HomeMy WebLinkAbout05-5095
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CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5795
Permit Number: 5795
Permit Type: COMMERCIAL
Class of Work: FIRE ALARM SYS EM
Proposed Use: COMMERCIAL
Square Feet:
Est. Value:
Improv. Cost: 6,500.00
Date Issued: 5/22/2006
Total Fees: 125.00
Amount Paid: 125.00
Date Paid: 5/22/2006
Work Desc: INSTALL FIRE ALA
Address: 6733 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 03-26-21-0010-03200-0020
Name: MAHOOTCHI, AHAD (MD)
Address: 6733 GALL BLVD
ZEPHYRHILLS, FL. 33542
Phone:
MASTER PERMIT 5074
ALL PHASE ELECTRIC & MAINTENANCE
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DUCTS INSULATED
WATER
FIRE DEPT. FINAL
H
ELECTRICAL FINAL
REINSPECTION FEES: Reinspection t1 s will comply with Florida Statute 553.80 (2)( c) when extra inspection
trips are necessary due to anyone of e following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or c~rrections not made when inspections called d) work not ready for
inspection when called e) permit not ~sted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements f ~his permit, there may be additional restrictions applicable to this property that
may be found in the public records of this cjJunty, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be m e before any further permits will be issued to the person owning same
"Warning to owner: Your failure to rd a notice of commencement may result in your paying twice for
improvements to your property. If y intend to obtain financing, consult with your lender or an attorney
before recording your notice of com e. cement."
OCCUPANCY BEFORE C.O.
I ~~
PERM IT OFFI
~PECTION - 8 HOUR NOTICE REQUIRED -
OTECT CARD FROM WEATHER
CONTRACTOR SIGNATURE
CALL FOR I
P
I'lltl
P.Ol/Ol
T~ANSACTION REPORT
DEC/22/2006/FRI 02:27 PM
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PREPARED BY:
11111111111111111111111111'"1111111/1111111111111111111 1111
2E1e5.2.3~5~5 ' ,,1 ..
RGpt: 941103 Rec: ie.51
DS: e.11 IT: '.Ie
~lIIS!.~ .. . . ; ~pty Clerk
JED piTj"AN~ PASCO C9UNTY CLERK
11/0S/0!5 J." 116.18 1. 0'.J.
OR BI< ,6,,86 PO 13~!5
REC
97886773
TYPE/NOTE
OK
tlliE
G3 3932
. ..,.....~. M. ....... ..... .~._._..._._..__....
t
IT it 5'0'74-
Leonard H. Johnson, Esqu' e V ks
Johnson, Auvil, Brock & 11/;00, P.A
Post Office Box 2337
Dade City, FL 33526-2337
RErURN.TO:
Clereen Brunty
Sun Trost Bank:
5435 Gall Boulevard
Zq>hyrhills, FL 33542
fD)~@~DUJ~~,
W NOV 11 Z005 W
,
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~OTlCE OF COMMENCEMENT
By
THE UNDERSIGNE ereby gives notice that improvements will be made to' certain real
property, and in accordance . Chapter 713, Florida Statutf'A\ the following information is
provided in this Notice of Co encement.
1.
The South ~ of Tract 32~ lying E~t of the
Seaboard Airline Railroad right-of-waYt: in
Section 3, ToWDShip 26 South, Range 2l
East, as said tract js ,numbered and $pwn
on the plat of ZEPHnmLLS COLONY
COMPANY LANDS, recorded in Plat :
Book 2, Page 6, Public Records of Pasco
County, Florida.
Description of Pro
2.
Construction of surgery center.
3.
Owner Information:
a. Name and Ad dss:
FlNA Real Estate Investments LLC
6739 Gall Boulevard
Zephyrhills, FL 33542
b.
Interest in prop
Fee Simple
1. McLaughlin & Company, Inc.
3019 SW 27rh Ave., Suite 102
Ocala, FL 34474
N/A
4.
Contractor:
(Name and Address)
5.
Surety:
a. Name and Ad
b. Amount ofBo
c
T _.:I_T_C___...;__.
