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Home My WebLink About05-4107 CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 4107 Permit Number: 4107 Permit Type: COMMERCIAL Class of Work: ADD/AL T COMMERCIAL Proposed Use: COMMERCIAL Square Feet: Est. Value: Improv. Cost: 100,000.00 Date Issued: 4/14/2005 Total Fees: 8,400.69 Amount Paid: 8,400.69 Date Paid: 4/14/2005 Work Desc: ADDITION TO MEDICAL OFFICE Address: 6340 FORT KIN RD ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: , Name: DR. K. T JOHN Address: 6340 FORT KING RD ZEPHYRHILLS, FL. 33542 Phone: J FIRST CLASS ELECTRIC CHRIS BAHR PLUMBING KINSEY CENTRAL HEATING & AlC ELECTRICAL FEE PLUMBING FEE MECHANICAL FEE RADON 113.60 WATER CONNECTION COMMERC 99.50 TRAFFIC IMPACT FEES COMM 80.00 TRAFFIC IMPACT FEES 99% COM 20.00 WATER METER RES 3/4" 1 R DUCTS INSTALLED PRE-SLAB CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED LINTEL PRE-METER WATER SHEATHING FRAME MISC SEWER MISC INSULATION WALL MISC MISC. MISC. INSULATION CEILING MISC. MISC.. MISC. DRIVEWAY MISC. MISC.. REINSPEcnON 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 The payment of inspection fees shall be made before any further permits will be issued to the person owning same "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." Complete Plans, Specifications and Fee Must Accompany Application. All work shall be performed in accordance with City Codes and Ordinances NO OCCUPANCY BEFORE C.O. '--f ~~ ~. CONTRACTOR SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER John L. Smith Construction 6340 Ft. King Rd. SQ. FEET PRICE MAIN OR LIVING: 2,000 $ 50.00 OTHER AREA UNDER ROOF: $ 50.00 OTHER: $ .. V ALUA TION $ 100,000.00 FEE SHEET $ 480.00 ADDRESS $ - DRIVEWAY $ - BUILDING: $ 720.00 CREDIT: $ - BUILDING LESS CREDIT: $ 720.00 ELECTRICAL: $ 113.60 PLUMBING: $ 99.50 MECHANICAL: $ 80.00 SUB-TOTAL $ 1,013.10 RADON: $ 20.00 TOTAL $ 1,033.10 SEWER: $ 3.355.38 WATER: $ 865.70 IRRIGATION: $ - TOTAL: $ 4,221.08 WATER METER:I $ IRRIGATION METER $ 180~00 I SUB-TOTAL $ 5,434.18 I - I 10C;,fO ]Jcv PARK IMPACT FEESI $ PUBLIC SAFETY IMPACT FEES POLICE $ 326.00 FIRE $ 350.00 5% $ 33.80 - I SIF'S:I S 97.5% $ 2.5% $ TI F'S: $ 11 ,866.00 99% $ 11,747.34 1% $ 118.66 ,,25'2 -;; '1C; ~ :- Q,9t;C,,50 ~\ <611.50 ~810' ~"r tJ~1,'-;' I ~ 1 O'q. 11li~ 0 TOTAL: $ 18,009.98 , q9t -- 2,13&. r;~ /'ic-- '21-.4>1 MaY.]!. ZUUb 4:21PM HERNASCO TESTING LAB &RNASCO l'ESTING LABORATORY, INc~ Materials Teltmg and Enpaeering 6301 Beajamiu Road - Suite 409 Tampa, Florida 33634 , TEL (813) liZ-Mil or (7%1) 856.5565 FAX (813) 888-6994 No.8252 p. ] IlEPORTNO,: JOB CODE: DATE TESTED: TRAVEL TIME: SImBT: SFR- 001 JOHN SMITH May 9t 2005 NONE 1 Of 1 FIELD DENSITY REPORT . CIJENT: 10hn Smith PROJECT: 6340 Port King Road -lq)hyrbills PERMIT #: NAI P.O. ##: N/A REQUESTED BY: Jobd Snlith REPORTED BY: Amanda Carey COUNTY: PASCO MATERIAL: EXISTING SOIL PROCTOR USED: 108.1 SAMPLED Flt.OM: COMPACTEDBUIWING PAD MINIMUM PERCENT COMPACTION REQUIRED: 95.0% GENERAL LOCATION OF AREA TESTED: . - Footer Bottoms SPEClFlf; LOCATION: DRY DDt8.TY % MOInURi % DDlSITY 1. 12' .south of the Northwest Comec 102.7 4.4 95.0 2. 18' South of the Northeast Col'I)et 103.] 5.7 95.4 3. 