city or county permits only. The Customer agrees to pay the cost for any additional special permits that
may be required.
12. Beginning the day after installation the Customer agrees to pay 11/2% per month service charge on any past due balance. The Customer also agrees to pay
all costs and expenses of collection of any unpaid balance due under this contract, including a reasonable attorney's fee through appellate.
13. All materials provided remain the property of Burton Fence, Inc. until fully paid for. Burton Fence, Inc. is guaranteed unobstructed access and the Customer's
irrevocable permission to enter the property and to remove same if not completely paid for when due. In such case, the deposit is forfeited. If costs exceed
the deposit amount, the Customer agrees to pay the difference to Burton Fence, Inc. promptly.
14. All excess materials remain the property of Burton Fence, Inc. If Burton Fence, Inc. is contracted to remove and haul away existing fence, then those
materials become Burton Fence, Inc. property.
15. Burton Fence, Inc. makes no warranty of merchantability or fitness of these products for any particular purpose. Burton Fence, Inc. is not responsible for, and
Customer agrees to indemnify and hold harmless Burton Fence, Inc. from, any damages arising from any personal injury or incidental or consequential
damages of any kind that may arise out of the use of these products.
PLEASE NOTE:WE ARE NOT RESPONSIBLE FOR UNDERGROUND UTILITIES AND SPRINKLER LINES. ALL FENCE LINES MUST BE CLEARED BY
CUSTOMER PRIOR TO INSTALLATION. SURVEY STAKES MUST BE VISIBLE FOR INSTALLERS TO PROPERLY LOCATE YOUR FENCE. A TRIP
CHARGE OF $75.00 WILL BE ADDED TO CONTRACT PRICE IF CREW IS UNABLE TO START JOB AND MUST RETURN AT A LATER DATE OR MUST
RETURN DUE TO CUSTOMER CHANGES. UNFORSEEN DIGGING CONDITIONS MAY RESULT IN ADDITIONAL CHARGES. HOMEOWNERS MUST
OBTAIN HOA APPROVAL IF REQUIRED. ADDITIONAL COSTS MAY RESULT FOR GROUNDING OF FENCE IF REQUIRED.
TERMS: BALANCE MUST BE PAID TO CREW WHEN JOB IS COMPLETE
GROUND PLAN OF JOB:
(A)
Fence to be set top straight (may
or may not be level. According to
ground.) Customer may fill in low
spots later.
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Fence to follow contour of ground
(bottom of fence to be in contact
with ground or up a little).
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BUILDING PERMIT~~
0527
CITY OF ZEPHYRHILLS
(813) 788-6611
Permit
-
Date
9-ltJ .-() I
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BUilDING
Property Owner:
Job Address:
Parcel I. D. #
ELECTRICAl
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P~J,JMS1NG-" "
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Sewer Conn
Water Conn:
Water Meter:
T.I.F.'s:
Zoning:
Description of Work
FINAL
NO OCCUPANCY BEFORE C.O.
DATE
Complete Plans. Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
c.o.
DATE
~ J/O"D -
Inspector
Valuation or
Contract Price
Permit Fee
City license Registration #
State Certified license#
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Company
Address
Telephone#
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BUilDING
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Meter Can
Const. Pole
Pool
Pre-Meter
Final
SlB
Tub Set
Water
Sewer
Final
Breakers
Ducts Insl.
Compressor
Final
Driveway
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Twenty Five and 001100 Dollars ($25.00) 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.
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FlA. "77 lAW.
FS 713.13
NOTICE OF COMMENCEMENT
~:::;' o~Orida } '-~... - -~~- ~~!11II~~~!~1111I1 1111111111111111111111111111I1111
The undersigned hereby informs aI/ concerned that improvements will be made to certain real property, and in accordance
with section 713.13 of the Florida Statutes. the fol/owing information is stated in this NQTICE OF COMMENCEMENT.
/ / - ,;J.(p - ';11
Description of property ..... <:'-~. ./ () ~. .0 $ 3..Q .0. -:-:-:-. . Q. I. J. S. . . . .. .. .. . .. .. .. . .. . .. . . . . . . .. . .. .. . . . .. .. .. . .. . .
..... .3.%5.1.(...../.1 .~~.. :-;j-x~!..)..? ~fh1.r:.h.,Jl$..).. B.... ~ ~.?(~I.q................................
SEMINOLE F:lRM 408
.............................................. 'j' '/,' .~~... .;:....~.... /. ~',"""""" '7" .~...... .1....:........ ..~. ....;
G Id " f' /,(// I((,,,-,?"_' / I '<'.'vr"/cc" '" --:- Iff...; /1,-//'~
enera eSCrlptlono Improvements ........ ..(.....,.'--...... .-.-.f...... .....".................. .......r. ......../.7.';[.: .~.~._.
Owner...... B.u.t-h.... .~.C!:-r:.r:.~fr:.... ............ ........ ...~.................... ...................................
Address ..0.?~1.!.... ..I.I.~... ..ffl(~:..). ..2 ~/?h.1.r:.hi.U~:J'" Fr...}'?!!Y:9..... ........... ........ ....