C.._T_.^"- 'D";'_1~.... Toft^
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CITY O~ ZEPHYRHILLS PERMIT APPLICATION
BUILDING ~EPARTMENT 5335 8TH St, Zephyrhills, FL 33542
. 813-780-0020 FAX: 813-780-0021
JOB ADDRESS
DATE RECEIVED
"'DtIJ\O (2U.~~-L,
PHONE CONTACT FOR PERMITTING 35l. .Z(pf&, . '~I~
PLa2.;~
LEGAL DESCRIPTION: LOT(S)
BLOCK
SUBDIVISION
PARCEL ID #
03
~
zt.e
D::::::> \ D 03200 coZo
WORK PROPSED:
CONSTRUCTION
o ADDITION
DALTERATION
o REPAIR
D INSTALL
D SIGN
DMOVE
D DEMOLISH
PROPOSED USE: ~ FAMILY
COMMERCIAL
BUILDING SIZE
DR
~
S-
DMULTI-FAMILY
D INDUSTRIAL
D# OF UNITS
D SWIMMING POOL
D MOBILE HOME
o OTHER
& HEALTH DEPARTMENT APPROVAL
SQUARE FOOTAGE Sl f.c1)
" ~~.
I "
21-(P bF'F
DESCRIPTION OF WORK
HEIGHT
~UILDING
ut' ELECTRICAL
01 PLUMBING
~MECHANICAL $
o GAS ~OOFING
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS &
COMMERCIAL: ATTACH (3) SETS ~F BUILDING PLANS & (1) SET ENERGY
IF SIGN PERMIT ONLY (2) SET 'OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY ~EQUIRED FOR ALL NEW CONSTRUCT
(1) SET ENERGY FORMS.
PERMITS REQUESTED
-if SO 1 if
ri
Progress Energy
D
W.R.E.C.
OTHER
VALUATION OF MECHANCIAL INSTALLATION
COM~UtJl1'f ?O~L... *
\'Z.D'2..:30 6~O b
~TEEL 0 OTHER .s.FF: ~: ~. -a~ .-=\ "Z.
F:E...M.~. -fLa::o~ X /
IS PROJECT IN FLOOD ZONE AREAD YES gNO
TYPE
FINISHED FLOOR ELEVATIONS
BUILDER
COM PAN
SIGNATURE
STATE CERT OR REGIST # CG:ll 0 \q, C€ I
ELECTRICI
r
*1* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** * * * ** * *** * * * * * *
I COMPANY ;}, \ V ~q~e- e.. J 4c-':'6
STATE CERT OR REGIST # €c..c.;>e>o 1,50
SIGNATURE
OTHER
PLUMBER
COMPANY Sodhern t'1 UlplN\-en+ Co rf
STATE CERT OR REGIST # eFco;l.q 735
SIGNATURE
SIGNATURE
******************************************* ~
COMPANY L [, 5 /# C C~7 fly/' "t'C1 I ) j V7 ( ,
- STATE CERT OR REGIST # C:/I1 C 05 t 12- /
~***********************************************
lW(./(vL
COMPANY D iL, b t> (J~~Cj ~
STATE CERT OR REGIST #
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictionsU which
may be more restrictive than City regulations. The undersigned assumes respon~ibility 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 pOftions of the "Contractor SectionsU 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 Guideu prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "ownerU, I cerify that I
have obtained a copy of the above described document and promise in good faith to deliver
it to the "ownerU 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 "AU or "A,etc.u, it is
understood that a drainage plan addressing a "compensating volumeu 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
$2,500 IN VALUE DO NO NEED TO RECORD AND ~ A "NOTICE OF COMMENCEMENTu.
~~\~ ~~
SIGNATURE: OWNER OR AGENT SIGNATURE: CONTRACTOR
Name typed, printed or stamped
STATE OF FLORIDA
COUNTY OF
The foregoing in~trument ~~cknowledged ,
Before me this ~day ~g~ , 20 f!j
by
(name of person acknowledged)
~ho is personally known to me, or
~hO has produced..1 ~z....- ~
(type of identification)
andwjP,1 Odid .,0d. id not take ~ o_ath
~'U-Zd1!:' /C~7/
Signature of pe taking acknowledgment
11-/;1 ;/ ZtJ 7/-J
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STATE OF FLORIDA
COUNTY OF
The foregoing in~trument wa~!cknowledged (__
Before me this.dL day of t!!fk.Pb2-', 200 ~
by
(name of person acknowledged)
~who is personally known to me, or
Il2(who has produced ..J[ &l.- k'
(type of identification)
and wJdLl did .. ~ did n~ t_ak~~. n. ~t?