24' South oltheNorth Existing Wall/1St East of the West Footer 103.6 6.8 95.8 ,'. " .~ ....\ If ~~!' ! :N "'I"'4 . ~. -. RBMARKs: ,~ I ',': .: 1 ',o! (~. >- N' \ , ... . .~. d....:.... J . . JeffNQvak: Field TeehoieUtD p . ~'~f,./J ,,'" . "... r." ':.;. .." Il~' . . ''':':.J._...-.. P.L #U217 ',. ,'&~ . '.:'l1.~.,_ l1..-eBlvd. #561 Duaedln, Florida 34698 May 10,2005 CITY OF ZEPHYRHILLS PERMIT APPLICATION BUILDING DEPARTMENT 5335 8~H St, Zephyrhills, FL 33542 813-780-0020 FAX: 813-780-0021 DATE RECEIVED. E / " 2- d 6 & f4 11) I/V( ~ It,Y C/ ( / OWNER'S NAME 71t tJ ~~..c 17 or k d b~~7,4, ,It:! k ij JOB ADDRESS ~ 1- Yc'J Fr./:-, <I'~y ) rI ;z t-/~ tZy/C"~//~ rL ~~S-7"-L PHONE CONTACT FOR PERMIT(N~ 7.[>/J-- t!J _.. PHONE LEGAL DESCRIPTION: LOT(S) BLOCK SUBDIVISION PARCEL ID # d)...r....J 6-~/ ~{!JCJ(!JCJ- &6J"p6it' - cPa!JO (OBTAIN FROM PROPERTY TAX NOTICEl \........ WORK PROPSED: ONEW CONSTRUCTION ditADDITION o ALTERATION o REPAIR o INSTALL OSIGN o MOVE o DEMOLISH PROPOSED USE: oSGL FAMILY DWELLING 21cOMMERCIAL oMULTI - FAMIL Y o INDUSTRIAL 0# OF UNITS o SWIMMING POOL o MOBILE HOME o OTHER c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL DESCRIPTION OF WORK If t/f/' I . 'II tV BUILDING SIZE .y tJ "%4"(1 I f 0 I/0B if IJ PF, 'c ~. ~tt SQUARE FOOTAGE 0;/ ~ d 4- HEIGHT /d I RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS PROPERTY SURVEY REQUIRED FOR ALL NEW o ELECTRICAL AMP SERVICE o Progress Energy ./ o BUILDING $ o PLUMBING o MECHANICAL $ 7;.rcJd , .LE- o GAS o ROOFING o SPECIALTY o OTHER VALUATION OF MECHANCIAL INSTALLATION I (i;j/~ i ot- ~0:~ DOTH~ ll(.~ IS PROJECT IN FLOOD ZONE AREAO YES 0 NO o STEEL TYPE OF CONSTRUCTION: tt BLOCK o FRAME FINISHED FLOOR ELEVATIONS ELECTRIC BUILDER fi ___> COMPANyJ'dh.<1 I.. . r-~,';lA {It! ,.,.('~ ~~rc SIGNATURE (~-/ ~ STATE CERT OR REGIST # ege {}S"7SI P ~ ****************************************************************** COMPANY :;:::;-;:r~f CJ4.~ .a ~c61 ~ STATE CERT OR REGIST # Ec ~5.?n SIGNATURE ************************************************** PLUMBER c~t:-~ COMPANY (?~~ If~ JlLtI~h6 STATE CERT OR REGIST # (I rc Ie;:< 6 ~ 8'"2 SIGNATURE SIGNATURE ********************************************i:;~************. *****/ /) i/ Af " .. COMPANY tt5....J ..u 5 .or /'12/1., ~~ ~ ./// C/, STATE CERT OR REGIST # / go:( MECHANICAL **************************************************** OTHER COMPANY SIGNATURE STATE CERT OR REGIST # 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, 813-780-0020. 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 indica~ion 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 corrunencement. 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. Appli~ation is hereby made to obtain a permit to do work and installation as indicated. I certify that no work or installation has corrunenced 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 corrunenced 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 corrunenced. 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 $2,50 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT". / O~ //~ rr;;: . A ~~.. IGNATURE: CONTRACTOR---- STATE OF FLORIDA COUNTY OF The foregoing instrument waft a~fnowledged Before me this ~day. of pi-I , 20 0'7 by .r oj-v'l. 1- 51''''''' , -+ 'L (name of person acknowledged) [1ho is personally known to me, or ftt-who has produced ~ L (type of identification) Diid not tak ~ ~"'l.5C-O OWNER OR STATE OF FLORIDA!"'