HomeMy WebLinkAbout04-2775
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
2775
Permit N mber: 2775 Issued:' 2/27/2004
Permit Type: NEW SINGLE FAMILY DWELLING
Class of Work: 101-NEW CONST/SFR
Proposed Use: SINGLE FAMILY RESIDENTIAL
I
Sq. Feet:! Est. Value:
Cost: 98,050.00 Total Fees:
Amount aid: 3,288.36 Date Paid:
Address: 6807 OAKCREST WAY
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: OAKCREST
Parcel Number:
Name: AVID W. JOHNSON BUILDER, INC
Addr: S504 FORT KING ROAD
OADE CITY, FL 33525
Phone: ( 52)523-0473 Lic:
Wor Desc: NEW SINGLE FAMILY DWELLING
DAVID JOHNSON
6807 OAKCREST WAY
ZEPHYRHILLS, FL. 33542
Phone:
WATER CO NECTION RESIDENl
RADON
419.00 MECHANICAL FEE
19.61 WATER METER RES 3/4"
"Iff} ~ 3('{ I,
'~r.)' ~V\V\.
69.50 II BUILDING FEE
180.00
Jto'OOI
\"15 1()1
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Allip'/ off '7-1:).-0'1 Pv
5(.:.10 .3~ 22- <<I !/:riP
FOOTER T W!
PRE-SLAB : CONSTRUCTION POLE I 2ND ROUGH PLUMB '
LINTEL ! PRE-METER ! WATER
FRAME -.2- -6 1 MISC ! SEWER I MISC
INSULATIO WALL - ._1) r,! MISC ' MISC. I. MISC.
INSULATIO CEILING 1 : MISC. MISC. MISC.
_~~~EWAY I __~___~___JMISC._ . MISC.__ ~IRE DEPT. FINAL
REINSpJ-cnON FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge ~ Thirty-Five Dollars ($35.00) shall be made for each trip for each trade:
(a) Wro'lJ address (b) Condemned work resulting from faulty construction (c) Repairs or corrections not made when
inspectio~ called (d) Work not ready for inspection when called
(e) Permit not posted on job site (f) Plans not at job site (g) Work not accessible
_Ihe. pay._~.ent of inspection fees shall be made before any further permits will be issued to the person owning same __~~
"Warnin to owner: Your failure to record a notice of commencement may result in your paying twice for
improve ents to your property. If you intend to obtain financing, consult with your lender or an attorney
I__bef~~r cording your notice of commencement. II
I NO OCCUPANCY BEFORE C.O.
----------~.._-
-.Lhu----- -.. .~
RS SIGNATURE PERM~~
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM 'NEATHER
l;.L'J.'~ UJ:i' ZEl?HYRHII~LS PERMrr APpr~rCATION
BUILnING OIllPARTMBlN'l' 5335 ath S'fREE'I' ZEPHYRHILI,S, FL 33540 . .
PhoneI813-780-0,020 Ji'axI813-780..00:n ",' .Lf
DA'n RIllClllIV.BID - ~.;l- O. r
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PJ,ANS RlllVIBIW i'!lI1ll . .. .
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mlHElR'B HAHEI ])A-1/I/) tAJ. flll..<JsoAJ PHONE CON'l'ACT6!'"iJ~Z~~73
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,JOB SI'11E] ADnRE]8slo$Q~'L.DAK~Z:=-~ ?H~~~L. ~~to .J.-<:J r 1!~_..,-------_
L.GAI, I).SCR,p'mJll, LOTISI___J5__ .BWCK ____ SUBUIVIBJOIl DlH(C'~r,~
PARCEl, ,If) # ()~ 'Z,(~::!4-:._J2_ z. sLI, -G)_~OOO ~O()O~!3 __~OB'rAIH P'ROM I?RO~~__TA~ NO'r~(!Bl)_
WORK PRPPSHllJ I ~W CONS'!'RlJCTION [] ADDITION []AI/I'ERA'rION [) REPAIR [] lNSTMJl,
[JSICnl
PROI?USEI> USEl 19'8~;lJ FAMILY DWEI,I,Il'1Q
[J MOVEl
[) DEMOLISII
[Jt1lJI.'l'r - FAI"IUN
[J# OF IINI'l'8
[) sw n'lMING POOL
[J MOBnm HOME
!J D'mHlR
[J CQt1MBlRU IAI,
[J INDlJS'l'RIAJJ
D RBlSTAURANT & HEAUru DEPARTMEN'!' APPROVAL
IlmBCRIP",,,,, OF I';,RK/ .s/~~t,tj Jjl]'ff~tvet.f...I,~.)6 ~____'___~/'_"_
BUILDINq, SIZE :if? ,x51 ~______ SQUARE FOOTAGE __./q~_~_ IIEl1m!'!' ,__~~___________
REBIDENt'IAI'1
(~OlvtMERbAIJ :
A'fTACH (2) PIJO'l' PIJJUlS & (2) SETS OF BunDING PLANS & (1) 8H1'r ElNHlROY FORMS,
A'I'TAC!H (3) SETS OF BUIIJDING PLANS & (1) SElT ENElR<~Y FORMS.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
r~IJILIJIljlG
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r~ELEJC'I'RlCAl,
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~ERMIIS REOUEeT~
L..7~~ ~ ..__ VALUATION OF 'rOTAI, CONS'!'RlJCTION
-,~~~ --- ANP SERVICE! l2r FL,ORIDA POWER [J
W.R.E1.C.
