HomeMy WebLinkAbout02-1314
BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N2
1314
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'BUILDING
1~ f /j-
ELECTRICAL
(813) 780-0020
/; 1 # 7j, ~S" ':9-.
PLUMBING M'ECHANICAl
Date _~ -,;/5- 0 d.-
Sewer Conn /1 ~ 7 ~ .~ \
Water Conn: CJ\Ld 'f-L(2~)
Water Meter: / J-() , (7tJ
c.
Property Owner:
Radon Gas: ~. t3
JM~~C
--
FINAL
C.O.
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
DATE
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a~ttI-jJ1/4a~ ~
~.
BUILDING ELECTRICAL
0."'1".1 .
Ftrt""'./ ~ -17-02 I2U.(
Pre SLB 17 -Itr ()"J- tI:J7;
Lintel
FRM. l/~'2-~;-n"1 88
Insul. CL
WL / <6 --3D -02 fLu.,
h/!sr aA5'.5
+Iqf,
P~rmit Fee:;; ~
,!6lgnature __
Company
Address
;aelephone# '--?FJf:J -10#5:7
l/ewrl.5 ~I/. Vii tk:I.
.
-iI '8'r f.,
PLUMBING
Valuation or jJ =? JJ, 'J...n ~
Contract Price ' f /, oLC/ .
City License Registration # / CJ /
State Certified License#
,
5c11/175 -#20(,:,
MECHANICAL
Tp. Servo . SLB .
Rough In V X' . :2 '1 ;- (7 2. ~6 Tub Set
Meter Can Water
Const. Pole Sewer
Pool Final
Pre-Meter y/ 1/- / - 02 K'Lr
Final
Breakers
/ X'. 2&j -CJ 2 ~ Ducts Insl. /~ -.;2 cj:.@2&8
Compressor
Final
Driveway
YRltI~ Ot1Ly 7-(::1 -elL I~:ro
FP II-L/-t?-< Ij{L5:C'''1 !'; 21 L.I-
'5 hec,-f" l VI' "% ;g- - fF -?,;2 RL~;I'J7)
REINSPECTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
a.
b.
c.
d.
e.
f.
g.
charge of twenty-five and 00/100 Dollars ($25.00) shall be made for each trip for each trade:
~,~.~
..~
../1
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.
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
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PASCO COUNTY. FLORIDA
Permit No.
1(.)
Date Permitted ' ,) ,-"
Builder Name/Owner Name
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County Parcel No. ' -', - {p.j I -(,; c..' .. ( D f 0
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AddressILocation {y;2 D l/ jj'1Ar1Y{;1' e iLl /: "-I.
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6
Subd.
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Classificationffype of Use
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Rate $
Zone No.
Sq. Ft/Unit
Prepared By
Impact Fee Amount $
Checked By
The above impact fee has been established pursuant to the Pasco C()unty Transportation Impact Ordinance as adopted by the
Board of Pasco 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
I
Gross Sq. Ft. (GSF)
Rate ERU -
54.00Near
or $0. I 48/Oay
ERU Assign No.
Assessment - (No. Units) x ($0.148)
x (No. Days) ..... ......
TOTAL FEE $ Ii>'. y./5
Assessment -
(GSF) x (ERU) x (0.148) x (No. Days)
100
TOTAL FEE $
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowiedgement below does not imply acceptance of concurrence. but simply receipt of a copy of this form. placing
the huilding permit owner on notice of this assessment and the conditions of payment for same.
Date
Received By
OFFICE USE ONLY
TRANSPORTATION REC. NO.
RESOURCE RECOVERY REC. NO. "S<f)~ It..) <'(
DATE
DATE
le:/ I '\ 1{;;~9-
BY
BY
'-l/~
White
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal:ce
PC93113094/E
CITY OF
ZEPHYRHILLS
IlNOTICE"
OF ADD.ITION OR CORRECTION
2; 3'S- f~
BUILDING
DEPARTMENT
DO NOT REMOVE
.,DfTE) PERMIT -#
M,\::)UvL.h.- ')=\ - ) ~ ' '8//5 D 2 J J
THIS JOB HAS NOT BEEN COMPLETED The following additiqns or corrections shall be made before the job
. will be accepted.