\A COUNTY OF "'-"..-SCO The foregoing instrument was acknowledged Befo~ JIle this ~ day pf A-r" ) , 20~ by ....r ~ ^- L 5r-.- I -H. (name of person acknowledged) owho is personally known to me, or tB:who has produced b L (type of identification) and wnoO did l6did not take an oath. Name "-\~, ,:.,J L. S~ \l)~ (Ji'CJ'. i i~C [. ? 'Y.C)j I Ki eJ L~ ru). ~~, c{"it c.i- I-kDOtfi~"'-l . e"J .."'\ i' " Square Feet ~ uLi "Donar Amount 5 ~.. t:::.::> 'Valuation Building Electrical Plumbing Cfq) C Mechanical ~D ,0<:" ~i)D~ LD.0 Connection Fees Sewer Water Meter 3 ~SS:~ 6 I ~ b:;-< 7C- I'~ 0.~~~ School Impact Fee I\l /0 . ~ Transportation Impact Fee 5;C{.3' 3 y... l,"'" ......., \,'D(Jo.""v Park Impact Fee r.j j fl , ~ h (l.f.... fA...~F>c-'1i::N : j 75, ,","0 t< Z ,0 - ~._ P~blic S~fe!~}mpact Fe.e j. \4'_.. t io J;, .,(.2- t -:::.- .-;:::- 3.-~.;J .. .::>-.; .- ~ 7 ~ ..:,~~. I. :;;.-):= '701. ~ ~ 3 lie ' ~ r~ COMMERCIAL CHECKLIST FOR NEW CONTRUCTION PERMITTING CITY OF ZEPHYRHILLS ~S. ite pJ.;Review req1,1irements satisfied &, appro oved - R>. 0J~~ () UiO ~te: -~'-t)'1 /7/cb.;/ ~~d!Jt Y;/,~~ -#"~?-~ /I-II-O~ V" Notice ox Commencement certixied copy ~ ~~J.j.cation completed in its ENTIRETY. ~. Check ix contractor & subs are currentJ.y registered. _J~:::::'/F1.orida Energy Efxiciency Form compJ.eted. ~.. THREE SETS of Engineered BuiJ.dingPrints with EJ.ectricaJ., PJ.umbing and MechanicaJ. diagrams. ~IX Business CJ.assuication is State ReguJ.ated, approval must be on engineered building prints. JJ1l. CITY R-O-W Use Permit, if applicable. JJll Pasco County R-O-W Permit, if applicable. ~ Department of Transportation R-O-W Permit, if applicable ~ Southwest Water Management Permit Enviromental Permit fromDEP Elevation Certixicate, if applicable. ~~erifY Water & Sewer Service. Sewer & Water Connection Fees & Water Meter fee paid prior to or at time of permit issuance. Transportation Impact fees may be paid 25% at time of permit issuance, with 75% of balance due prior to C.O. Pasco County Resource Fee must be paid prior to issuance of Certificate of Occupancy. Public Safety Impact Fees may be paid prior to C.O. ***** SEE ATTACHMENT REGARDING CERTIFICATE OF OCCUPANCY CHECKLIST. CERTIFICATE OF OCCUPANCY CHECKLIST FOR COMMERCIAL PERMITS CITY OF ZEPHYRHILLS, FLORIDA The following items need to be verified before a C.O. is issued. · VERIFY THE FOLLOWING FEES HAVE BEEN PAID: · Public Safety Impact Fees · Transportation Impact Fees · Miscellaneous Fees · Pasco County Resource Fee · VERIFY THE FOLLOWING HAVE BEEN RECEIVED: · DEPT. OF TRANSPORTATION APPROVAL · PASCO COUNTY R-O-W APPROVAL · SOUTHWEST WATER MANAGEMENT PERMIT ~/!s.1 01<. 1--i!-{):J ~ · ENVIROMENTAL PERMIT FROM DEP & · SEALED LETTER OF APPROVAL FROM ENGINEER OF RECORD · DEPARTMENT HEADS SIGNATURE ON DEVELOPMENTAL ORDER Return To: LEONARD.H. BAIRD,JR. .~ . AU,ome, at Law ,,' Jt:l.: r:-o, Draw~r12106lS. .,."" n .J ;i-tnnont, FL 34712.1066 'tn. ' 111111111111111111111111111111111111111111111111111111111111 2005036181 )f / , Rcpt.: 859461 Rec: 18.150 DS' 0 00 IT: 0.00 . . opty Clerk 02128/015 JED PITT"AN. PASCO COUNTY CLERK 02/28/05 02:~ 1 ~'2~ OR BK 624ti PG ~ 1 THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property and in accordance with Chapter 713 of the Florida Statutes, the following infonnation is provided in this NOTICE OF COMMENCEMENT: STATE OF FLORIDA COUNTY OF Lake .