HomeMy WebLinkAbout05-4398
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
4398
Permit Number: 4398 Issued: 6/09 2005
Permit Type: NEW SINGLE FAMILY DWELLING
Class of Work: 1 01-NEW CONSTlSFR
Proposed Use: SINGLE FAMILY RESIDENTIAL
Sq, Feet: Est, Value:
Cost: 160,800,00 Total Fees: 3,657.68
Amount Paid: 3,657,68 Date Paid: 6/09/2005
Name: YMAN CON
Addr: 36413 S,R. 54 WEST
ZEPHYRHILLS, FL 33541
Phone: 813 782-0825 Lic:
Work Desc: NEW SINGLE FAMILY DWELLING
Address: 6941 NORTH LAK DR
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: SILVER OAKS
Parcel Number: 03-26-21-0180-00000-0660
ROBERT & LINDA A KLlN
6941 NORTH LAKE DR
ZEPHYRHILLS, FL. 33542
Phone:
L
WATER CONNECTION RESIDENl
WATER METER RES 3/4"
419.00 MECHANICAL FEE
180.00 RADON
1,
94.32 BUILDING FEE
32.16
1,054.50
~\DV
(,~ ~~ ~
r R
Ifr ~J;-n
~~1,~
~ .
D
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.
REINSPECTION 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."
NO OCCUPANCY BEFORE C.O.
~-.
S SIGN URE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Ryman Const.
Lot #66
North Lake Dr.
SQ, FEET PRICE
MAIN OR LIVING: 3,216 $ 50.00
OTHER AREA UNDER ROOF: $ 50.00
OTHER: $ -
VALUATION $ 160,800,00
FEE SHEET $ 663,00
ADDRESS $ 30.00
DRIVEWAY $ 30.00
BUILDING: $ 1,054.50
CREDIT: $ -
BUILDING LESS CREDIT: $ 1,054.50
ELECTRICAL: $ 144.70
PLUMBING: $ 117.00
MECHANICAL: $ 94.32
SUB-TOTAL $ 1,410,52
RADON: $ 32.16
TOTAL $ 1,442,68
SEWER: $ 1,616,00
WATER: $ 419.00
IRRIGATION: $ -
TOTAL: $ 2,035,00
WATER METER:I $
IRRIGATION METER $
180~00 I
SUB-TOTAL $
3,657.68 I
769.56 ~
PARK IMPACT FEES I $
PUBLIC SAFETY IMPACT FEES
POLICE $ 254,00
FIRE $ 273.00
5% $ 26.35
SIF'S: $ 1,694.00
97.5% $ 1,651.65
2.5% $ 42.35
TIF'S'I$
99% $
1% $
: I
TOTAL: $
6,674,59 I
0\\
. \J'
~\
n
(1
n
(1
n
n
105763
n n
~
~
~
PERFORMANCE BUSINESS PRODUCTS, INC. 813-719-8008 FAX 813-719-7919
CITY OF ZEPHYRHILLS
ZEPHYR HILLS, FLORIDA
5-'i~09
I
WATER ACCT. NO.
DATE
0/;105
,
OWNER/
RENTER
~~
~, ,~C""
,
MAILING
:'SJ2-e
~ IJ>>Jf> .
~ 9Lf( rJ~ ~ dr,
,LoT??
SERVICE ADDRESS
SHUT OFF SERVICE
o
[J/'"
Q-/'
VWATER
TURN ON SERVICE
o SEWER
INSTALL METER
o GARBAGE
READ METER
o
GJ...1N CITY
CHECK METER
o
o OUT CITY
!
_ No. OF UNITS
OTHER
o
. (
_ DEPOSIT AMOUNT
- AMOUNT LAST BIU
3 fr II
uJ;:ifr ~
_ DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
f-t -7' - ~:) /::.f
~
Retain white form in office at all times.
Send pink & yellow forms to Water Service Oept.
Water Service Oept. to sign yellow form & return to office.
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8TH St, Zephyrhills, FL 33542
813-780-0020 FAX: 813-780-0021
DATE RECE IVED
~7/o$-
I /
PHONE CONTACT FOR PERMITTING
~I n:J4.. Ad< I; t'l
N.~r:d) !-k dJr .