ct. ~~) ~ Dn~rU r~ tS~ ~) \ '\c )=>,
i} ~~s.c>~ 'Sb..,) T l'hJ~A \.L Lh.. f-.- Gf ~\\rL (~ekr-llA (s- N I ~ ~ IN Iv. I U2lU\~lL CL, r-
ftL- ~r r1\~ At kASU2.~.'~ ISh- fJ..yJLt~f cDpP.~ll I
~ Wv <) 6't- ii.\\~) liS f1\ ~b T~ M~ft H()(/-VUUl('lfl... LL.t p)
~Sc f)Y'J>J1P~ ~AtL6.(L f~Vt ~f) ~ ~Ii.i) ~tlUJ~) f1C ~trl.~O
~ j~,\l.iv-"'- ~(L l~ bG- I~~',:w
(G _VL~lr4<J k ~\f) 11"4.'l. f--!-fIA& I~( CM/l.1LCb- _
G) -iL'0I1'"\.6i~ slfCrC-~ N\~17~'\ l>A 1\..:) ~(.yrSl >')tL or w~
ADDRESS
It is unlawful for any Carpenter, Contractor, Builder, or other persons, to
cover or cause to be covered, any part of the worK with flooring, lath, earth
or other material, until the proper inspector has had ample time to approve
the installation.
OFFICE HOURS 7:30 AM - 5 PM MON.-FRI.
AFTER CORRECTIONS ARE MADE CALL
780-0020 FOR RE-INSPECTION
1'7 \ /! EC' . - ')
INSPECTOR J S LVL.J.5' ) )
APPLICATION FOR PERMIT
CITY or ZKPHYRRILLS
. BUILDING DEPARTMENT
-.... "'r)/oJ
.~,
DATE tur.O;IWD:2- -;)...7-' 0:..<...
PLANS RKVtn dlI:
OWNER'S NAME
PHONE
JOB ADDRESS
.--- . ;:::/ (
LEGAL DESCRIPTION: LOT (S) I h~l.~r Il(
,
rMCEL I D f# ~5 - a b'd r-- b)1J() - a; FiJ
{OBTAIll FROM
fM:~~~ ~~t;:,
BLOCK
SUBDIVISION
WORK PROPSED: ~NEW CONSTRUCTION
[j SIGN
PROPOSED USE: ~~GL FAMILY DWELLING
o COMMERCIAL
o ADDITION
o MOVE
OALTERATIOll
D REPAIR
[j tNSTAtL
o DEMOLISH
OMULTI - FAMI L Y
o INDUSTRIAL
0" OF UNITS
o SWIMMING POOL
d MOBILE HOME
o OTHER
BUILDING SIZE
CJ RESTAURANT & HEALTH DEPARTMENT APPROVAL
jJ~~~ )feN
do '( tfu SQUARE FOOTAGE
(6 .J-- 0
HEIGHT
DESCRIPTION OF WORK
.~
RESIDENTIAL:
COMt-fERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENE~GY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FoRMs.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
~ot/
r1 BUILDING
~ ELECTRICAL
Ij6 PLUMBING
~ MECHANICAL
o GAS 0 ROOFING
$
VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
~ FLORIDA POWER
o W.R.E.C.
$
VALUATION OF MECHANCIAL INSTAL~TION
o SPECIALTY
o OTHER
FINISHED FLOOR ELEVATIONS
~
FRAME
o STEEL
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
IS PROJECT IN FLOOD ZONE MEAD YES
D NO
BUXLDER
S:(GNATURE
COMPANY
97r--x1' -.. STATE CERT OR REGIST
~ CITY PROCESSING "
******************************************************************
COMPANY .~/ ~!;) 'C e4 s ~
STATE CERT OR REGIST ~c'" 0 rJ ;/",- 7 <.J
CITY PROCESSING # I K
BLBCTRICI
******************************************************
./t;-~/~ S,6;e'vl,l'" C d,?'~a k/<--.
PLtJMBBR ~ ~ COMPANY,
STATE CERT OR REGIST "
SIGNATURE /.... CITY PROCESSING " ~jC,
* **** ** **.** * * ******* * * ** * ** ****** *** * * **** ** ******* **********~** ~rI-.
