HomeMy WebLinkAbout03-2474
CITY OF ZEPHYRHlllS
5335 - 8TH STREET
(813)780-0020
MOBILE HOME SET-UP
2474
Permit Number: 2474
Permit Type: MOBILE HOME
Class of Work: MOBILE HOME SET-UP
Proposed Use: MOBILE HOME SUBDIVISION
Square Feet:
Est. Value:
Improv. Cost:
Date Issued: 11/05/2003
Total Fees: 3,315,50
Amount Paid: 3,315.50
Date Paid: 11/05/2003
Work Desc: MOBILE HOME INSTALLATION
Address: 37609 LORENA AVE
ZEPHYRHILLS, FL.
Township: Range: Book:
lot(s): 115 Block: Section:
i Subdivision: GRAND HORIZONS
--
i Name: CITRUS HOMES
Address: 37609 LORENA AVE
ZEPHYRHILLS, FL. 33542
Phone:
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LILLEY AIR CONDITIONING INC.
LILLEY AIR CONDITIONING, INC.
M
MOBILE HOME SET-UP
MOBILE HOME MECHANICAL
MOBILE HOME TIF/SUB 99%
WATER METER RES 3/4"
IRRIGATION CONNECTION
4.
60.00 ! WATER CONNECTION MOBILE HC
35.00. MOBILE HOME PLUMBING
1,572.12 MOBILE HOME TIF/SUB 1%
180.00 IRRIGATION METER
175.00
rXC (J1?t :5 I F-t,
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REINSPECTlON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of Thirty-five dollars ($35.00) 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
_ Th~J)~yment _l?f inspection fees shall be made before any furt~~r perr:nits will be issued to the person OWning~e oJitc. F
l Complete Plans, Specifications and Fee Must Accompany Application. 5$5tJ~f5
__u____.____~1I work shall be performed in ,!ccordallce with City Codes and Ordinances - 1<..uJ11Jf _
I
--'-"---'-~-""'--------'-'------_._-- .-.-----..----- ----.----.--------.----..--..---
NO OCCUPANCY BEFORE C.O.
.-
CONTRACTORS SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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Installation Instructions ft)r ABS Pads
For use on all Mobile and Manllfatttnjd H(1)'l~ including
HUD approved Homes and Modular Housing .
. paIcnIiISSCWOO lIJId otber.......~
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GENERAL lNS1'R.UCTIONS:
1. All pads arc to be installed flat side down. ribbed side UD.
2. The ground under 1bc pads should be leveled as smoo1h as possible willa aU l'......,~ RlIJIOved. Pads
to be placed on nabJra1 grade ua1ess otbcrwise pmwnittP.d by the local 'baiJdiaa"8Idhorily.
3. Pier & pad spacing win be determined by die manufactured boDJcs. wriUaI scHIp iDsk_1ious Qr any
local or state codes, J1.& ..
4. The open cells between the nDbing on the upper' side oftbc pads may be f.iIled with soil CX' IIDd aftBr
instaUation to pnwent any 8CCPmP~ ofstapaat wider in the pads.
s. A pocket pear:txometi:r may be used ~ ~ !be acbW soil bciarh)s value. If soil-aIius
equipmant is DOt avaiJable. use aD ~ soil w1uo of 1000 1bs./ squaa mot.
6. All pad sizIes shown am nnnnn.l ~. and may vary up to 1/8.... .
7. 'Ibe ~ deflection m a dn~_ is SIr ~ ftom the h""""'point~ the Jowestpoiat
of the top face. (N01.'B: ~ ..1'Cl8UID __ lea .... 518"')
8. III fiost areas. a 6" dr:cp Cx.t.fine,lI pavelbaac ~~ ill weIl.....iuecl DD"n-Dost to..:eptible IOil is
recommeaded.
9. Pad loads are the same when usiDg siug1c staok or double staek b1ocb.
10. The maximum load at any intermediate soil value may be ~ined'as1J1e avaage oftbe next
lower and next higher soil value given in the table below.