/Lt-L-/L~L tf '..-- ~L t:ti
Signature of pers~ taking acknowledgement
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, printed or stamped
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Dortar Amount
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Valuation
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Building
Electrical
Plumbing 52<0; ~
P-ADo~
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Mechanical
7)
Sewer 2-,'"1>4' 2-- i W\ '
Water '1- 04 ~ , ~\c
Meter il .-;:-
J,LOa -., ~,f
-rUt I ) " rU;'~
_ j ;)'1~.S" I o'F..IJl' .-
tt~,~ -
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School Impact Fee
t'4/~
Park Impact Fee
6tbJ)IT
F--"")fi~ i,-
~8/.J 72-. bl M~)i~ - 3Cljbb<6,~1 (LtZ-~jL. -
( I~ l{o'l. "C> ~lrH- )
Transportation Impa t Fee
Public Safety Impact Fee
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ct.~.PrT }'d\- ~i)T j N l:r j~G.
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~ City of Zephyrhllls
Weter ,lid Sewer Impect Fee Celculetlon
Land Use Type: I
Doctor or Dentist Office
.of Practitioners
No. of ployees per 8hr Shift
Impact Fees
Within City Limits
$ 2,043.06
$ 5,075.95
$ 2,842.73
$ 9,961.74
Outside City Limits
$ 2,555.04
$ 6,343.72
$ 3,549.75
$ 12,448.51
I I:
City of Zephyrhllls
Water nd Sewer Impact Fe. Calculation
Land Use Type:
Retail
N . of Square Feet
Water Distribution Syste
Wastewater Collection S stem ~if\
Wastewater Treatment P . t Ca acit
TOTA
Impact Fees
Within City Limits
$ 1,070.51
$ 2,659.67
$ 1,489.52
$ 5,219.70
Outside City Limits
$ 1,338.78
$ 3,323.95
$ 1,859.98
$ 6,522.71
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5'5,
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J. McLauchin & Company
6739 Gall Blvd.
Same Day Surgery Center
SQ. FEET PRICE
MAIN OR LIVING: 8,175 $ 110.00
OTHER AF EA UNDER ROOF: $ 50.00
OTHER: 55,946 $ 0.85
VALUATION $ 946,804.10
FEE SHEET $ 2,574.00
ADDRESS $ -
DRIVEWAY $ -
BUILDING: $ 3,861.00
CREDIT: $ -
BUILDllIl LESS CREDIT: $ 3,861.00
ELECTRICAL: $ 431.30
PLUMBING: $ 526.50
I MECHANICAL: $ 432.00
SUB-TOTAL $ 5,250.80 /
RADON: $ 81.75 /'
TOTAL $ 5,332.55
,
SEWER: $ 1,353.21- Credit Given
WATER: $ 972.55- Sewer - $1,353.21
i IRRIGATION: $ - Water - $972.55
i TOTAL: $ 2,325.76
I
r VATER METER] $. I tr_ 250.00
IR I ATION METER $ - I
S fS-TOTAL $ 7,908.31
PA IMPACT FEEST $ - 1 ;Jl~
PUBll SAFETY IMPACT FEES
, POLICE $ -
. FIRE $ -
! 5% $ -
I TOTAL: $ -
I
r SIF'S: $ -
100.0% $ - rJlp'
1.0% $ -
TOTAL: $ -
TI F'S: $ 18,404.00 Credit Given
99% $ 18,219.96 $30,068.61
I 1% $ 184.04
,
TOTAL: $ 26,312.31
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PERFORMAN9E BUSINESS PRODUCTS. INC. 813-719-8008 FAX 813-710-7910
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
5 oN 5 Cfif '?
WATER ACCT. NO.
DATE lo;i7~.r
I
OWNER/
RENTER
:r Me L~~I,;" J- ~~
-;z 7ri. live. Sit:. /tJ.:(
ff. 3L/V7Y
,
G~ 0(vJ,
~R
/-0 T z.