MJl:CJlARICAL COMPANY t?r~Ar'I-'f l>.~l'J -__
STATE CERT OR REGIST # m e>
CITY PROCESSING #
SIGNATURE
**********************************************
OTHER
COMPANY
STATE CERT OR REGIST "
CITY PROCESSING "
SIGNATURE
***************************************************************~*
~--VEED RESTRICTIONS
__----.-"1'he.. und'ersigned understands that this permit may be
may be more restrictive than City regulations. The
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 Zephyrhi1ls Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
cont~actor(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 il
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 aocument 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 Bayheads, Wetland Areast
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 permtt 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".
SIGNATU~ SIGNA~T~
STATE OF FLORIDA /1 STATE OF FLORIDA /J
COUNTY OF ~ ~bJ COUN;Y OF n..fIY ~
.
The foregoing in~~rument was~cknowledged The foregoing inst~ument was~~knowledged
Before me this _nJi.. day of ~ , ~~- Before me It~is ~b djlY of /-r:7:;:). , 19_
by I.-A"c.t~~, by ~e/ ~-'(JL!.....
~ (name of person acknowledged) ~,~ (name of person acknowledged)
I _ho is personally known to me, or ~,o is personally known to me, or
Owho has produced Dwho has produced
~ (type of identification) (type of identification)
a~ whoO did ~did not take an oath. and who Odid ~id not take an oath
~OIY'(A tr) ~ u JaM ~'ir)tdMdj.
Signature of person taking acknowledgement Signature of person taking acknowledgment
Dana M Word' .t~~ Dana M. Word
. f*i :~ MY COMMISSION # 00038228 EXPIRES
Name typO I:..... in&e6 IHe
'trr" ,
subject to ~deed restrictions" which
undersigned assumes responsibility for
Name typ
nted olJly*'tQlped
ilOHDEo lHRU JIlOYFAIH ~ INC.
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STATE.OF FLORIDA
City of Zephyr hills
> "
;~ '.1'
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PASCO COUNTY
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~_f;.:~:':~';~~:;:~'i r
5335 Eighth Street
Zcphyrbi1ls,.FIOrida 34248
(813) 782-1525
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CERTIFICATE FOR CONNECTION FEE CREDIT
ZEPHYRHILLS MUNICIPAL WATER UTILITY
THIS CERTIFICATE IS ISSUED AS A FORM OF REIMBURSEMENT FOR
A PORTION OF THE OFF-SITE COST OF WATER LINES CONSTRUCTED c',
TO SERVE ~iiv{lr ~
AND OTHER ANTICIPATED DEVELOPMENT.
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THIS CERTIFICATE MAYBE EXCHANGED BY BEARER FOR ONE
RESIDENTIAL WATER CONNECTION TO SERVE ANY DWELLING UNIT
WITHIN ~~
U&~T5 WILL BE ISSUED.
PRESIDENT OF CITY COUNCIL
f~a7t~~
CITY MANA -
ATTEST:~~_ _k
IT .' CLERK ~
CITY SEAL
/0 - ,~LI- ,r7
DATE OF ISSUE I"
50-88-048
SERIAL NUMBER
NOT VALID UNLESS ALL
SIGNATURES ARE RED
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~~~~~~~~!~IIIIIIIIIIIIIIIIIIIIII 111/111I111111111I
STATE OF FLORIDA ) NOTICE OF COMMENCEMENT Rcpt: 597576
COUNTY OF PASCO ) DS: 0.00 Rec: 10.50
THE undersigned as 0 06/19/02 IT: 0.00
in accordance with sect::e;i;~tifies al" parties that improvements 'U Dpty Clerk
Commencement: . 3, Flonda Statutes, the fOUowing.;1 be ~a~e to certain real property d
DESCRIPTION OF PROPERTY' ID ormatIOn IS stated in the Notice of ' an
. See Exhibit "A" JED
GENERAL DESCRIPTION OF IMfR 06/ 1~~t~tlA:5 : :CSCO fOUNTY CLERK
OVEMENTS: CI B Hom~ OR BK 4982m PG i993
OWNER AND OWNER'S ADDRESS:
Thomas M. & Dana M. Ward
6439 Huntington Drive
Zephyrhills, FL 33541
OWNER'S INTEREST IN THE PROPERTY DESCRIBED AS: Simple
CONTRACTORS AND CONTRACTOR' S ADDJU:~~S;
iG,bid Medallion Homes, Inc.