LEGAL DESCRIPTION: LOT (S) (i)Coro 0 BLOCK CD~
PARCEL 10 # 03 -c;;<,/O-OU.- DI!YO -Of.Xr:D - 0&>00
OWNER'S NAME'RO be,.,-..+- c:::i
Joj/jjJss . ~~
PHONE IS f3--- 7 &'c2 --f.) rd..$'
SUBDIVISION
Ol,ft)
(OBTAIN FROM PROPERTY TAX NOTICE)
WORK PROPSED: ~W CONSTRUCTION
o SIGN
PROPOSED USE:~AMILY DWELLING
o COMMERCIAL
o ADDITION
DALTERATION
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
DMULTI - FAMILY
o INDUSTRIAL
0# OF UNITS
o SWIMMING POOL
o MOBILE HOME
DOTHER
~ILDING
~ECTRICAL
o RESTAURANT & HEALTH DEPARTM~NT. APML ~ ....
DESCRIPTION OF WORK -.D 'P1A-\.s:.l rLez I~ 4~L ~l ~e.( (d~~
BUILDING SIZE '70 X LI::;./I/-4' SQUARE FOOTAGE ~/to 1bt:ftJ.... HEIGHT /,f/'-/.f
. .~ 0 ..s: -f-to r-i.1
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 REQUIRED, . ~ ~
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION, DC ot:. v
JJ )l2$7":;;1)i\.F-J1
PERMITS REQUESTED
$c:X'OO (l}f) f)ZJ VALUATION OF TOTAL CONSTRUCTION
cXQ D AMP SERVICE 0 Progress Energy D
W.R,E,C,
VPLUMBING
PM'ECHANICAL
D GAS ~FING
$ ~500Dc)
VALUATION OF MECHANCIAL INSTALLATION
D SPECIALTY
D OTHER
TYPE OF CONSTRUCTION: D BLOCK
D FRAME
D STEEL
D OTHER
FINISHED FLOOR ELEVATIONS
IS PROJECT IN FLOOD ZONE AREAD YES D NO
SIGNATURE,
~~~.H.:~:~:.~:~~.~~.~:~~:~.:.:::..?:~5 /51
BUILDER
EI&CTnC'ANb~~;U
SIGNATURE' .
COMPANYf'\\cu--H t'\.., C-I~LL
STATE CERT OR REGIST # e-L.- J3()eJ /3((3
PLUMBER ....................:....::.......:::::::.~;:~;~~~~~:~~/~
SIGNATURE ~ ~~ STATE CERT OR REGIST * c:.-FC.. J<I:(~4>{).:L
************ ***************************~-*. ********~** * 11*** ,
MECHANICAL / _ COMPANY -......:::L)' VI.. ..g ~ <\.
SIGNATURE p~ STATE CERT OR REGIST # R m fC}{)
OTHER
******************:~**********~********* .;1(
COMPAN~ ~"'f-rLl~ O(,)V\lL
STATE CERT OR REGIST # ~ J3:25505
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 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
0, 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,
Appli~ation 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 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 NE 0 TO RECORD AND POST A "NOTICE OF COMMENCEM
STATE OF FLORIDA
COUNTY OF
The foregoing inst~ent wa~~~n~wledged .
Befor~ m1 th~S~9-c;.Y of_ ~ ' 20 l~
by ~9b.')A. ~ ~ I <':1 ~ <r'
(name of person acknowledged)
~o is personally known to me, or
..--
of identification)
take an oath,
f person taking acknowledgment
-' Kevin Ryman
r.J'... My Commillion 00127426
~,~,2IIlIX' stamped
Name
Name
"
TRANSACTION REPORT
JUN/08/2005/WED 11:19 AM
P.01/01
RECEIVER
817278157000
TYPE/NOTE
OK
FILE
SG3 12B4
5335 - BUt St,
ZephyrhlUs, FL 33542
City of Zephyrhills
Building Department
Fax
To: JUDY From: KIl1Y
Fax: 727-815-7000 Pales: 1
Phone: Date: 6/812005
Re: ADDRESS CC:
D Urg.nt X For RevIew o PIea8e Comment PI... Reply o Please Reeycle
PARCEL 10#03-26-21-0180-00000-0660 NORTH LAKE DR
~~L.rIC1..' ....t"'....L.f'...:.~;.'_... ..-....\,... _....J..:::....:: ;...~-~~....~~"'~i.-.. '.....n.
;;;;;;;~;;;~;~;~;~~~~~:~:::::~i
Ii:
~~~~qt~~~q;~i~;~~~~q;~~~~~~~;~E
~~~~~~~~~:~~~~:~~~~~~~~~~~~~~~!
iltiiiit;~lil~i~~~~~==:ai8i~~:~
~=~~~~~~~8~88~8gg8ggggg~ggggg8i
-- -
~~~~:~~:~;==:;~~;~~;~~~;~~~;;;~
F~~Z~~e;;;~~~~~o~_.~~.~.~~7~:~1
~~~~~~~~~~~~t.~sel~~~~'#~~t~:~~
~~~~~~;t=~a~.~t~o~~x=~~~~:~jrri
~~~~~~~~~e:!~~~~e~egot~~~~~~~~o
~Z..~.ZZZZZ_~_~______~_~..~.z.1
~~~~~~~~~:~~~~~~~~~~2~~~~~~~~~=
~~~~~~~~~~~~~...~~~-~~~~~~~~~~~,
~~:53~5~S~~~:~;~:::~~~~~~~~~~:i
r..,....rrrr-rrr..