1 L Any configwation (see reveise sido) may be used to rcp1acc a home mau.nfilcttuer"SlaC(DnrllMVJed
concrete OJ" wood base pad. _'
12, If the home manufacturer sbows soil.t-iti- greaW'-than 3000 lb. whc:n usiDgABS plds;cio DOt exceed
3000 lb. soil pier spacings per set up __I ..
Pad-8ize
Pad Area
1000 lb..Soil
2000 Ib. Soil
3000 lb. Soil
Itt X 16" 2S6 sq. in. 1780 1bI. ... 3560 lbs. 5333 Jbs.
16" x IS" 288 sq. in. 2000 lbs... .,df -. 4000 n.. 6000 Jbs.
13" x 26" 338 sq. in. 237Slbs. . -... 4750 JIJs. 6400 Jb&
lS.5" x lS.S" 342 sq. in. 237SJbs. 4750... 7100 Jbs.
OVAL IT x n" 360 sq. in. 2SOO lbs. SOOO ~.. 7500 IbS.
OVAL 17.5" x n.s" 384 sq. in. 26671hs. S334 Jb& . . 8000 Jb&. ·
20" x 20" 400 sq. in. SSOO .... . .82S0.Ibs..
~ ;.:.> OVAL 17S'x 2SS" 432 sq. in. ./" 3000 1bs. '; QJOCt los. " ',:9000 IbL ·
24" x 24" - 576 sq. jp,. 8000,... · '8000 Jbs. ·
26" x 26" 676 sq. iD. 4800 Ibs. 960'~'" ~ 9600 Jbs. ·
)4" x 22". :/ 748 sq. in. SOOO lbs. lorAO... · 10000 lbL ·
35" x 2S.S~ SSO sq. in. 6000 Jb&. UOOO lbs. · . 12000... ·
· Concrete b1oc:1cs are only nded at 8000 pcnIIIds. 8000 pounds aad..... DIIIIt be double bJocked.
13. ALABAMA ONLY: The 16>> X lei"' IDI1055-10.1&S- x 1&S- IDI# 1055-99 W X 20.
IDi# 1055-1.11" xU..JDt# IOSS-I6, 11.5" x 25.5"lD#l855-I'7 .......ay...approvedla tbeRate
of Alabama, aDd ...... DOt IIave 11IOI'8.... 3Ir defIedIoR. See cIaut..... ~....... OD c:ornet
lnstaUadoa Ia Alaba..... _ .
Note 1: For Alabama ollly: _Whe8 setting in sOil capecities over lOOO-1bs ps( 1be block (eMU) ~
configuration shown in this drawing is n=quired on the 20".x 20" (lD f# 1055-7) ancIthe I8.S" x 18S' (#
10S5-9) J'Slds.
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ADDENDUM
GENERAL NOTES / TIE-DOWNS
~
I. FRAME T1E-00WIS SIf.4ll. IIINSTAUED TO ffiOPER!.Y SCCUll( 1)1[ HOWE.
2. \(RlICAI. lIE -!lOft) All IIEQJR(O IH ADllIT!af TO lIE fRAWE 1[ -00JIl5.
1 vnu lES NAY BE 5E'CIlRED TO Itfr SAllE: GACA.Hl AHOlllR AS 1HE FRAMf tIE -OOr.NS 'M!EH A DCl.8!
HEIJIEIl AtOIDR 15 USED AND IS CAPA9..r (I RE9S1IIC Tl€ COlol8INID lOAOt/C. VIhE~~ AHCIiCRS .4RE HOT
INSTALUD AT TIE N1Cl.,(~) SPECIfIED N THE: TAai(S), A ST8JZER PlATE LiUST 6( :NSTAU!!>
IN ACCaI)AN(I \11M JliE AHDial UANUFN;1\JI/EIfS IlSIRlX:1IOMS.
4. f'RAIAE 11[-lXlYf4S AND .o'.NCIdS IJIE NOr UPUED BY ~ tOIE$ (TO BE !.PPLIfD BY onuS).