tf HB)<~HA1HCAI,
$___JJ$t90~ ~
,
VALUATION OF MEC'HANCIAr, INSTAI,L,ATION
[) (1M:!
rtfROOF'IHG [J 8I?ECJIAl/l'Y
OF 'CON8'!'RUC!TION: [~OCK
o OTHER
'l'l:'Pl:iJ
[] FRANE
[] S'I'ElHlIJ
[] OTHER
F LNISHBlII FLOOR EIJEVATIONS
----
18 PRO,fEC'I' IN FLOOf) ZONE AREA 0 YES
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COtiJPANY PAvI-Z> Cc.),~~0/~ /AJ::,
ST'A'I'EI CBlR'l' --;RRElGIST # .___. ..... C::X;;C:::>3~--
CITY PROCESSING L___
........... ~.............................. "f!;;;;' iti;~.....
lllI'B1alrRIaIA~. ~~ COHPANY_~~..~___.
/ ~ =:::--,. ~ S'l'A'l'E C'ElR'I' OR RE)<HS'l' # /""'"/ /3 ~~
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SJGNArIJR~~. -..k..,. .-__._ CJ fY PROC'SSING # 97 ,l3~
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PLUMBBlR 4fl ~ (!OMPANy-,~4-~-cJ~w-__L!v~k.01~..__
STATE CElR'l' OR REGrST # ..J.lE-CD-.66-!1b'3 ____._.
SlGNATI1R~ __ . --.M _. CI'l'Y PROCESBING # ~_~__._.___.____
, * * * * * * * * *' .... * * * .* * * * * * * * * * * * * * * * * * , .. * .. * * * * * ~ * * , * * * ~* * 'k * * * * * ..
NIcaAluctl, f),' rJ ~~~,;.~N~.R';-';~'-;.:; ~#-'rr /I'\-O:~-kq6'T---
SWHATURE ~~.# CITY PRocmsaIHa # ---.--~=~=.=_~:::=:::
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OTHBlR I
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Cor,1PANY
STATE CERT OR REGrST #
CITY PROCESSING #
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-----.-.-..--------.-.-..-.------..---.,
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands th~t lhisp.rmit may be subject to "deed reatrictionsff which
may be more restrictive than Clty regulations. The undersigned assumes responsibility for
compliance with any applicable deed restrictions.
B. UNLICENSED CONTRAC'l'ORS AND CONTRACTOR RE:SPONSIBHI'l'IES
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 01.' intended contractor are uncertain as to vlhat
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 tIle
contractor(s) sign portions of the "Contractor Sectionsff 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 I,IEN LAW (CHAP'l'ER 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 Guideff prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owllerff, 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 conunencement.
E. CONTRAc'roR' S/OWNER' S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be done in oompliance 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 Hork or installation has conunenced 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 j\Irisdiction. 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
Envirollmental 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
*Vepartment of Health & Rehabilitative Services, E:nvironmental 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 "Aff or "A,etc.ff, it is
undet"stood 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
Jssu8nce.
A permit issued shall be construed to be a license to proceed with bhe 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 requJrJng 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 conunenced wi.thin
six months of issuance, or if work authorized by the permit is suspended or abandol1ed for a
period of silt months after the time the work is conunenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
ill writing to the Building Official. An approved inspection must be logged during each six
month period, or the project will be considered abandoned.
