HomeMy WebLinkAbout06-5649
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
5649
Permit :5649 Issued: 4/20/2006
Permit Type: GENERAL BUILDING PERMIT
Class of Work: 101-NEW CONST/SFR
Proposed Use: SINGLE FAMILY RESIDENTIAL
Sq. Feet: Est. Value:
Cost: 154,000.00 Total Fees: 3,748.85
Amount Paid: 3,748.85 Date Paid: 4/20/2006
Name: NEW MILLENNIAL LC
Addr: 7303 N. NEBRASKA AVE
TAMPA,FL. 33604
Phone: Lic:
Work Desc: NEW SINGLE FAMILY RESIDENCE
Address: 5814 19TH T
ZEPHYRHILLS, FL.
Township: Range:
Lot(s): Block: Section:
Book: Page:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 11-26-21-0010-07700-0051
Name: NEW MILLENNIAL LC
Address: 5814 19TH ST
ZEPHYRHILLS, FL. 33542
Phone:
BUI
MECHANICAL FEE
WATER CONNECTION RESIDENl
POLICE IMPACT FEE
RADON
WATER METER RES 3/4"
PUBLIC SAFETY 5%
L B
SEWER CONNECTION RESIDENl
FIRE IMPACT FEE
(J,G' /00
q/{)?-
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Re~L. fJ)', (;
~ 35.C5D
lW-~f~e~~"(
F 1 UMB
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: Reinspection fees will comply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or corrections not made when inspections 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.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, 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 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."
~~ '1Z_
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CTORS IG TURE PERM~
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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OWNER'S
CITY OF ZEPHYRHILLS PERMIT APPLICATION
BUILDING DEPARTMENT 5335 8th STREET ZEPHYRHILLS, FL 33540
Phones813-780-0020 Faxs813-780-0021
DATE RECEIVED 3-30 --c::<o
PLANS REVIEW PEE
PHONE CONTACT (-W ("3 n. ( 0 --4 36 {
7/
SUBDIVISION
(, If ..f2 'fJ..l;fb
PROPERTY TAX NOTICE)
PARCEL, ID # j ( - ^ ~ ~ ^ ( - ODr 0
WORK PROP~ED: l'5NEW CONSTRUCTION
OSIGN
- 077,DO- (~D5 r (OBTAIN FROM
o ADDITION
o ALTERATION
o REPAIR
o INSTALL
o MOVE
o DEMOLISH
PROPOSED USE: ~GL FAMILY DWELLING
6 COMMERCIAL
OMULTI-FAMILY
0# OF UNITS
o MOBILE HOM
DESCRIPTION OF WORK S,
~ 13 ,..v;~
BUILDING SIZE ~ I.f 00 Q.~r~
'50 en. 'f-~
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
o INDUSTRIAL
c=J RESTAURANT & HEALTH DEPARTMENT APPR.
HEIGHT
& (1) SET ENERGY FORMS.
FORMS.
$~~O
I '0 AMP SERVICE
VALUATION OF TOTAL CONSTRUCTION
t'JOc. ~
fn~ QUa.-~~
'f BUILDING
~ ELECTRICAL
( ~LUMBING
/ rECHANI CAL
o GAS 0 ROOFING
PERMITS REQUESTED
r
FLORIDA POWER
o
W.R.E.C.
$ 3 ?DO
~
o SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
TYPE OF CONSTRUCTION:tBLOCK 0 FRAME
'6 (,. q 1t. S tf ~ .5
FINISHED FLOOR ,ELEVAT ONS '.J g"(i. 9
o STEEL
o OTHER
IS PROJECT IN FLOOD ZONE AREAD YES
o NO
BUILDER
SIGNATURE
BL"ECTRICIAN
I .
SIGNATURE
**********....*..*..**.*.*...*.*.*..**..**.*.*....**.*.*...***.*.*
-'~\(Y"
COMPANY~~' t~~'e (' ,'. /L~
STATE CERT OR REGIST # -A J::: O{,)~~aJ L .