3. 'rt:R'IlCAI. It S1RAPS WAY BE .!lJPI'lEI) BY .If1C08stN HOt.€S OR AHCHat MACKET WAY BlIHSTILlfD 8'1'
JACOBSrH HOIfS rOR ATTACHlfJIT OF \9nllE S1RAPS, IN 6lHER CASE All mMS AlID 00
1REAlWlTS Nit TO BE Sl.fPUfD By OTHERS.
l ALL CROl.ND ANO<<ei AND fRAUE DES SH1U 8€ INSTAU.ED PER 1HE II>>aJrACTI.lElfS INSt,fUA1l1J.I
INSTllJC1DIS. cJOut,O .vfOjOO$ AHIl AlAll( 1(S ARt t<<), TO 00DCl ~ 1llE f'.X'IERllR WAU. (1
1HE UNIT.
7. sm ~ [11PI/ENT EXfItSEIl m TIE Y(Al'IO 5ItAlL IE PR01lCllD Q It NW. rs 0.30 ffl.. or
ZINC CD.\ lWG PeR SQlARf FOOT IF mn.
a. ~ 1IASEi> ON 95 III HlfAII SPACK HI) A UAXIIUI SIll(WAIJ. tmtl ~ 11'-0' (lit I-BtALI
SPAatG 15 ACCD'JASU: 1m 10' 'MIlE SEC1IONS Of ~lI-MIE lilts '1/90" SI/lE\Y,u HflCHT ONlY).
9. LONGI1UDINAL lIES SH.U BE flSTtJlEO (t4 11( INSIO( cr EAOt HJEAw AT 11( aross-MOirn L0CA1IONS
OR PCR At,1ERHA1E (tfAIl.S IN MX:DRDN<I IlH THE SPAONll TI\9I.lS AlII JIOlES 4. S. 7 AND 16-
10. fRAIl[ 1IE-00Ytt4S SiALL II "MtAPPfD" ARClJNO 1HE tWll-lI".W (AS ~ (If rP. Cl5-SEClIlW
DElMS) AMl SIWl. aIlE (JF 1HE T(Il FI.MGE If lHE HIEAW YlllH All ~ lIJCXl.E tR tOlP.
11. ANOitRS 9lOl1.O BE CERTHD fCft nm OOIDDS BY A PRMSSKIlAl. EItHER. ARQIltCT 00 It
NA 11lJW.I. Y 1IECOCHI2EO 1ESllHC I.ASlRA TOllY AS to 1lOt RESISl""CE BASED lJ/ 1If IIISTAUEll ANIlE (,f
1)( IlIACONH. 1If NfJ/OI. OQ l.OADINC NIl AIIGI.[ <F AlIOiOR INSTAUAllClI NlD T'lPE Of SOl fH
IItlDf T1f[ N4CIIOR IS TO IE IHSTALED.
12. GROl/II)..tOMS SIflJUlIIE El&DIlID BELOlW 1[ mOST lJt( AHlI 8[ AT IIAST It ABO\IE nr WAttR
TAIlE,
Il GIlOONO ANDOlS StWID BE IISTALlED TO no Fllt.L DEPnI. NIO ST..au2EA Pl.A ns 9tCiUUI1lt IHSlAl.l!ll
TO PRO\tll Am RtStSTAIICt TO 0'ttRtUVR OR !UH FlmS.
14. NOlaG E<llJRlEHT 9lOOlO BE BY A RmSIDID ~ ENaHmt at ARClfIECr TO RfSIST no:
SImF(J) FDRCIS IN :M:ClIlDAMC[' 1lID! 'ES1It(; flIlOlIllHS .. ASlII ST.ooAID Rt1FICAD O~",
StANOARLJ SPECfICA 1Kff FCIl SIRAPl'ING, FLAT sa AIID !US.
15. AU. CIOUHO ANOIlRS TO II: RAm FlIlLQAD U$1EO lit TA8I.E\ 00 f.$ $A.rm F'~OR ca AN 111lUAlE
lOH) Of m.5, (J1501ll(~ lON)l fHOtE& IS RAtER. VN..W t4 11( TAIlES ARE IlED l,M) VAllES.
1&. A lWIWlIK or 111) 11tlQ1\DHAl1lE-DOIlH SlIAPs lIAY E IHSTAU.EIl AT A !HlU CIi05S-tmIfR l0CA1KJ..
