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BUILDING PERMIT
CITY OF ZEPHYRHILLS Permit N!! 1 369
(813) 780-0020 Date 7,:l~ - tlcot
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Sewer Conn
Water Conn:
Property Owner:
Job Address:
Parcel 1.0. 1/
f(~ 3~!tI fi;'1T .~q;f(
I
dr.
Water Meter:
T.I.F.'s:
Zoning:
OescriDtion of Work
Energy Code:
)J~
Radon GJJ:
~~ '/J2.crW-
FINAL ~7 --? 0 -~ ~
DATE
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.
C.o.
Inspector
DATE
!2L-Lf/ ;/fD
,
City License Registration'
State Certified License'
'(r
Permit Fee
-\Signature ~ ~'7__J?~
Company
Address
',~elephone' 977-S....S-o
Valuation or
Contract Price
"0 l;r(V f,dl-s
/1('1_
~~fdtI
h'~
BUILDING
ELECTRICAL
PLUMBING
MECHANICAL
Breakers
Ducts Insl.
Compressor
Final t/ 7,- 30 -02 IIro
f2t...'f
SLB
Tub Set
Water
Sewer
Final .. /' 7 - ~ {}- 0 2. ilJ /)
{2L'1
Tp. Serv.
Roughtn
Meter Can
Const. Pole
Pool
Pre-Meter
Finall/ '7 - 30,. 0'2.
Ftr.
Pre SLB
Lintel
FRM.
Insul. CL
WL
HJv
12 1,4
Driveway
i..)V eC- ~'/y'-LJ).... 5~Y/~ IO!IfIU
REINSPECTlON FEES: When ~~ra inspection tripf 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 8th STREET ZEPHYRHILLS, FL 33540
Phone:813-780-0020 Fax:813-780-0021 7_ ~/ /? '')
DATE RECEIVED 0<.1/ -c/ -<
PLANS REVIEW FBE
OWNER'S NAME ~C Jill;' . ~I'I (~~
JOB SITE ADDRESS L c r /:'l~
PHONE CONTACT
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
.-
J!',"~.i.J ~,~ I
PARCEL ID #
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: DNEW CONSTRUCTION
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
Os IGN
o MOVE
o DEMOLISH
PROPOSED USE: DSGL FAMILY DWELLING
DMULTI-FAMILY
0# OF UNITS
81fc5BILE HOME
o COMMERCIAL
o INDUSTRIAL
o SWIMMING POOL
o OTHER
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
ff4tt-I'"' /WtJ... (
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 REQUESTED
o BUILDING
$
VALUATION OF TOTAL CONSTRUCTION
o ELECTRICAL
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
o OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES
o NO
BUILDER
SIGNATURE f"J ~O~
COMPANY
STATE CERT OR R
CITY PROCESSING
******************************************************************
BLBCTRICIAN
SIGNATURE W.,....
~
IJ.,
COMPANY At:..""-
STATE CERT OR REGIST #
CITY PROCESSING # ~
******************************************************************
SIGNATURE
w~ -l')~
COMPi\NY ..)~iL2
STATE CERT OR R GIST #
CITY PROCESSING # ;)..,;;:;1. 3
PLUMBBR
SIGNATURE
******************************************************************
COMPANY . ~~
,
STATE CERT OR REGIST #
CITY PROCESSING # ~
w~~
MECHANICAL
*****************************************************************
OTHBR
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
CONDI~IONS OF PERMIT AFFIDAVIT
"A. NDTICE OF DEED RESTRICTIONS
The undersigned understands that th:Ll, permit may be subj ect to "deed restrictions" which
may be more restrictive than City re9ula,t.ions. The undersigned assumes responsibility for
compliance with any applicable deed rest.rictions.
B. UNLICENSED CONTRACTORS AND CONTH1\CTOF: R.ESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake.wo.t"k, ~ey may be required
to be licensed in accordance with state and local r~gulci'l~io~s. ""'I~ bh~ ,wc)ontractor is not
licensed as required by law, both the owner and contractor~v be-qited for a misdemeanor
violation under state law. If the owner or intended contr~~~ at~ uncertain as to what
, -licensing requ~rements may apply for the intended work, they are advised to contact the
\, -.o,1t1\. o'.~~ls 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 ,. )t>. {\ . ~""\~.
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 af~.'~~,1tme the work is commenced. One 90 day extension of time
may be allowed for the pehnit with fee charge of $15.aO.', T~e ~tens~on sh'tll be requested
in writing to the Building Official. An approved inspe~~~~~~ lo~~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 ATT~~~EFORE RECORDING YOqR NpTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "N~'1'I~".~.!'~ ~~NCEM~~,
SIGNATURE:
OWNER OR AGENT
~ -,.'" \:....,
\
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this _ day of , 19_
by ...'.. ~
(name of person acknowledgea)
Dwho is personally known to me, or
of identification)
take an oath.
STATE OFcFLORt~A. t .
COUNTY 0lF.i _....,y~._~ ..~ ""'oJ
The foregoing instrument was acknowledged
Before me this _day of 19
by
\ ~name of person ark~owledged)
C1bQJ iB::.J.l~b~lly.~Wrt'to me, or
.
Dwho has produced
(type of identification)
and who Odid DUd not take an oath
Dwho has produced
(type
and whoO did Ddid not
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
e7/24/2002 a6:29 813-783-34e6
BEL lURE
PAGE 62 .
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