ro Box 1536
ZephyrhilIs, FI 33539
SURETY (if any) and SURETY ADDRESS: NIA
AMOUNT OF BOND: $N~
NAME AND ADDRESS OF LENDER, IF ANY, MAKING A LOAN FOR CONSTRUCTION OF THE
IMPROVEMENTS:
Community National Bank of Pasco County
Post Office Box 639
ZephyrhilIs, Florida 33539
NAME OF PERSON WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM
NOTICES OR OTHER DOCUMENTS MAY BE SERVED:
Community National Bank of Pasco County
Post Office Box 639
ZephyrhilIs, Florida 33539
IN ADDITION, OWNER DESIGNATES THE FOLLOWING PERSON TO RECEIVE A COPY OF THE
LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13, FLORIDA STATUTES:
EXPIRATION DATE: June 17. 2003
Larry Hersch
Attorney at Law
Post Office Box 1046
Dadec;~~ Rd
Thomas M. Ward
Community National Bank
of Pasco County
Post Office Box 639
ZephyrhilIs, Florida 33539
~ IlJ ull1Jki
Dana M. Ward
STATE OF FLORIDA
COUNTY OF PASCO
The foregoing instrument was acknowledged before me this 17th day of June 2002, by
Thomas M. & Dana M. Ward, who is personally known to me ~
~, and who-didtdid not take oath.
Witness my hand and official seal in the County and State last aforesaid this 17th day of June 2002.
-, ~t~
....tl.y Pi/. OFRCIAl.NOTAAV SEl\L
0....... ~<'- JENNIFER K WARD
~ ~ COMMISSION NUMBER
< CCB42252
~ ~ MY COMMISSION EXPIRES
OF f\.O JUNE 1,2003
STATE OF FLORIDA
COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COpy OF THE DOCUMENT ON FIL~
OR OF PUBLIC RECORD IN THIS OFFI~J~SS M
HAND OFFICIAL SEAL THIS' DAY OF
2 .m2.
JED FMA 'LERK Or CIRCUIT COURT
DEPU1Y CLERK
BY
t{....S). (It J'I CIA ~ At(onSo
JJ.:.;,' (.:. c,t/,1 ~
I"~i
(y{o /cJ
}Y'\L rl
Department of Community Affairs - FLORIDA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTIO
FORM 600A-97 Residential Whole Building Performance Method A ~ . CENTRAL 4 5 N6
BUILDER:
PERMITTING CLIMATE
OFFICE: ZONE: 405 060
PERMIT NO.o=:cr=o=ITI JURISDICTION NO.: rn:=r=r=o
PROJECT NAME:
AND ADDRESS:
OWNER:
1. New construction or addition
2. Single family detached or Multifamily attached
3. If Multifamily-No. of units covered by this submission
4. Is this a worst case? (yes / no)
5. Conditioned floor area (sq. ft.)
6. Predominant eave overhang (ft.)
7. Glass type and area:
a. Clear glass
b. Tint, film or solar screen
8. Floor type and insulation:
a. Slab-on-grade (R-value + perimeter)
b. Wood, raised (R-value + sq. ft.)
c. Concrete, raised (R-value)
9. Net Wall type, area and insulation:
a. Exterior: 1. Concrete block (Insulation R-value)
2. Wood frame (Insulation R-value)
3. Steel frame (Insulation R-value)
4. Log (Insulation R-value)
5. Other:
b. Adjacent: 1. Concrete block (Insulation R-value)
2. Wood frame (Insulation R-value)
3. Steel frame (Insulation R-value)
4. Log (Insulation R-value)
10. Ceiling type, area and insulation:
a. Under attic (Insulation R-value)
b. Single assembly (Insulation R-value)
c. Radiant barrier installed (yes I no)
11. Air distribution system:
a. Ducts (Insulation + Location)
b. Air Handler (Location)