--NOTICE OF COMMENCEMENT DESCRIPTION OF PROPERTY: See Exhibit "A" attached hereto and made a part hereof GENERAL LOCATION OF IMPROVEMENTS: 6340 Fort King Road, Zephyrhills, FL 33541 GENERAL DESCRIPTION OF IMPROVEMENTS: Renovate office building OWNER: ELIZABETIi A. JOHN; MARY C, JOHN; TIiOMAS A. JOHN; ROBERT A. JOHN, EACH AS TO AN UNDIVIDED ONE-FOURTH (1/4) INTEREST, 6340 Fort King Road, ZephyrhiIls, FL 33541 OWNER'S INTEREST IN SITE OF THE IMPROVEMENTS: Fee Simple CONTRACTOR: lohn L, Smith Construction, Inc" 4240 Coats Road, ZephyrhiIls, FL 33541 SURETY: None NAME AND ADDRESS OF ANY PERSON MAKING A LOAN FOR THE CONSTRUCTION OF IMPROVEMENTS: Public Bank P.O. Box 38 200 East Broad Street Groveland, FL 34736 NAME OF PERSONS WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM NOTICES OR OTHER DOCUMENTS MAY BE SERVED AS PROVIDED BY SECTION 713.13(1)(8)(7), FLORIDA STATUTES: K. T, lohn, 6340 Fort King Road, Zephyrhills, FL 33541 IN ADDITION TO ITSELF, OWNER DESIGNATES THE FOLLOWING PERSONS TO RECEIVE A COpy OF LIENOR'S NOTICE AS PROVIDED BY SECTION 713.13(1)(8)(7), FLORIDA STATUTES: Tom Mioducki P.O, Box 38 200 East Broad Street Grove~d,FL 34736 1 I EXPIRATION DATE OF THIS NOTICE OF COMMENCEMENT IS FEBRUARY 19, 2007 ~j.4^- 6340 Fort . Road, Zephyr 'lis, FL 33541 ~ 6340 Fort King Zephyrhills, FL 33541 Thomas A John 6340 Fort King Road, Zephyrhills. FL 33541 n(} STATE OF FLORIDA COUNTY OF Lake The foregoing instrument was acknowledged before me this 19th day of February, 2005 by Mary C. lohn, Elizabeth A. lohn, Robert A. lohn and Thomas A. John, who are personally known to me or who have produced their Driver's Licenses as identification and who did taklcJlJlXlSlthc: not take an oath. My Commission Expires: Prin~N~ Commission nns INSTRUMENT PREPARED BY: Public: Bank 2500 )31b Street II Sl Cloud, Florida (407) 892-7137 Jenny Ramsey . . . I" . ... t:- OR BK 6246 PG 922 2 of 2 '.! EXJtIBIT "A" ,. .PARCEL 4: Being a portion of Lot 2, LITTLE. ACRES, as recorded in Plat B09k 5, page 132, Public Records of Pasco County, Florida, and that portion ot Tract 79, ZE~HYRHILLS COLONY COMPANY LANDS, as recorded in Plat Book 1, page 55, Public Records of Pasco County, formerly occupied by the now abandoned Seaboard Airline . Railroad, lying East of Fort.King Road ahd being further described as follows: Commencing at the Ea$t quarter corner of Section 3, Township 26 South~ Range 21 East, Pasco .County, . Florida, run West along the East-West center line of said Section 3, 467.35 feet (record .461.04 feet measured),.thence run South 433.7 feet for a. Point of Beginni~g, thence continue South 101. 30 .1 feet to the South line of Lot 2 of said LITTLE ACRES, thence run West along the South iine of sa.id Lot 2, 192_.~ feet to the East Right of Way lIne of Fort KIng Road,. thence. run North ~.5. 40.' 