CITY PROCESSING # \'1 i ,~,. . " J-'I
OTHER
COMPANY
STATE CERT OR REGIST #
~ CITY PROCESSING #
PLUMBER
SIGNATURE
,~
. *AiI* * * * * *..-':.4....... * *... * * *. *. *... *. *... *. * *... *.. *. *.. * *.. *
SIGNATURE
COMPANY ;U [ 1m:! -J.. e.l e L /-v,' <-
STATE CERT OR REGIST #
CITY PROCESSING #
(:b--
**..*****.**..*.*.....**.. ~~~l.***.*.**.
.~.
CONDITIONS OF PERMIT AFFIDAVIT
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" ~hich
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 accura~e 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 lRUst 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 V 0 NOT TO RECORD AND POS A "NOTICE OF COMMENCEMENT".
SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _ day of
by
acknowledged
1~
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _day of
by
acknowledged
19
(name of person ackno~ledged)
Owho is personally known to me, or
Dwho has produced
(type
and whoD did Ddid not
(name of person acknowledged)
[1ho fs personally known to me, or
of identification)
take an oath.
o who h~s produced
(type of identification)
and who Ddid DUd not take an oath
Signature of person taking acknowledgement
Signature of person taking acknowledgment
Name typed, printed or stamped
Name typed, printed or stamped
New Millennlal, LLC SIP '-/1
5810 - 19th St.
SQ. FEET PRICE
MAIN OR LIVING: 1,750 $ 88.00
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 154,000.00
FEE SHEET $ 642.00
ADDRESS $ -
DRIVEWAY $ -
BUILDING: $ 654.84
ELECTRICAL: $ 144.45
PLUMBING: $ 96.30
MECHANICAL: $ 67.41
SUB-TOTAL $ 963.00
RADON: $ 17.50
TOTAL $ 980.50
SEWER: $ 1,616.00
WATER: $ 419.00
IRRIGATION: $ -
TOTAL: $ 2,035.00
WATER METER:I $ 180_.00 I
IRRIGATION METER $
FIRE DEPARTMENT FEES
PLANS TOA TL:
INSPECTION TOTAL:
PERMIT TOTAL
TOTAL: $ -
PUBLIC SAFETY IMPACT FEES
POLICE $ 254.00
FIRE $ 273.00
5% $ 26.35
TOTAL: $ 553.35
SUB-TOTAL $ 3,748.851
PARK IMPACT FEESI $ 769.561
SIF'S: $ 4,314.00
100.0% $ 4,314.00
1.0% $ 43.14
TOTAL: $ 4,357.14
~-
TI F'S: $ 1,588.00
99% $ 1,572.12
1% $ 15.88
TOTAL: $ 10,463.551
111111111111111111111111111111111111111111111111111111111111
2006072166
State of FJ t) /'; d 4..
NOTICE OF COMMENCEMENT
P
County of U Ct _<;. ( 0
Rcpl: 987223
DS: 0.00
04/10/06
Rec: 10.00
IT: 0.00
Dpty Clerk
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property, and in accordance with
Chapter 713, Florida Statutes. the following information is provided in this Notice of Commencement:
1. Description of Property: Par~1 No. -1.1 - '1 ~ -- ~ J - {)O [ ()
if lock '7 () ~
010 I 5f- /II/-
ru wJ ).../ (J. .,...,',cJt?(1 / "-(
/
JED PITT"AN~ PASCO COUNTY CLERK
04/ 10/06 0~ : 3jpm 1 of 1
OR BK 692~ PG 733
2.
coSi
General Description of Improvement
AJ c> \tv
3.
Owner Information: Name _~ ) eo,,-) ^^'> \, \.0 n VI'tO l IlL..
7~ A..l J'Uc'bfClt;~f'J AtiZ. '-r:vv..IJ/'.
Address ~ I '
Interest in Property: AJ~ W 0;'1,} ft-{rrl'17; ({~$;&jCV'1 ("--<-
Name of Fee Simple Titleholder:
,- {
lale
(If other than owner)
4.
Address
Contractor: Name ~k-e.\
Zlca ~btC~ /~c.
City
sh~nl
,4,_- '-=rz; rr c_
City
Stale'
~L
Sale 2 ?j..eSYo-.