F WalE 'IHAN I'M! Ulr4t'tl/OlNAl Jt-lQ1NS ME IElURED (B: NIPRtPRlATE SPAOIIC TAIILIS) ADIlI1001. CRQiS_
MMtRS UUST lIE usm rat ATTAQ6DT Cf SlRAP(S) (~ sa OllQ !a~S tCR Al,1[IlNA'( STRAP ATTAOIIfNf).
17. LIJHQRIOHAl llE-DOII SlRAP(S) liAr IE' NlAWO AT Alf NlQ.E NOT IWDfi)/Q.UR TO H atOSS-Unlll'R
TO IIIOf IT IS ATTAO(O (sa NOTE 16) IF ~ TO t.tSS PIER UICA1(WS ~ 01IG O8$1RUC1Il:W($).
It AU fDJR[S (OCTAlS) SIfJII( rt 1lIS SEClDI ME. 1lPD.l.S III. Y. REnR to tHE APPIlRATE TAIlI.ES. ftR
llf: REWRfJI NlUlEI. SPAQHG NfJ!rM SPt:CS Cf SPECfIC 'II[ -IX)'aIS NtII ANClltIS REIlJIRm
19. SE[ OTHER DETAIlS IN 11( SET-uP t.WIUAL MID HlllENDUM FOR IlOCXtlC R[llJIREUOOS. AU BLClOO<<: DUAlS
CONT~D IfTHlN THIS UAHIJAL ARE APAJCAIlL( FOR AU. ZHS AND AU. [XPOSUI/[S.
NQT1l:S'
DIQIIER 0 "'.It
:!o....~ ~lI!
~.. ........... ~
/~;.G'STf.,~....
I 1::.:t. No. ~o..
j f ENES703571 "\
: :
lW'Li .01:
_JACOBSEN HOMES
P.o. ~x _
lW!TT HNt8OR. f'I.DllIDA MO!l&
PHCM (II)) 72....m.
A
ROVED BY ~
..... 1 5_
INC
THESE MOtts AND DJi:l'ADl! ARE APPLICABLE
FOR 'lIND aON!: II AND/OR WIND ZONl; III. 181lY
ARE AlSO APPLICABLE To BOtH: EXPOSURE 'c'
AND EXPOSURE 'D". SEE APPROPRIA11 TABLES
FOR SPEClnC INP'ORWATfON ON BACH.
11& ttT1l1t
i.
loa
OWNER'S NAME
~\+rus )..fvn~
CITY OF ZEPBYRHILLS PERMIT "APPLICATION
BUILDING DEPARTMENT 5335 8th Street, Zephyrhills, FL 33542
813-780-0020 FAX:813-780-0021 Q/~v)o~
DATE RECEIVED / . _
PLAN~/~EP-iU.-..~__
//---CtJ.11 J(.th'rltL (9
~SYI(-S3l{9_
SUBDIVISION 6~ ~,~ .pitt-
1--0 ( -e li~
'Za.,ohy (~ll Ls
A-K,
JOB ADDRESS 37&; D q
LEGAL DESCRIPTION: LOT(S)
it S-
PARCEL I D # 3lJ -~';;).I .. [;.cliO - 000{){)- lL S-O
BLOCK
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ~EW CONSTRUCTION
OSIGN
PROPOSED USE: OSGL FAMILY DWELLING
o COMMERCIAL
o ADDITION
o ALTERATION
o DEMOLISH
o REPAIR
o INSTALL
o MOVE
OMULTI-FAMILY
o INDUSTRIAL
O. OF UNITS
o SWIMMING POOL
jtf)MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DESCRIPTION OF WORK Nu..J Q~i8{(x t&;'8d mDblle j,".(J'yy~ /t1~l-af1(i._Jiuz-..J
BUILDING SIZE 9&/(3 II y. I...{l.c' 8 I( SQUARE FOOTAGE !;).Lll./ HEIGHT l<t (
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
~UILDING $ f)LfOO~
~LECTRICAL BOD
~LUMBING
~CHANICAL CP.
$ I ~(){) ./
o GAS o ROOFING o SPECIALTY
PERMITS REQUESTED
& (1) SET EN Ji.:RGY'F'ORMS';,
FORMS. /'. ~ :
(!~
VALUATION OF TOTAL CONSTRUCTION ~""_"__'__'"
AMP SERVICE
o FLORIDA POWER
o W,R.E.C.