30/9 S. w.
tJc_Je. I
SERVICE ADDRESS (r 7 3 3
MAILING
SHUT OFF SERVICE 0
TURN ON SERVICE ~
INSTALL METER ~
READ METER 0
CHECK METER 0
OTHER 0
o SEWER
o GARBAGE
~
o OUT CITY
-L No. OF UNITS
- DEPOSIT AMOUNT
I,
tJ$r ~
- AMOUNT LAST BILL
/
----
_DATE
_ MISC. CHARGE
WORK COMPLETED BY
& DATE COMPLETED
ORDER TAKEN BY
ain white form in office at all..ti1'A811,
pink & yellow forms to Water Service Dept.
tar Service Dept. to sign yellow form & return to office.
II
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
5095
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued: 11/01/2005
Total Fees: 175.00
Amount Paid: 175.00
Date Paid: 11/01/2005
Work Desc: PARK MODEL SE
5095
MOBILE HOME R IPARK
PARK MODEL SE -up
RV PARK !
I
Address: 3326 MALACHITE DR
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: EMERALD POINTE RV RESORT
Parcel Number:
L YN McC RKLE
3326 MALACHITE DR
ZEPHYRHILLS, FL. 33542
Phone:
,IN
GARY KOSMOS ELECTRICAL CONTRACT
PETERSON CONST & MH SET UP, INC
AIR WORKS LLC
FINAL
REINSPECTlON FEES: When extra in ion 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 wor resulting from faulty construction (c) Repairs or corrections not made when
inspection called (d) Work not ready for i ~pection when called
(e) Permit not posted on job site (f) Plan not at job site (g) Work not accessible
The payment of inspection fees shall be e before any further permits will be issued to the person owning same
"Warning to owner: Your failure to rd a notice of commencement may result in your paying twice for
improvements to your property. If y ~ intend to obtain financing, consult with your lender or an attorney
before recording your notice of com e cement."
Complete Plan ,!Specifications and Fee Must Accompany Application.
All work shall be 'rformed in accordance with City Codes and Ordinances
o OCCUPANCY BEFORE C.O.
~~
NTRACTOR SURE . PERM~
CALL FOR I $PECTION - 8 HOUR NOTICE REQUIRED
Pc!>TECT CARD FROM WEATHER
~f'
ALL WORK SHALL COMPLY WITH '
PREY AlLING CODES, FLORIDAB
CODE. NA TION1:L ELECTRIC CODE
CITY OFZI:P:'Y'
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OCT/25/2005/TUE 11:32 AM ZEPHY.. RHIui;,ILDII\t FAx ~~. ~J3-780-0.02r. .
ex" O. PHYIUIJ:UlB JnmKr'l" APP!.ICAT%OH
BU'nDtNG DE r 5335 8'" 8~, ZllPhydli1la, It. 313B42 'I' /; /.
1~-780-0D20 ~:813-'eO-0021 V
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IlIlICRI P1':1COl ~ 1II01lIC
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OJINEJI'S NAME
olCJI ADOllEB8
l'ARCIi:L 10 .
WORK PROPSED: ~ cONS'.!'
C:lIGN
PROPOsl:l> USE' DSGr. PAHtL
o APDl:J'ION
b MOVE
o AI. 'I' !lRA'r:tON
o DEHCLISlI
o REPAIR
OI<<lt.TI-!"Mllt. 't
D IllOOSTRIlIL
0. OF t1lIlITS
o SWINfING FOOL
IlUILOING snl
IIEIGIIT
. ell S~ ENERGY
I'OIMS.
ilKS.
RESIlWIl'IAL: ATTACH 12)
C~RCIAL: ATTACH (3) S
IF SIGN PERHIT ONLY 121
PROPERTY SU
P SUllIes
o progn... Sn'r<1Y 0
W.R.f:.C.
/
~ r}oQ0
o lSUILDING $
o ELECTRICAL
o PLUMBING '
VALOA'I'ION OF TOTAL COtlSTJl.UCl'ION
o m:CHANlCAL
o GAS 0 ROOI'XNG
TnE or CONSTRUCTION: 0 Ill.
s
VALOArION or MECH1.NClAI. INSDLI.A'l'ION
[J O'l'KBR
,
.