5. Surety: Name
Address
City
Stale
6.
Amount of Bond: $
Lender: Name ~~~
3~c--..Ce,,~ ~ ~ ~U
Address
~ 7e:\ef''Shsc..
City 0
~L
Slale
7. 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)(a)(7), Florida Statutes:
Name
Address
City
Slale
8.
In addition to himself, Owner designates
of
Notice as provided in Section 713.13(1 )(b), Florida Statutes.
to receive a copy of the Lienor's
9. Expiration date of Notice of Commencement i~one. ear from the date of recording unless a different .date is
specified.
q/ ~Jn I...
Dale
i~~)_/~~~
STATE OF FLORIDA ;J f} ( tJ
COUNTY OF C
L c_ ~..:.I(,.
The foregoing instrument was acknowledged before me the
ell Ii. U /J- VI{/ Iii L/Lr
~ who has produced
....~~It;:'" Sharon S. Lopez
Seal: f'?-\';&~~~~ MY COMM!SSION # DD2.20624 EXPIRES
C. ~':~E lune 12, 2007
~"*~~ OF' 'r'-.-~~"':: bONDED THRU TRey FAIN ,!NSU\;U\NCE, INC
'111111\\\
If) 4 /1"1. l.I f fJ lIt JI/tl (date). by
(name of person acknowledging). who ~
(lyp of' entification) as identification.
dv/pc053048
APR-05-2006 10:07
PASCO COUNTY DEV REVIEW
727 815 7000 P.01/01
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'City of Zephyr hills
BUJldt~g"Department
5335, :~Il:1 Street
,zephyrhUtS.. F-Iorida 33542
813':760-0020
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Fax Oover Sheet
TO:
FROM:
DATE:
SU6J:
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Ju~y/Gail
Karen
Fax:
727 -815-7000
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Numeric Address
,
Good Morning. !~Wa have a permit a~lication which reflects an address of 5810
191h St with a parcellD -' 11-26-21~01'0..07700-0051. This permit is for a new
single family r8JSident. In looking at the property appraisal website it appears
nothing has been built on it before. I.s this address good?
If you have any questions... please contact me. Thanks.
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TOTAL P. 01
APR-20-2006 02:05 PM NEW.MILLENNIAL
23687470
P.0l
Mcleod Electric
Services llC
1" 11 U"UUIIWllfI In r'luuJ I
Tampa, FI ~361~
813-885-7368
Fax 813-243-0643
Lie # EC13003092
...
H'I .. Uti
-- ...-..
"Serving the Bay Area
Since 1977"
April 1" 2006
I, Charles E. McLeod. license: holder for McLeod Electric Servi(;es LLC, State
t'ortitlod hllllntrirnl "'ontn('tm'.itl1(' I 'OOlnQ? I hrn'h)( rUlthnri/i1lillJl Ihsi
follmuinn TOl1ritl:MntnthrtlJ: rrnm 1\lc\IJ Millenni"l Hnmf''i II ('. tn nhll1in 1~1r.r,frir.ft'
p<;l.'luits on l.uy bGhAlt':
JUSl'IN HATEIELO IPNY MALU~] EM1!:- Y COYJ,E
Sincere , r:;-- i~/
/' . .,,-/ (' /
!/r~~<cf~<,'Ifc~1 ,/
Cha.r1es E. Mcleod v
Mf;'1 I'M t<lt'rtrk ~t'rVil~I~S 1,1 Ie
J\~tt..IIUWICU~I::U U~lUl'- ..n_. ,,,I., ,1.1. .L.J "Ll,I..,,:1, OOOl,
D)' Charles E Mr.l.r:nrl who i~ personally known and did not take an oath.
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IJA'Wl\ M f'doglt\3 Notury l~u Ii\:
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PERFORMAN9E BUSINESS PRODUCTS, INC. 813-71ll-8008 FAX 813-719-7918
\o-Ob~1
CITY OF ZEPHYRHILLS
ZEPHYRHILLS, FLORIDA
WATER ACCT. NO.
DATE
'1/ ZO !o&,
.