WARNING rro OWNER I YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESUI,'!' IN YOUR
PAYI CE I!'OR IMPROVEMEN'l'S TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN I!'INANGING, CONt~UL'r
WI YOUR ENDER OR AN ATTORNEY BEFORE RECORDING Y TICE OF COMMENCEMENT. .:JOB 'UNDER
2,500 ALUE DO NOT NEED 'I' R ORD AND POST NOTIC OF COMMENC~ENTff.
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _ day of
by_
_ (lIame of person aoknowledged)
II who is personally known to me, or
STA'l'E OF FLORIDA
COUNTY OF
The foregoing instrument was acknowledged
Before me this --------"pay of---, 19
by
(name of person aoknowledged)
C1ho is personally kno\'m to me, or
acknowledged
, 19__
[] who has produced
(type
and who[] did [Jdid not
o who has produced _~__
(type of identification)
and who [] did [}::lid not ta ke an oath
of identification)
take an oath.
Signature of person taking acknowledgement
Signature of person takillg acknowledgment
Name typed, prlnted or stamped
Name typed, printed or stamped
David Johnson
Lot #3 Oak Crest Way
SQ. FEET PRICE
MAIN OR LIVING: 1,961 $ 50.00
OTHER AREA UNDER ROOF: $ 25.00
OTHER: - $ -
V ALUA TION $ 98,050.00
FEE SHEET $ 476.00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 774.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 774.00
ELECTRICAL: $ 114.25
PLUMBING: $ 96.00
MECHANICAL: $ 69.50
RADON: $ 19.61
TOTAL $ 1,073.36
SEWER: $ 1,616.00
WATER: $ 419.00
IRRIGATION: $ -
TOTAL: $ 2,035.00
I
I
WATER METER:I $
IRRIGATION METER $
180~00 I
SUB-TOTAL $
3,288.36 I
SIF'S: $ 1,694.00
97.5% $ 1,651.65
2.5% $ 42.35
T IF'S: $
99% $ 1,465.20
1% $ 14.80
1f5<6K
l57)")
s r f Y
I
TOTAL: $ 6,462.36 I
fl II. 1011 LAW1i
t'1I 7'''.1:1
NOTICE OF COMl\ lENCEMENT
SIiMINOt.G POflM401
IPl1ltp"a. IN \)UI'IdIt YIO
510tllt of flotilla }
(;:J)Uf~tv or \
111a uodaraignad horobv Informa all armcl!lrnltd that ImprullOntDf to will bu InodD tu ollrlolo rOl:llllropony ond I d
with sBetlDI" 11~1.13 of lhB t=lorldq Sthtutelt. tho followin(J in'mnul :lul1 Is stl1ten In this NO"f1CE Ot: COMMF.N~:::~~~CI
Desariptionolpnaptlny .. t;?k::.Ur.--:'1'l~(?'.~'~:?? ~.~~.~.~~ .':. r::.~_~"3
.. . .. . .. .... . .. .. .. .. .. .... .. . ....... .. .. .. .. .. .. .... . .. .. .. .. .. .. .. .. .. .. .. .... .. .... .. ..
..............
111111111111111111111111111111111111111111111111111I11111111
. . . . . . . . .. . .., . . . ........ .... . ...................... ..... ............ -......... 200401116!5
Gftn~rBI desQrlptlol1 of bnprovemllnts .~1J!!f.!o/l~ ??i?.~~~.~ ~~~r; ~!.~~. .. . . - .. .. ..... ., ..
1)At/I'l:> W,flHAJSO,u
OW"'Br .. , .. . . .. . , . . . .. . .. . .. .. .. .. .. .. ... .. .. .. .. .. .. .~....... ........ ... .. .. .. .. .. ,..... . I .. 1'.. .. .. .. .. ........ ................ -... .. .. ..
Addtoss . 'l.~ f E!:.':!-!~c?' .~~~~ ~~ E~. ~3. ~~~...
'........... ........ .... ......--~....................................... .....
Rcpt: 7494!58
OS: 0.00
01/22/04
Rec: 6.00
IT: 0.00
Dpty Clerk
Nll'qe ...
~... ~ ".~".' - ..-.. ..-.......................................-.. .......