30" West 201.16 feet along ~aid Right ot way lIne, . thence East, 279.66 feet to the Point of Beginning; AND Being a portIon of Lot 2, LITTLE AC~ES, as recorded in Plat Book 5, page 132, Public Records of. Pasco County, and that portion of Tract ~6, ZEPHYRHILLS COLONY. COMPANY LANDS, as recorded in Plat Book 1, page 55, Public Records of Pasco County, tormerly occupied by the now abandoned Seaboard 'Airline.Railroad, lying East of Fort King Road and being further described as followos Commencing at the East quarter corner of Section 3, Township 26 South, Range 21 East~ Pasco County~ Florida, run West along the East-West. center line of said .Section 3,467.35 feot (record 461.04 feet measured), thence run South 15 feet to. the South rIght of way line of Founta~n Road, also known as County Road No. 54, said right of w~y line being the North boundary line of said LITTLE ACRES, for a Point. of.Beginning, then~e continue South 218.7Q feet, thence run West 250.0 feet, thence run North 218.70 ,feet to the South right of way line of Fountain Road, also known as County Road No. .54, thence run East 250.0 feet along said right of way line to the Point of.Beginning; tESS AND EXCEPT the No~th 10 feet thereof. . (Par~el..2) 1 AND Being a portion of Lot 2, LITTLE ACRES, as recorded in Plat Book 5, page 132, Public Records of Pasco County, and that portion of Tracts 66 and 79, ZEPHYRHILLS COLONY COMPANY LANDS, aa recorded in Plat Book 1,. page 55, Public Records of .pasco County, formerly occupied by ,the now. abandoned Seaboard Airline Rai1road, lying East of Fort King Road and.~eing further described as.follows: Commencing at the East quarter corner of Section 3, Township 26 .(' South, Range 2.1 Eaot, Pas.co County, Florida, run West along the East-West center line of said Section 3, 467.35 teet (record 461.04 feet measured), thence run South 233.7 .feet for a POINT OF BEGINNING; thence continue Soutb 200.0 feet, thence run West 279.66 feet to the East right of way lIne of Fort King Road, thence run North 25.40'30'; West, 221.91 feet along said. right of way line .of Fort King Road, thence run East 375.01 feet to the . Point of BeginnJ.ng. (parcel 3)". SUBJECT TO easements, restrictiono and reservations of record. r City of Zephyrhills Water and Sewer Impact Fee Calculation Land Use Type: Doctor or Dentist Office No. of Practitioners No. of Employees per 8hr Shift Impact Fees Within City Limits $ 865.70 $ 2,150.83 $ 1,204.55 $ 4,221.07 Water Distribution System Wastewater Collection System Wastewater Treatment Plant Capacity TOTAL Outside City Limits $ 1,082.64 $ 2,688.02 $ 1,504.13 $ 5,274.79 r-- I (] ~ (] in n n ;' 1 05763 n (") (] <" PERFORMANCE BUSINESS PRODUCTS. INC. 813-719-8008 FAX 813-719-79111 CITY OF ZEPHVRHI~ 2. ("3 T ZEPHVRHILLS, FLORIDA WATER ACCT. NO. DATE '-4;' f.{ (oS" OWNER/ RENTER ~h.V\ S VV\.\~ ~,MC. / r:2 5""0 fYf)~ 1?dJ, ftr-4///1/ // 33SC//" SERVICE ADDRESS 3'{ 0 F OR.T K (~0, R~, MAILING SHUT OFF SERVICE 0 TURN ON SERVICE ~ INSTALL METER [J/' READ METER 0 CHECK METER 0 OTHER 0 ~ATER o SEWER o GARBAGE ~N CITY o OUT CITY L No. OF UNITS - DEPOSIT AMOUNT %/'- W~~ - AMOUNT LAST BIll _DATE - MISC. CHARGE WORK COMPLETED BY & DATE COMPLETED ORDER TAKEN BY Retain white form in office at all times. Send pink & yellow forms to Water Serv. Dept. Water Service Dept. to sign yellow form & return to office. Li -I ({ - 0 s K-t ORDER GIVEN BY ~ --?~