OWNER/
RENTER
'N.o..l.L) mi \ \~nn\aJ L~
MAILING
1303 N. ~leb~~~Q ~
\~{:b-J h.-
33<ocy
'"
SERVICE ADDRESS 5~14 \ q-t'h ~
SHUT OFF SERVICE 0
TURN ON SERVICE [g'"
INSTALL METER I:i]/'
READ METER 0
CHECK METER 0
OTHER 0
liJ..."'WATER
o SEWER
o GARBAGE
~N CITY
~-
o OUT CITY
--L- No. OF UNITS
_ DEPOSIT AMOUNT
3/4 ' I W. \'Y\Jz,tt.J...
Yec-n-v..X - 5" <0 ~9
_ AMOUNT lAST BIU
_ 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 Service Depl.
Water Service Depl. to sign yellow form & return to office.
CITY OF
ZEPHYRHILLS
"NOTICE"
OF ADD.ITION OR CORRECTION
BUILDING
DEPARTMENT
DO NOT REMOVE
, c-/. h > DATE PERMIT +
/1' 'Sf ~)(, '-17
THIS JOB H;A.S NOT BEEN COMPLETED The following additiqns or corrections shall be made before the job
. will be accepted.
,
ADDRESS
:0' /4
G0;/1 SIArl
vAl
It is unlawful for any Carpenter, Contractor, Builder, or other persons, to
cover or cause to be covered, any part of the work with flooring, lath, earth
or other material, until the proper inspector has had ample time to approve
the installation.
OFFICE HOURS 7:30 AM - 5 PM MON.-FRI.
AFTER CORRECTIONS ARE MADE CALL
780-0020 FOR RE-INSPECTION
INSPECTOR ~ /'
1S!!3
NI!W MILLENNIA\. HOMES
L1l1i1dingAmlll'i,,,," D/"eam,!
O~ Your 1,,)/ tl/' OII1',f
NEW MILLENNIAL HOMES
7303 North Nebraska Avenue
Tampa, Florida 33604
To:
Bob
From: Dawn
/ 0,/ D /.r;
/y f'~
/"2~ ~IPyvJ
1: J
Fax:
B13~780-0021
Pages:
Phone:
Date: 6/5/06
Re:
cc:
Urgent
Ll For Review 0 Please Comment 0 Please Reply 0 Please Recycle
. Comments:
Bob,
Attached are the compaction test results for 58141Sth Street-Zephyrhills.
Ifyou have any questions, please call Winson Hayes at B13-2104336,
Thanks
Dawn
210-7544
e6/~5/20e6 B4:37
18138721876
1Esr IMINe.
GEOl'ECtN;AL & MA1'ERIALS
~ 1ESl1fG & INSPECmN
".0. lOX 1m2' TAMPA, JILOllIDA".... Il"""""1IQ
P~OJEcr: 5814 19th St. Zephyrhills, FL
Document No. 1090 179aG31250
CLIENT: New Millennial Home!
TEST LO~TION
NO.
Pi1l Mtlll:rial-
BullcUnl SlAb Area
7 best trt'.....t No. ,
NE comer
, R" orT. N.. 5
Center
I) R.u. or,..t No.4
SW camc:r
rES 1 LAB I !1'lC.
DEPTH I DENStn' MO.sTIJIQ:
1fET DR.)' %
QIeI) (,d)
0..12" 1~6,S 11305
0-12" 1aU 117.4
0-12" 1'l1,4 \11.7
COMPACTWN MAx1M\IM ax OmMVNI
TEST NO. D~SlTY (Pd) MO~
%
2
118.0
hwl007-OO9, fdt
10.5
\1.5
13,'
14.1
J j/&1i
(:o~ II'AcraON
T i:ST NO,
2
2
2
p~(.;F 11:L
FIELD DENSlTl.' TESts
(Naelear DeDllty G.. Metbod)
PROJECT NO:
TL-8446-638
DATE:
June 5, 2006
COMl'AC11ON
'I.
R(.MAAIa
"% Req....