.~;=;~~=~O.~~~~w~ ~
uu.z~zzzz..~_~~zz,
~~"~'~~;~~,.~~;~~i
~~~~~~~~~~~~~~~~~~i
===tD=~==a2tt2~~t~
~~~~~~...._-~.~..-
o
~-tt~~~=~.~~=g~*~~g~
~~~~~~~~~~~~~=~=~tS
~
.,
i
en
:r
"'
"'
...,
""
:gt~~
C:l'T'Il'T'I-t
Z "'_
o~m~
z"'f
....~-<
xn..
"'0,.,
'"
""..
~~~
-o~
""'-
o
"'_z
~!~
i~",
0..,.,
"""
..~
~...~
'i!iS
;;....~
n"'"
0-<-.
ia:s
Z :::l'T'I....
o
o
"TI
'"
.J80ra
r ~
~i~
iljZ
i:
I
9I~
i~1
!@
i
"m
em
;;>
..r-
jr
'i: .~
~.. .
~; E~ \ .....
~ o'__fi --;t . (0)
1II ~~ fl
...
~ ~
::: 8
</
rl
J
L. :::d.
5 3S-46-Sg-E
.."
....
~"'~
~:I
::e
~~~
f".
z.~
~~z
i~i
"'~..
:S~
!oS
~~i
~f~
li'
~~
.;
- '"
o
0.... --t
"ftim m
1: ;, ID
!lai
~ii
.~z
~~M
2~~
~,:z:
:fi;i
~i!:
.~.
. g
!I
i.
~I
.~
~
;--,
I
--1
=8 I
CII .-o~
GlI "il~ ~~. . I
: 5 ~ t
~~...-
~~
.'..;....iJi~it,.
!'.,.." ~.:.. ".' .." ;..,......~ .~
LIlf....
.....~-::.tl:- ::r."
~
~ :
01
!f
r;
~
~
~~F
il
<>
.f~
Ii
=
01
.....
'"
~
~
..
..
,., 00'
t,.. 7406'
..
<>
, .
In w'
01
(0)
~
, ,.
s .So", SO"I' I NIt I I
" ;;
.....
. --,/.
-1;;
221.13'
~
'.
....
I.
f - ii!
:: ~ ~,;
~ ~ p
-.,..
is L-.,. a7 .OJ'
/1 ~ J~
,. : i=. ~ I 010
. : l:r 1.!Qh"
- ", I" I '"
II.' ; l!~ t
=" I"~ '
-,
75.00'
st...,
" ... 7 ..~ " 00'
.. " ~= "
~8 ~? .. "
" .; ClD ~ CD
'"
"
01
o
'"
, ...
,S ""2'38"~
j I I I riu
Ie:: ~. e: .1ft
I"........ ..J .T "L'" ...1. ....... _ I
f I't....t &Oak :5.. 'MJ($ 15D " .'" ~ ___ ,.,-
---L__L.
STEPHEN' 8 PATH
<
In
. ?
'.-..;r:.
.~-.}~ . ~ -...." ....,--.
. ~ .~ . ;.....~.
" )
x)
........:.~..~.:~ ':":'u~r~-.- . h.:......~.
. . O~~?i;;;!~ ,..
:~!,,~-.OI! =
. . ...",.". z
"
~ ~
i 0
.. m
.
:> ~
.. 0
D ! ~
n ~
-
~
~
'"
0>
(lO
-N
ia
ii~.'.
~i t
(lO i /
-/
/
//
." ,..
.....:""""'"f
i
en
-I
m
"'tJ
:J:
m
Z
en
)> Ci)
-ien r-
OC
::elD m
ZO
~S z '-"~
;;~ \;
",0 f'-
o>Z )> r"
(1)0 -f ~;
0" ~ .
~)> f:
.t'
;r:" en ~.
~..
0 .'
;0;0 P:'
)>-i r.
r..
Z- r- t.
C)O
".,2 < f
1\;>0
-" m f"
~(
1Tl-i :D . .
)>::t: ~
enlTl ?-
~Z t:
0 0 ~~.