I 8IGNATtnU:
r ..........,............... .~*....
I
I. SIGNA'1UR
I
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i
I Pr.tNIIUt \.\h lllCUY\
!
I SIGNATURE
................*...7**.
..~CAJ.. W t.tQJ.Q..n\
I SItmA'l!OIlE
r
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r O'rRIIR
I
S:IGW\~OIUl
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o STat
. CI OTIlQ
COMPANY
StATE CERT OR RIGIS'l'
- ;pitY
g~/
FINISIlEO FL~ SLEVAfIOWS
IS PIlOJlC'l' IN FLOOD BOG AJlEArj YIS
....-.....~***.*.*...**....~.....*..*.*.*....
~ +0 ft-
~/~
CXlNPM/
STATlt CEII'1' OR REGXS'l' .
I . d
XI:L:l .l3r~3SI:l'" dH
W1:l22:11 S002 S2 ~OO
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,OC1/25/2005/TUE 11:33 AM ZEPHYRHILL BUILDING
II
FAX No. 813-780-0021
P.OO
A.: NOUe::!: OF one RE8TRtct'1011S
Thill undllra.i.qQed underlrta~lI ,the t~18 pem1t llIay be subjec1! to "deoed restrictions"
maYbe ~orereatrictive bane1 y regulationa. The undsralqned assume. reeponalbl
Compliance Hith ony' .ppl cable d reGtrict10ns;
B. ONLICIMS20 CON!RACTo AND ONTaAC!OR RESPONSIBILITIES
If the owner haa hireG a c6ntra tor or contractors to undertake work, 'they aay be
to be licensed in aeoord oe wi h atate and looal reoul~tions. It the cOntractor
licensed aa r.qutrad by law, be the ownar ond eantractar ..y' be citod tor 8 mi.d
.iolatign ~r state 18. If Owner or intended contractor are unoertoin a. t
11o.n8.11\9 nlquireunts ilia' appl for tile ~nten~ _...k, th.y'a.re advilled to OonCiIIO
City of Zepbyrbills Build'nq Ce ~ent, 813-780-0020.
'\Jrtbarmore" if th. owner ,,*S h ed a oClntractor, cr controcto~s, he .ia advi.ed ~o
oantractox(e) .iqn po~ti $'OL . ~CoAtractor SectionsN of this appllcstiOD fox
will b. reaponaible. It the owner .iqns aa,the con~ractor, you ars ~nd1Qa
you, rather ~h.n the 'cont a~e re.pan'.1bLe for the wor~. ,1% the contractor
you to sign ~ contractor y be ~n indlca~ion that' ha i. net p~arly ~ic.n_
nqt .nt.1~led to perlll11:tln ag.. in tbe,City ot ZephyrhUl~.
c. TRANSPOR'rA'I'ION IMPACT D tnIUTY CONNBC'I'IOll'l E'1l1lS
p. CONS1'Il~I1ION L12N a' 713, i'UlIUDA SI'A'l'tiTES,' AS AMENDED)
I cerbify that I, the app hays been provided with B copy 'of ~'lo~da's Cona
Hen L'aw - HOIlIOloWl1er'. ,Pr tllCti Guide" prepU'ed b)' the Florida Department ot Agr'
and ConaUlt.er AUain. If ~e ap l1cant ia someone ot:he,r that l:~e "o_r", I cerlt
hBYe obtained a cOPY' of t abo deaor~ed document and promi.. in good fa.ith to
it ,to the "o~arN pr10r t ~omma celllent.
E. CONTRACTOR.' S/OWtlER' S f'IOAV 'r
1 oerti!y that all the in o~tl n in this application .ia accurate and that all wo
be Clone in compliance wit ,.11 a plicabIe lawa rllgulat:ir.q construction, zoning, an
development.