96 lbt*es8 or fill
tppC'OllicbaIeJ, 3'
99 Thidmc:ss or fill
Ilpproximately 3'
" Tbicld\8lUl or fill
appI:DXtmalDly 3'
DATE SAAlft..D:
05/"'06 OV
REI'OIlTS TO:
New Mi1Iemnial Homes
AtIn: Sue PaI'k (2)
TEST LAB, INC.
TRANSACTION REPORT P.01/01
SEP/21/2006/THU 11:48 AM
RECEIVER
92368747
TYPE/NOTE
OK
PASCO COUNTY,. 'FLORIDA
, . ~..
- . .
permit No. " ~W~ .
Date Permitted." ..:.. ~, -o~
.
l3ullder Name/Owner Name OClt.-U V"Y\~.llL'~r1\" 0 Control #
. County parce.1 No. \ \ - ~-cl\ ~ t"'"\OIt'\ _ Ot7Do-t'a5f. SubDiv:
Address/Locatlon ....5~ 'l.\- \ ~ ~+ -
. -..
Classlfic~t1onlType of USE} S \ ~ In' R'> ^'"""': ~ L l if) [} ^ 1. ~ r"
TRANSPORTATION IMPACT f.E:E,' ' Rate: _ 8q F~ Unit:
. j:xempt 0 Xes ~o How D~termlned
Impac~ Fee Amo~.nl j, \ 5 ~ ~ .60 .
~one No. .
TAl:
. .
SOHOOL'IMPACT'FI;E . ,
Aocount (056) Slngle..F~mIlY petached House
" . (057) Mobile Home
(056). . Other ~eslclentlal ,
]:123)' Collection Fee .
. ~xempt ,U Yl3l:! [}t<fQ How petermln~d
Amount $ ....:{-3,l,5 '1 , , t..f
'.
PARKS'AND RECREATION FEE '. '. .
l-and AocoUl1t ' Land Credit
L~nd Total
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~~enipt ' 0 Ves 0 No
. LlaRMY FEJa .
~and Aooount .
Facility Aocount
. ,"
HowP.etermineq
R~creatl~n Total.
Reoreation Aocollnt
Zone
,.
I=xernpr 0 Yes, 0 No
,'RESQUR .'E 'FeE
. TOTAL AMOUNT
How Determined
Land Total
Facility Total
. Tot~' Amount
.-.
~and Crectit
'-
_ 0
PASCO COUNTY, FLORlqA
~:~~~~~ltted f~~~-o~
Control #
Builder Name/Owner Name nQ.u..) \"'r\.L.l1.L'fYJnl,., 0
PATE
RECEIPT NO.
County Pafcel No. \ \ - O><.e -oH _ t)C:M") _ C~ 7700 - ('a5( SubDiv:
Address/Location 5 <t;; I 4- \ C1--t1r\ S+
-
ClassificationlType of Us~ 6 I 0") L 0 . ~ /Y"':r\: Q L ( If? Q ~ ~ L' Q
Sq Ft Unit:
TRANSPORTATION IMPACT FEE, Rate:
f:xempt D Yes ~o How Datermlned
Impact Fee Amount $ \ 5 'is <6 .0-0
Zone No.
TAZ:
SCHOOL IMPACT FEE
Single-Family Detached House
Moplle Home
Other Residential
Collection Fee
Q-No . How PetermlnE;ld
Amount $ Y-35'I, I t.f
Account
(056)
(057)
(058)
J:123)
U yes
Exempt
Land Total
PARKS AND RECREATION FEE
Land Account Land Credit
Recreation Total
$
Exempt DYes 0 No
LIBRARY FE!:
Land Account
Exempt DYes D No
RESOURCE FEE
TOTAL AMOUNT
Recreation Account
Zone
Facility Account
How petermined
Land Credit
Land Total
Facility Total
How Determined
Total Amount
Prepared By
Checked By
NO CI:RTfFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOl,JNTS LISTED HAVE
BEEN PAID ANP
R!:CEIPTED FOR BY A CENTRAL PJ:RMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not Imply accep~ahce of concurrence, but simply receipt of a copy of this form, plaolng
the building permit owner on noUce of this assessment al'!d thE! conditions of payment for same.
RECEIVED BY
DATE
BY
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