Rept: 526474 Ree: 6.00
Owner's interest in site of the improvement. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. DS: 0.00 IT: 0.00
Fee Simple Title holder (if other than owner) 09/05/01 Dpty Clerk
Name q q qq. q q qq. qq qq. q q'q. '.q qq qq q q q q qq. q ~0;}~A:.c, res~O fOllNr:, ct.."ERk
Address .......................................................................... OR BJ< 4712 PG 1214
Contractor...... ~ C. ..F:. ~;.f:. >.-.... .Y\ .i:-:\-:.\::--~..t.\.\". .Y.. ~~..................... .......................................
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Address...........:....1. ..)..0:..... ............ .If]'.! I.... .1-,:) . .............. ~............\........~.. g.............................
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Surety (if any) . ~.'" .t:.C: .'-)l....P /.1:. /.?';.~!.<:'.. Ct':..~... t. )..J,...h....; /1:-:~.~i''.l'N...'.:;, ."~.........................:.....
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Address .... t. {... . i. . . . A . . .. . ./..4-. . ... .. . .......;:{. . I. I "'-..:J;:f.-. . . ..6; /tf.-IO\. . . . .7.. ~t". . . .Amount of bond S .5:.<.. .. . .. _. .
Any person making a loan for the construction of the improvements:
Name ...........................................................................................................................
Address ...........................................................................................-.............................
Person within the State of Florida designated by owner upon whom notices or other documents may be served:
Name ......,...................................................................................................................
Address ........................................................................................................................
In addition to himself, owner designates the fol/owing person to receive a copy of the Lienor's Notice as provided in Section
713.13 (1) (h). Florida Statutes. (Fill in at Owner's option). .
Name ..... ._......... _...... ........ .__....~___..................................................................................
Address ........................................................................................................................
THIS SPACE FOR RECORDER'S USE ONLY
Ii.
Owner
Sworn to and subscribed before me this " $. ~ . . . . . . . . . . . . . . . . . . . . .
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OWNER'S NAME 'R (J ~~
JOB SITE ADDRESS _~ g S i ,
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DBPARTMENT 5335 8th STRBBT ZBPHYRHILLS, PL 33540
Phone:813-780-0020 Pax:813-780-0021
DATB RBCBIVED 9....;5:0 I
PLANS REVIEW FBB .
PHONE CONTACT '7t{g-S8/~
f?,zsco Po--~t {- -
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LEGAL DESCRIPTION: LOT(S)
II
CJCJlb-~~.3
BLOCK I~ 6
SUBDIVISION d /
PARCEL ID #
1")0- ellS-
M. ADDITION
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ONEW CONSTRUCTION
o ALTERATION
o REPAIR
o INSTALL
OSIGN
PROPOSED USE:~L FAMILY DWELLING
o MOVE
o DEMOLISH
OMULTI-FAMILY
0# OF UNITS
o MOBILE HOME
~ER
o COMMERCIAL
o INDUSTRIAL
o SWIMMING POOL
DESCRIPTION OF
o RESTAURANT
WORK 1tJ.u; - P II- Ti 0
f) d.. V;-9~
& HEALTH DEPARTMENT APPROVAL
{(co F / A-Jt/d s i J4b
SQUARE ~TAGE ~~tf
l1e/,;: 1/ /It;.
HEIGHT /0 I -10
91
BUILDING SIZE
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 REQUESTED
~BUILDING
o ELECTRICAL
$ 30tl. ~
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o FLORIDA POWER
o W.R.E.C.
o PLUMBING
o MECHANICAL
$
VALUATION OF MECHANCIAL INSTALLATION
o GAS
o ROOFING
o SPECIALTY
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
o FRAME
o STEEL
~ER A--IUHt/nt<~
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES ~
SIGNATURE
IJ. COMPANY _])JW;::'s #f ~"" '/VU"",,
. :Ie ~ . STATE CERT OR REGIST # R /'} ~ 6\ / ? q
'A/J-< ~fA'~ CITY PROCESSING # 29 J t2
I(
******************************************************************
BUILDBR
BLBCTRICIAN
COMPANY
STATE CERT OR REG 1ST #
CITY PROCESSING #
SIGNATURE
******************************************************************
PLUMBBR
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
MECHANICAL
******************************************************************
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
OTHBR
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITIONS OF PERMIT AFFIDAVIT
.A. NQTICE 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 t~~ owner has hired a contractor or contractors to undertake work, they may be required
to b~: 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 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 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 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 landuevelopment 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 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 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 ~NO CE OF COMMENCEMENT".
/
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'/srf!J;:;::; <iOWN~Em
S
STATE OF FLORIDA '+1
COUNTY OF /1E('o
The foregoing instrument was acknowledged
Before ~e this~ day of 5ertl"'.uh<< " ~~I
by I~ I...LLrr~
(name of person acknowledged)
Dwho is personally known to me, or
STATE OF FLORIDA 'u"--'.c /Or.
COUNTY OF r~
The foregoing instrument was a kn wledged
Before m th' s1'^- ay of e ~-<, lii.:;;lCOj
by L
~" (name of person acknowledged)
~ is personally known to me, or
o who has produced &nUer~ IlCeuSt'./
(type of identification)
~d not ta e an oath.
o who has produced
(type of identification)
~ not ake an oath
Si
person taking acknowledgment
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