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BUILDING PERMIT 0
CITY OF ZEPHYRHILLS Permit N_ 1161
(813) 780-0020 Date '-I - /5- O~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Pmperty Owne' ZeD ~ Y I' '411 A VIWo
Job Address: ,'3 <( ; \L;- _ L& ~ .
Parcell.D. ,
Zoning: Energy Code:
Description of Work T", S-tl3t ~~;.~ ~
NV~51~5 ~
Water Meter:
T.I.F.'s:
Radon Gas:
f\v-e Su,n~~ S/':)-I1'~
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
FINAL
C.O.
(~ ~ ~ ,- 0 :;;..
DATE
NO OCCUPANCY BEFORE C,O,
Inspector
DATE
C'(;) ~;J
Valuation or
Contract Price
~5 <? ~ ~
(!J..A::J
Permit Fee
)("Signature I'J ~ -,--'
Company
Address
'>-ielephone# 81"1' - {j J 3 . d-7 7 /
City License Registration #
State Certified License#
f)737
a.l'v.h1~ F~ PMJteL1;~
SLB
Tub Set
Water
Sewer
Final
MECHANICAL
BUILDING
ELECTRICAL
Ftr.
Pre SLB
Lintel
FRM.
Insul. Cl
WL
/
/
/
/
/
Tp, Servo
Rough In
Meter Can
Const. Pole
Pool
Pre-Meter
Final
Breakers
Ducts Insl.
Compressor
Final
;'
(D- S--fp /0 ;2
/
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.
OWNER' 8 NAME Ze.ph':jr h aYe" nLLrs') n3 H-orY\e...
JOB 8ITE ADDRESS 3 cg d-60' A. Pv en u.. G
CITY OF ZEPHYRHILLS PERMIT APPLICATft~V ~.IulJo!>
BUILDING DEPAIt'rIbmT 5335 st:h STRBBT ZBPRYRRILLS. PL 33540 :3'" ~ 7-~a
PhoneIS13-7S0-0020 PaxIS13-7S0-0021'. 3 /),.- "",/'\ I.A
DATB RBCHIVlm '" d- j ,. vel-.
PLANS REVIBW PHB
PHONE CONTACT( S>I3) 18;), - 5S0&-'
(' ,Act \
r'rL ~
~
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID #
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION
o ADDITIO~
DALTERATION
o REPAIR
INSTALL
DSIGN
D MOVE
D DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
DMULTI-FAMILY
0# OF UNITS
D SWIMMING POOL
DMOBILE HOME
~THER
D COMMERCIAL
o INDUSTRIAL
o RESTAURANT & HEALTH DEPARTMENT APPROVAL
-
J)E8CRIPTION OF WORK InsfQlla.+lo" ur A1~lU. hre SLL/JprcS~ICf\ S:Js;teff!
BUILDING SIZE
SQUARE FOOTAGE
HEIGHT
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 RBQUa~TBD
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
D ELECTRICAL
AMP SERVICE
o FLORIDA POWER
o W.R,E,C.
TYPE OF CONSTRUCTION: D BLQCK
D FRAME
o STEEL
D OTHER
o NO
D PLUMBING
~ MECHANICAL $ (5~g. ou VALUATION OF MECHANCIAL INSTALLATION
D GAS D ROOFING D SPECIALTY D OTHER
FINISHED FLQOR ELEVATIONS
IS PROJECT IN FLOOD ZO
BUILDBR
COMPANY
STATE CERT OR REG 1ST #
CITY PROCESSING #
SIGNATURE
******************************************************************
BLBCTIlICIAH'
SIGNATURE
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
******************************************************************
PLUHBBR
COMPANY
STATE CERT OR REGIST #
CITY ~ROCESSING # '
- ~ "
SIGNATURE
******************************************************************
KBCHAHlCAL COMPANY E;ri n/"'\e..I( F ,..- c 1~-h:c..~rY'\
n . STATE CERT OR REGIST # f 3073LC<:.X] 2. ZCCO
SIGNATURE -\!lho..A1A1G. fY) Yo). JJA,,( J...T'YI.A. 4J C~TY PROCESSING # ?_q~ C,
*****************************************************************
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDITI0NS OF PERMIT AFFIDAVIT
A, NOT,ICE 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 STATUTEa, 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 tne 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",
acknowledged
, 1!L-
av Jl~ a. vn..Ja 1. J v /1 jA.~~
SIGNATURE: CONTRACTOR
STATE OF FLORID4') 1./I-\.QQe>-a
COUNTY OF \ .
The foregoing instrument wa~ledged
BefO~II.le this ~~ of :: ' ~L
by . lilAu Ct. ---r-vI," () 110 Ai)'; .....st
__ ~name of person acknowledged)
~o is personally known to me, or
SIGNATURE: OWNER OR AGENT
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _ day of
by
(name of person ackno~ledged)
o who is personally knowii to me, or
o who has produced
(type of identification)
and whoO did Odid not take an oath.
o who has produced
(type of identification)
id not an oath
Signature of person taking acknowledgement
ture of person taking
MICHELLE L. ELLIS
. Nota{y Pllhti<:. State of Flodda
Name t"'ebmdr,r;x,~.r. ~ 28&FPed
, Comm. No. CC813967 .
Name typed, printed or stamped
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Grinnell Fire Protection
A Division of Grinnell Corporation
4701 Oak Fair Blvd
Tampa, Florida 336 10
Fire &
Security
Grinnell Fire
Protection
Tele: (813) 626-5482
Fax:: (813) 886-6320
1-800-769-5326
AUTHORIZATION LETTER
To Whom It May Concern:
I, Jeffrey J McKinnie, contractor license number 130736000200 hereby authorize
the following to act as my agent in obtaining permits in the City of Zephyrhills:
Theresa Sauerwine
Mike Snyder
~%~-
f1It . M..<--l
effi e McKInnIe
License Holder
State License #130736000200
Sworn to an
2002 by
or has prod
who did (did not) take an oath.
to before me this I~fvjay of a J2.v jJ ,
---r;~ , who is 2-ersonally known to me
as identification and
~\\\\""I11"'111.
~'~(1.~\ C. BAR/'II'~
~ ...~"V" ........ '~ ~
~ q.' .::,,\SSION ;.. <.9 ~
~ .- ,~\~~ <..:f; . ~
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=*= .... :*E
~-z:;o\ #CC 751380 j ~~
~::;:A..~ ~"9:~
~ ~ ." %ty Bonded \tI\~\\'\~. !2~
~ ")-~.. PUblic\Jn~.".<.<( ~
~ ""'U ........ C' ~
~I'III. '8LIC 51 ,.,,'(. ~",'i:
IIII'"i '""\\\'~
~~'C;.Ad~
Notary Public
My commission expires
~ - /4 --cJ,)