,,;0 .,
)>-i )> .,
en::t: f'
()::E "
o/TI t
en I
()-i en t.
0 f'
c- I
I
z...... '.
_ ,-t. t.
:<0
" -0
"en
'm ::I:
o()
~-i )>
0- en
)>0 -0
Z r
VJ m .I>
-i
lD
-I 0
0
^
::I:
:D
m
m
..... ,...- -~..;.....
'".:.;.'
',"~'l'
Ma~ 26 05 11:lla
~
~
~.~
'~
7\--
{!J -
> ?
~ tf.S""
~ o.l!
\i)~
Q
"-
..
r
~
6;
. lU C,
I- :.1
".~ ::,i
(,) CJ
.'
R~man Homes
8137886773
p. 1
-
PLAT OF SURVEY
- {)/Ro-
~
F.lR I/B.
'iB811fJ
G01J CART PAm
IJJT68
,
.~
Cl
6. ~ 47"'20'07M
R = 35.00'
T = 15.34'
L = 28.92'
. THIS SURVEY NOT VALID
UNLESS EMBOSSED WITH A SEAL
THIS STAMP IS REO
..
;"/"C2
_., ._.---L::...=.20!28.~34~ .
. H'.'-if:;;- iifoo'
T = 13.55'
L = 26.80'
IBII! ~o\. FJJ
m:tru.._..:.a_'c!II"JIllI__
:=z= L-e-=-::,~,m:"f';:" DI
====-- -'-~~~~
IfT_ J'fL ......~ ~.1If__
Gill,.... -. .o.-..~_.-a.lIl' IV __
47z~I~'
BJ.l.L R. .B.RtJ>>i. .P..L3. #35~5
-. i-
R
Re(:ord I11d Return to:
~dWa \!tle Coq1pan>~ Inc.
~~ Olftce Box 23'37 \IT O'5~cHJ I 9~
Dado City, Florida 33526-2337
(m) 561.1241 Fax (352) 567-0457
I 1111/1 IIIIIIIW 11II1I1IIII11111111I111111I1111111111111I11
2005101719
?;:
J
NOTICE OF COMMENCEMENT
.<~-.
\,' \
r.) \\0\\Tax Folio No.
\\ !\.c, '0~ \) '<) llJlJl) D \ JED PITTMAN PASCO COUNTY CLERK
State of Florida Y. .. j .. \ OS/23/05 03: 29pm 1 of 2
County of PASCO r' _./~,;, OR BK 6383 PG 663
THE UNDERSIGNED hereby gives noti~;~~: will be made to certain real property, and in
accordance with Chapter' 713, Florida Statues, the following information is provided in this Notice of
Commencement.
Rcpt: 886843
OS: 0. 00
OS/23/05
Rec: 18.50
IT: 0 . 00
'--.-... Dpty Clerk
Permit No.
1. Description of Property (Legal Description):
SEE ATTACHED LEGAL
Street Address
6941 NORTH LAKE DRIVE, ZEPHYRHILLS, FL 33542
2. General description of improvement:
Single Family
3. Owner Information
a. Name and Address: ROBERT W ACKLIN and LINDA K ACKLIN
b. Interest in property: Fee Simple
c. Name and address of fee simple titleholder (if other than owner):
Same as owner above
4. Contractor (name and address): RYMAN CONSTRUCTION
36413 SR 54, ZEPHYRHILLS, FL 33541
5. Surety:
a. Name and Address:
b. Amount of Bond:
6. Lender:
R-G Crown Bank
105 Live Oaks Gardens, Casselberry, FL 32707
7. Persons within the State of Florida deSignated by Owner upon wh.om notices or other documents may
be served as provided by Section 713.13(1)(a)7 Florida Statues (name and address):
8. In addition to himself, Owner designates R-G Crown Bank. 105 Live Oaks Gardens. Casselberrv. FL
32707 to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b), Florida Statutes.
9. Expiration date of notice of commencement (the expiration date is 1 year from the date of recording
unless a different date is specified):
My commission expires:
s.;gnature of Owner . fl. I I!
--<~ A.QQ. tjt~ 1(~{JdJL 'J
tate and CountY,ijforesaid to
C\ ;;l. .
1= , T
~ ~ MY COMMISSION # DO 317354
"'1- Of l\~" EXPIRES: July 31 , 2008
1-800-3-NOT ARY FL Notary Discount Assoc. Co.
Notary Public
DOC #:552078 APPL #:0206006943
,,-"'--::::~1
. --'. '.....\
i"'"\\--;:::J 1'\ \:.,:;
I yr.\ 1 ,.:J U 1: ~
If'!'=> :ii.,:
~~ JUN 0 9 2005_~J
By _;-::..._---=:::::::;....-...