12. Cooling system:.
(Types: central-split, central-:;ingle pkg., room unit, PTAC., gas, none)
13. Heating system:
(Types: heat pump, elec. strip, nat. gas, loP. 'gas, gas,h.p., room or PTAC, none)
14. Hot water system:
(Types: elec., natural gas, solar, loP. gas, none)
15. Hot Water Credits:
a. Heat Recovery (HR)
b. Dedicated Heat Pump(DHP)
c. Solar
16. HVAC Credits
(Use: CF-Ceiling Fan, CV-Cross vent, PT-Programmable thermostat,
HF-Whole house fan, MZ-Multizone)
17. COMPLIANCE STATUS: (PASS if As-Built Pts. are less than Base Pts.)
a. Total As-Built points b. Total Base points
1.
2.
3.
4.
5.
6.
7a.
7b.
CK
,# t!. .
>;~l; .
/CI(>
f @ :1-0
/'
Single Pane
/"1 (, ~ sq. ft.
sq. ft.
sq. ft.
ft.
Double Pane
sq. ft.
sq. ft.
8a. R= 0
8b. R=
8c. R=
I 1{1./
_ I. ft.
sq. ft.
sq. ft.
9a-1
9a-2
9a-3
9a-4
9b-1 R=
9b-2 R=
9b-3 R=
9b-4 R=
10a. R=
10b. R=
10c.
R=
R=
R=
R=
II
lilt{
sq. ft.
sq. ft.
sq. ft.
sq. ft.
30
sq. ft.
sq. ft.
sq. ft.
sq. ft.
10 J- 0 sq. ft.
sq. ft.
11 a. R= ~ ,u!lf (cond.luncond.)
11 b. V Jf,' C v /". (, (cond.luncond.)
12a. Type: C ? A- 7 (~ (
12b. SEERlEERlCOP: I L' I c: 0
12c. Capacity: :J.l. II () U
13a. Type: 1'-1 ~
13b. HSPF/COP/AFUE: -1. 0
13c. Capacity: 'i). '-{. 0(.1 Q
14a. Type: ~ t e c.
14b. EF: ; q (
15a.
15b.
15c.
16. C r:
117.
17a.
p.js<.:,.
I '.,
I
17b.
'b l3~
DATE: 1- ;)..~() 1-
pliance with the Florida Energy Code.
Review of plans and specifications covered by this calculation
indicates compliance with the Florida Energy Code. Before
construction is completed this . uilding will be fnspected for
compliance in accordance w h S tion 553.908, F.S.
BUILDING OFFICI '
DATE:
I hereby certify tha
compliance with t
OWNER AGENT:
DATE:
.1.
Revised 1998
PASCO COUNTY, FLORIDA
Builder Name/Owner Name
Permit No. /3 'f Lf
Date Permitted (p - ;Zs - 0 ~
G~cO ~~ Control #
County Parcel No. D3 --2& - L (- D 2-00 - ooF 0
Address/Location lc~(0'-L-J~JcO LN.
Classification/Type of Use ~~J.J S 1 '^tz
SubDiv:
s~~ !J~ V:'Iky-
TRANSPORTATION IMPACT FEE Rate:
Exempt ~Yes D No How Determined
9
Sq Ft Unit:
Impact Fee Amount $
Zone No.
TAl:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House Amount $
(057) Mobile Home
(058) Other Residential (,)1\ _ -0'-- 0
J.:123) Collection Fee fD< \ ~ ~ ~ n .D !' ,?--'iSS t;;
Exempt U Yes 0 No How Determined)~ \
/1 0 CZL(
PARKS AND RECREATION FEE
Land Account Land Credit
Recreation Account
~ ion Credit Recreation Total
~
./---- TOTAL AMOUNT $
Zone
--
"....'
~~
Exempt.,/[Jves D No
./
How Determined
Facility Account
Land Credit
LIBRARY FEE
Land Account
Facility Total
Exempt /p_
How Determined
Total Amount
...-
RE'SOURCE FEE
TOTAL AMOUNT
/CJ. 95
ERU
Prepared By ~Or ~ ~heCked By
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not imply acceptance of concurrence, but simply receipt of 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
RECEIPT NO. Seg/tJ V DATE /~~f~~ BY