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
Qti FRAME
o STEEL
,0 OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAO YES @"No
ELECTRICIAN ~
SIGNATURE - ~
BUILDER COMPANY :S::OVd'\;Y\.~ JY\ \-t ~
1\ ~ ^ ~ STATE CERT OR REGIST # .: ~ HO()()O/C)../
SIGNATURE ~~ CITY PROCESSING i ~
**************************************************************~16Z0
COMPANY ~
STATE CERT OR REGIST
CITY PROCESSING #
******************************************************************
# Ere 0010 S?2J/
V
SIGNATURE
~~
COMPANY ':l.e.lAlI\ l ~Gyl m}+- ~
STATE CERT OR REGIST # '"J:1+tJOOO/J-1
CITY PROCESSING #
PLUMBER
********************************************~************
COMPANY
~~ STATE CERT OR REGIST # c,r::t-GOJf3 9&/7
J[r'=- CITY PROCESSING * ~
************************************************************ GI j' 0 I~
MECHANICAL
SIGNATURE
OTHER
.~
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*****************************************************************
.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.n, 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
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
~J~L-?
SIGNATURE: OWNER OR AGENT
- - ----..-... ....._-.&,.....,...~..l..L
~~
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _ day of
by
acknowledged
20
----
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was acknowle~ed
Before me this _day of '-.:.....
by
(name of person acknowledged)
[1ho is personally known to me, or
o who has produced
(type of identification)
and who Odid Dlid not take an oath
(name of person acknOWledged)
Owho is personally known to me, or
o who has produced
(type of identification)
and whoO did Odid not take an oath.
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
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PASCO COUNTY, FLORIDA
, . " Permit No, ___~ iZ1 _
Date Permitted -/.tl-~
'- BuilderNam~!OwnerName ~;$-.5jt(control# ~._..~_.
COllnty Parcel No. J1j'.:M:-~~o'Ji> -lu)c)~-/~Q SubDlv: ~
Address/Location --~2Jz.tJ-!t--~1L tb _. ._____________
Classiflcatlon/Type of Use ._____
-----.----------------.----.-".--
TRANSPORTATION IMPACT FEE Rate: _ Sq Ft Unit: _~______
- Exernpt [.I Yes 1>.s(NO How Determined _______________.___________________
Impact Fee AllloUllt__~_J,5:.BF!~/sjoj Zone No, TAZ: _________________
_..a.....-
.SCIIOOL IMPACT FEE
Account (066) Single-Family Detached I-louse
(057) Mobile Home
(058) Other Residential
\ 1~23) Collection Fee
Exempt ~ Ves [J No How Determined -'~~.k.L5f!~
PARKS Ar-:m RECREATION FEE
Land Account Land Credit
Amount
$
---._._~-~...._~_.-_.--
~---_..._--.----_._.__.....---...._---_.-
___.4__.~______.._,~_.___~
------. -'~-"'-----
Land Total
----_...__._-_._---~
Recreation Account
Recreation Credit
Recreation Total
Zone
TOTAL AMOUNT -._L_____.__________________
Exernpt [I Yes [] No
How Determined
----------_._---,_._--_._~----,_.._-
Iis'RARY FEE~~"--._---
Land Account Land Credit
Land Total
--_.~-------.__._---
Facility Account ____________ Facility Credit __________ Facility Total .________
Exempt [] Yes [J No
How Determined Total Amount
----- ----------
RESOURCE FEE ~
TOTAL AMOUNT __~~_______
~--
ERU
--_._-----~--
-.--.....-..---
-' -----
Prepared By ______-'-___________________ Checked By
--..--.-----.---.-
NO CERTIFICATE OF OCCUPANGY WILL BE ISSUeD OR FINAL INSPECTION
PERFORMED UNTIL 'fHE TO.fAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
AGlmowledgernenl below does 1I0t 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 paynlent for same,
--.....--.-------.--------..----.--
DATE
RECEIVE613'(""------------
RECEIPT NO, UJO--:LUa-_ DATE ~\. - :=\_::::.~ BY
W'~ .
-_._,.~~_._~-------_._-,-----_.