~pliq.tion 1s ~e~eby mad' to ob ain a'perm1t to dO work and 1nataliation a8 indica
certity tnet no wock or 1 .'.11. 1an ha. c~nced p~loz to 1.~anoe o~ . permit an
all work will be perf~ tq ~ t atandarae ot ail laws regulating co~.truation,
oo~.., zoninq regulations, ~d 1 nd d.9~lopmerit regulatione in the juri.dict~on. I
oectify that Iunclenumi that t e regtiJat1.oNl of o~her !lovec_ental agenci.. _y ..
the jntend.d work, and th t ,it i my responSlDl1itv to idontify what aet1.on. I .uet
be in compliance. S~ch a e~oies inolUde but ate not l~it.d to: *Deparement 0:
EnviroriMental aequ1ation- ypre,a Baynaads, Wetl&nd ~eas and Environnentally 8ena1t ve
Landa, Water/Waatewater T .t~en
*Southwaat Florida Water n.~ nt D1Btriat~ell., Cypre.. Bayheads. Watl4nd Az...
Altering Watercourse.
~Aimy Co~p. of Enqineera-S
*Departbent of H.alth , Re
Wastewater Txeatment, S.pt
.U.S. Environmental Pcot.o
I also certify thet, if fi
.understood that a'dza1naqa
is prepared by a profeslio
i"suance.
A permit 1s!ued ahall,ba ,c nstruto be a license to FroC8ad with the wor~ ~d not
authority to violate, can: , a1 er, or s.t asida,any provisicfta ot tne ~cbnical
nor shall i,auanoe of a pe . t P event the 8gild1ng arfic1al tram ther..fter ~8quir
oorrect1on of ~rors 1n pI e, nstruction, ~r violationa or &ny code. ' Rvery pa .
~.,u.d .hall becOme in".li ~D~e a the work authorized by such pera1t 1. caNmenoea
siX II\Onth. cf i.SUGCII, or it wo Jc. authorbed by the pertllit. is s\Upendad or abandon
period or s.ix II'IQn~h. after thli t "the. work J.s c~ence<1. On. 90' day exten.lon of
-y be allowac:i tox tne'pe t wi h tee Charge o:f $1S.00. Tne exttlne.1.on stwl.Ll be re
1n writing to "the 81l!ldir>q ot~:l.c al. Jll\ -,proved in.pection must be lOCJ9ed dUJ:inq
IIlOnt~ period. or the proja t, wil be COneidered abandoned.
WARNING TO 0WNEIt: YOUR LUllE 0 RECORl> A NOTICE or COMMENCEIG&N'l" MY RIIStlLT IN ~O
~AnNG TWICE rem' IMPIlOVEMJ: T~ '10 YOOR pj\OnR'l'Y. II' YOO INTEND '1'O,OB'r,Jl.IN i'IllAWCING,
HX'l'1l YOUR LalCEIl OR AN A'rT IlblEY EFORE RECORt>ING YOUR NOt'IC2 01' COHHDlCll:H!:N1'. JOB'S
$2,500 IN VALUE: DO NOT NEE TO !I' CORD AND POST A "KO'l'IC!: or COHKE~EMEHT".
..,ill
land
, DOck," ro:Iav1qable Wsterways
at1~e Services, Enviro~ental ~~alth Unit-Wella,
s
eDCy-~b..to. .batenent
rial L.. to b. o..ed 1n 1"100<1 Zone "A" or "A,. etc:....
e."1n" a "compensating volume" 11111 be suDm:itt.
i~.r,r.;ister~ 1n the State of rlo~ida ~rior to
r
1.
stGNATOU: OIfN&:R DR AGENT
"
S1<:NAmRe : COtl1'1lAC'rOR
STATt or 1'L01UDA.
COON'l'Y OF
~he fcreqoinq ~R~trum.nt we
eafore lIIe tllis _ day , of
,by
fna.e' or person aoknqw
(Jwho 19 personally Kno~n
O'who twlli produced
, , (type
and ..lioO cUd Qdid Dot
STATE OF' f'LOllIDA
COUN'l'~ 01' '
The torego.l.nq inatrwDeDt waa aelmoNl
!!d'ora ma, tl\i.' ----sIB)' or:
by ,
(n._ or peracn aOlllJo"ledqedl
CJ.ho ia personally .known to .., or
o who ~s produced
It YEN' of idenU f'
and wl\o Ocha D:11d 'not take an 0
9i9nature ot per"OD
Slgnature df parsan tak1no .ckno~~
Nane typed, printed or
HIllY typed, pzlnt.d or ""'lIlped
2.d
)(l:l~ .J.3nJ3Sl:l.., dH
Wl:l22:11 S002 S2 ~OO