. . . . .. . . . . . .. ~'92~~~1f1~~: :r:;O fOUNTY CLERk - .
. _............ .~~. .~~. .. ~.?~~.. . , . ~~... ~.~72
Owqe,'s inlerest In sito of the ImprovelllMt .... . . . .. . . . . . . .. . . . . . . . .
Fl';ffJ ISimpl1ll Tltffl holder (If other 111811 OWD8rt
?'>..i"''r" Address -.................... - . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . - - . .. .... - . . . . - . . . . - . . . . . . . . - . . .. . . . - . . . . . . . . . . .. . . . . . . . . . . . . . . . .
.~{ c......"'., ~ '.l> lA,}:. .;mff.'!~m/~.w. '??~~C::.. - -..... h. ..... . . .. .. . .. .. - ................. -.....
Ad~.Ss . q(P't. fi!~~!.~t;?~(.7:M.~.~.~.~!~~~.................. -.......... - -..
Sur.tv (i. any) .. - . . . . . . . . . . . . . . . -. . - - . . . . . . . . . . . . . . . . . . . . . . . . . . . - - - - .
, . .. .. . . . - .. . . . .. .. .. .. .. ~ . .. . . .. .. . .. .. .. . . .. .. .. .. . .. .. . . . .. .. . .. .. .. . . .. '"' .. .
Ad~'DSS . ..... _ . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . - . . . . . . . . . . . - - ....... - . -' ..... - . . . . . - . Atnount of bond 5 . . . . . . . . . . . . . . .
An~ person mRlling D loan for the QOAstruellan of the Impruvumul tG:
Na~e ~.~~...... .~. .~~~~.. .'fi!~::?1:-?:.. -?r:~f>/-(~~'Y:>'.......... -................
AddroGs ...... .............................. . . . - . . . . . . . . . . . . . . . . . .. ........ - . . . . . . . - . . . . . . . . - . . . .. .. - . . . . . . . . . . . - . . . . . . . . . . .
Plu~on within 'tho Stato of Florida dosign..d by owner upon wile m noticeD or other donumont9 may bo surved:
Na....(t ...... - . . . . . - - . - . . . . . . . . . . . - . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .............................. - . . - - . - . . . . . . . . . . . . . . . . . . . . .
~dt~~~la~ 't~ 'l~i~"~~li .~~~; 'd~~i~~~t-;~ ~~ f~'li~~i~U .~~~~~~ i;; ~~ ::~i~~ ~ ~~~.~; '!'I~~' i.i~,~~~;~ 'N~ti~~' ~~. ~~~ui~i~d 'I~~ 's~~ti~
71~_13 (11 lh). Florida SlettolDII. t'Ulln at Owner"s optiun).
Na,ua ............... ~_. . . --, . . ..... ...._.~.~.-....... ....... -.. . - . . .
I
Ad~r1t8S .................................... - - . . - . . . . . . . . . . . . . .. .
rms lJ1tACE FOR ReCORDER.S USK OIl!I.Y
SWDlII to 81 d lllulJscribud boforo m
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STAT~ OF FLORIDA
COU TV OF PASCO
T HIS IS TO CERTIFY THAT THE FOREGOING IS A
RUE AN CORRECT COpy OF THE DOCUMENT ON FILE
OR OF P BlIG REGORD IN THiS OFFICE. WITNESS MY
HAN D OFFICIAL SEAL THIS~ DAY OF
2 .dlJ.!/
;~ PI.. ~ RK OF CIRCUIT COURT
! ~ U/'.....:./ DEPUTY CLERK
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., WINTER POINT MULTIPLIERS (WPM)
6A-10 \'IIINTER OVERHANG FACTORS (WOF)
CLIMATE ZONES 4 5 6
~r
We>::
m[
6A-11 WALL WINTER POINT MULTIPLIERS (WPM)
FRAME
~ WOOD-----~- STEEi:----
EXT ADJ EXT ADJ
68 5.3 9.4 6.7
2.5 2.1 4.4 3.3
20 1.8 3.3 2.6
1.8 1.6 10 24
1.1 10 2.6 2.2
.7 .7 1.4 1.2
R-VALUE
0-6.9
7-10.9
11-12.9
13-18.9
19-25.9
26& Up
6M2 DOOR WINTER POINT MULTIPLIERS (WPM)
DOOR TYPE! EXTERIOR ADJACENT
WOOD
7.6
5.9
INSULATED
5.1
4.0
6A-14 FLOOR WINTER POII~T MULTIPLIERS (WPM)
SLAB-ON-GRADE RAISED
EDGE INSULATION CONCRETE
I R--!'0~_'.2L:.~E R-vAIUE WPM
-b~2.9 4.0
3-4.9 3-4.9 1.8
5-69 5-6.9 1.1
-7&U 7& U .8
6A-15 INFILTRATION & INTERNAL GAINS
Air Infiltration 0.87
Internal Gains - 1.15
Infiltrationllntemal Gains -0.28
(Combined)
CONCRETEBLOCK(NORMAL~
INTERIOR EXT.