CB075
Exhibit A
OR BK 6383 PG 664
2 of 2
Lot 66, Stephens Glen at Silver Oaks Phase Three, according to the map or plat thereof as recorded in Plat Book 32,
Page(s) 54, Public Records of Pasco County, Florida.
Parcel Identification Number: 03-26-21-0180-00000-0660
..
File Number: 05-04-108
. . .. '. 'f: ~/ ".
t, ......-
STATE OF FLORIDA' " " (~
COUNTY OF PASCO '.' .,:
THIS IS TO CERT,\fY ~HAT THE FOREGOING IS:A
TRUE AND CORRECT COP-V df THE DOCUMENT ONFI~t'
OR OF PUBLIC RECORO~"Tki,S OFFICE WITNESS. MY,
HAND AN FFICtALSt~L'll;1lS~ DA" OF
"'2' .iJJ.r
JED PI MA~~~~~C~RCOIT COURT
BY ~ DEPUTY CLERK
DoubleTime<il
.......,,, "
~-
n ()
~
(1
(1 n n ('\ 0 n ~ c)
PERFORMANCE BUSINESS PRODUCTS. INC. 813-71$.8008 FAX 813-7111-79111
WATER ACCT. NO.
~-~ J ~\J
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
DATE '-..t -\9.-0(0
OWNER/
RENTER
R~ ~~.v-. (l (~-\-Y-. ) c:*-t Uv-..,
MAIUNG
SERVICE ADDRESS
{o'141
SHUT OFF SERVICE
o
~
~
TURN ON SERVICE
INSTALL METER
READ METER
o
CHECK METER
o
OTHER
o
Pe~ - J..tsq 1S'
314 II -:r:.v--v. ~
WORK COMPLETED BY
& DATE COMPLETED
la.lU-
~~.k~ 1::x Lot fR(,p
~TER
o SEWER
o GARBAGE
~N CITY
o OUT CITY
+ No. OF UNITS
- DEPOSIT AMOUNT
- AMOUNT lAST BIll
_DATE
_ MISC. CHARGE
ORDER TAKEN BY
Retain white form in office at all times.
Send pink & yellow forms to Water Service Dept.
Water Service Dept. to sign yellow form & return to office.
.. C.";'..!'f'j;;'.."".! I:'C'J:',;.u" .......(. '.' :'. I'U
;":;:,:'1..,,:..
! ;
l...i, ..l ~ ,} I Y
.i..l.)(':
C) ~",.} ~ T< ,..':j": ~::: 1< y-" I" ,: ')'1 ,/.":) ()
"'iF::::.:~ '.<\"i''('i('':i'.',~ (..'C)i""...!:::~;";"
f'<' "1':;\,,' ~~ (:':/~.::......!. J r,!,. :;;':.:'r~; ~,",(':lt:::E:: J);::.'
J ::
; .l. L. . ~::~
>.: :,;,:.: ~,~.:,; /_;, :~"O::
.::',;. iI.,' .
i,.;J 1 'i~:::' "f' t:..
f -j l.t',
(2)2A/r\.-J (;3 9 ~iH
..1....;.: ,.
C', iJ () ; r<(:~ c:: 'r c; h: ~~ ',.:) !.") :L (.) () (;
''['(J'J'r:':.it.,.
('1 iyi f:) i.,'! j'..) 'Y' ;;
,.~'.; :..:.... ,,:':.) ..:',~,
(:j t.::: (.:: i.....~ 'r
~:CJr''''':F'(.':''"(
(:.~ c: I.... CJi..Jf') 'j'
..:.. ()1T L.'
(: r.(~ (.J tj(..~ 'r
":.!'::..:" (,..:..!.
')(.')!:'-H")~")(")i: C'C'': I)) ii!,'::-.'... 're ;:.
1::'C'
;..i..
. . ..::.~,
'f:.; ,.:-.:. ~:.,,~. ,I
'. '. . I I p...'
r ": [ C. L r i.n ..C' .i3 "(
G2~. .
..................--.,... ".' .
. '. ,-- .
,'....,
nCL
'...'1 '
.,. ... -. , .
.",',.. "
,~'u '...' ..,-., ',..' :._.'
i
.i
i':i::,!, !.
)) I::: H C ::~ I !'r I U ;'.1./ ,. >.. ':.' "ij ,
f.j: ;: .,
'!::":o L'
, ." . L,
.0;:\ {(';
; ',i..' .'
l.. -'I. ;.~