INSULATION INSUL.
EXT ADJ EXT
6.0 3.1 6.0
3.8 2.3 2.8
2.9 1.9 2.0
2.3 1.5 1.5
1.5 1.1 .8
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R-VALUE
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3-4.9
5-6.9
7-10.9
11.18.9
19-25.9
26 & Up
1.168
1.053 ·
0.995
4.5'
1.225
1.067
0.994
5.5'
FACE BRICK LOG
R-VALUE WOODFR R-VALUE BLOCK
0-6.9 7.0 0-2.9 3.7 6 INCH SINCH
7-10.9 2.1 3-6.9 2.6 R-VALUE EXT EXT
11-18.9 1.7 7-9.9 1.8 0-2.9 2.2 1.2
1 S-25.9 1.0 10&UP 1.3 3-6.9 1.2 .9
26 & Up .6 7 &Up .9 .7
I NOTE: SEE SECTlON2,Q OF APPENDIXC FORMUL TIPLIERS I
OF ENVELOPE COMPONENTS NOT ON THIS FORM.
6M3 CEILING WINTER POINT MULTIPLIERS (WPM)
UNDER ATTIC
. -R:vALDE-' r- -WPM
19-2[9-- r -.8-7
22-25~9 I .78
26-299 _L .69
30-37.9 -64-
38 & U .55
RBS Credit 0.850
IRec Credit 0.905
White Roof Credit 1,044
6M6 AIR HANDLER MULTIPLIERS
Located in Qaraqe
Located in conditioned area
Located on exterior of building
Located in attic
WPM
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0.92
1.09
1.11
I SINGLE ASSEMBLY i CONCRETE DECK ROOF
- j- R-VAlDEl - WPM--l I~ -CEILING TYPE-
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19-25.9 .62 21 & Up .54 .5~f
26::i9.9 I .50 r-- . -
:JO&Up- . i .46
RAISED WOOD
POST ORPiERu
CONSTRUCTION
i ---WPM'----
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(f7S
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.. .-STEMWALL wTUNDEi'C--AoJACENT
FLOOR INSULATION
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6A-17 DUCT MULTIPLIERS OM s.. r,ble 6.10 for Code minimums.
DUCT RETURN DUCTS In:
SUPPLY DUCTS IN: R-Value AtticJ AtticJ
RBS IRCC
1.098 1.100
Unconditioned Space .0
Attic!Radiant Barrier (RBS)
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PASCO COUNTY, FLORIDA
Permit No. __.-d.17 S
Date Permitted
Builder Name/Owner Name VI) v I tI J6 A h50h
Control #
County Parcel No. ______ ____ SubDiv: _____ ___.______._.
Address/Location __~ rz--~~f } k~* 3 ._________
bassification/Type of Use _~~1~ _~~_____________________
TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit:
Exempt [J Yes ~ How Determined
$ I,Ct:N;::-.. Oi'.__ Zone No.
Impact Fee Amount v() 0
TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House
(05?) Mobile Horne
(058) Other Residential
.023) C2l!e~ Fee
Exempt [J Yes f_fNo How Determined
Amount $ ---.---~i5t...____
.PARKS AND RECREATION FEE
Land Account Land Credit
Recreation Account
----.------.---
Recreation Total
.tone
TOTAL AMOUNT
$
Exempt
-=---
liBRARY FEE
land Account
How Determined
L.and Credit
-------------
Facility Total
No
How Determined
Total Amount
ERU
Prepared By ________________ Checked 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 concurrenc6, 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.
MTE---------------
!RECEIPT NO. 726 <j&,L{ATE
}t RECEIV
& /25 Y
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