HomeMy WebLinkAbout07-6701
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
DRIVEWAY PERMIT
6701
Permit Number: 6701
Permit Type: DRIVEWAY
Class of Work: DRIVEWAY/NEW
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost: 2,000.00
Date Issued: 5/14/2007
Total Fees: 40.00
Amount Paid: 40.00
Date Paid: 5/14/2007
Work Desc: 804 SQ. FT CONCRETE DRIVEWAY
Address: 38651 N
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
Name: PIKE, HAROLD & DOROTHY
Address: 38651 NORTH AVE
ZEPHYRHILLS, FL. 33542
Phone:
- ~1
~\ (' 0-".0
5;0 I~
REINSPEcnON 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 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,"
MUST BE 6" DEEP WITH WIRE MESH AT RIGHT OF WAY
",..s~~ &dwJq f~ ~
CONTRACTOR J PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
PROTECT CARD FROM WEATHER
JOB ADDRESS
I
I
Fee Simple Titleholder Address I sam L I
I '5'i5f!A-!fM M_, ~!Jrb./~ FL 335'12 I lOT" 1/- 5" I
I OaR. PARCELlD#1 OJ--X-c)/--O()l(D-{b"&JtJ-<<J1 () I
Ef (OBTAINED FROM PROPERTY TAX NOTICE)
NEW CONSTR D ADD/ALl 0 SIGN 0 MOVE 0 DEMOLISH
INSTALL D REPAIR
PROPOSED USE 0 SFR D COMM 0
TYPE OF CONSTRUCTION 0 BLOCK D FRAME 0
DESCRIPTION OF WORK I CtJ/<..crele d;/~~
BUILDING SIZE I / ~ I ~ 1# 7 I SQ FOOTAGE I j Ol/ If HEIGHT 1
1I",IIIIII'"IIIII"IIIIII"'I.'IIII',111111"'lllllrrll111"111'"11""1111111'"111"111"'"11""111'11111'"'"11"'II""lt""II"III""III,,"IIII,111
City of Zephyrhills Permit Application
Building Department
~Pe(/J'lif S?tlt
Phone Contact for Permittin
Fax-813-780-0021
tk~ 101.
813-780-0020
Date Received
Fee Simple Titleholder Name
Owner Phone Number
ner Phone Number I
Owner Phone Number I
Owner's Name
Owner's Address
SUBDIVISION
WORK PROPOSED
OTHER I
STEEL 0
OTHER I
[X] BUILDING 1$ 02 I' Oa:J. 00 VALUATION OF TOTAL CONSTRUCTION
~
D ELECTRICAL 1$ AMP SERVICE PROGRESS ENERGY D W.R.E.C.
D PLUMBING 1$
D MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION
D GAS 0 ROOFING SPECIALTY 0 OTHER ~O
FLOOD ZONE AREA DYES
MECHANICAL
SIGNATURE
I
I
I
I
I
I
I
I
I
License # I
111111111111111111111111111111111II111111111I11111111111111111111111111111111I11II1111111111I11I111111111II11IIIIIIIilllllllllllll
Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster
Attach (3) sets of Building Plans; (1) set of Energy Forms.
Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Sanitary Facilities & 1 dumpster
All commercial requirements must meet compliance.
Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement Is required. (AlC upgrades over $5000)
Agent (for the contractor) or Power of Attorney (for the owner) would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs Sewers Service Upgrades NC
COMPANY
REGISTERED
BUILDER
SIGNATURE
Address
License #
ELECTRICIAN
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
PLUMBER
SIGNATURE
COMPANY
REGISTERED
YI N
FEE CURRENT
Y/N
License #
Address
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
License #
OTHER
SIGNATURE
COMPANY
REGISTERED
Y/N
FEE CURRENT
Y/N
Address
111111111111111
RESIDENTIAL
COMMERCIAL
SIGN PERMIT
Fences (PloUSurvey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS: The undersigned understands that this permit may be subject to "deed" restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions.
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 Pasco County Building Inspection Division-Licensing Section at 727-847-
8009. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County.
TRANSPORTATION IMPACT/UTILITIES IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands
that Transportation Impact Fees and Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings, as specified in Pasco County Ordinance number 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
receiving a "certificate of occupancy" or final power release. If the project does not involve a certificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LIEN LAW (Chapter 713, Florida Statutes, as amended): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided with a copy of the "Florida Construction Lien Law-Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the "owner", I certify 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.
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. Application is
hereby made to obtain a permit to do work and installation as indicated. j 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, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government 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 Protection-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.
US Environmental Protection Agency-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the following restrictions apply to the use of fill:
Use of fill is not allowed in Flood Zone .V" unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume" will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida. .
If the fill material is to be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will be used only to fill the area within the stem wall.
If fill material is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under the attached permit application, for lots less than one (1)
acre which are elevated by fill, an engineered drainage plan is required.
If I am the AGENT FOR THE OWNER, I promise in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other ~nstallations not specifically in?luded. in the application. A
permit issued shall be construed to be a license to proce~d With the work a~d not as authorl~y !o vlol~t~, cancel, alter, or
set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the B~II.dlng OffiCial from the~eaft~r
requiring a correction of errors in plans, c~n~truction or viotat~o~s o~ any codes. Every ~ermlt Issued. shall become. invalid
unless the work authorized by such permit IS commenced Within SIX months of permit Issuance, or If work authOrized by
the permit is suspended or abandoned for a period of six (6) mo~ths after the time th~ work is commenced: An extension
may be requested, in writing, from the Building Official for a period not t~ exceed n1n~ty ~90) da~s and Will demonstrate
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the Job IS conSIdered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT INYOUR
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.
FLORIDA JURAT (F.S. 1 7.03)
CONTRACTO
~ed and sworn r affl edlbefore me tJ:lls 7
p..,c ~7by MJJ::UJtltJn'
Who i are personally known to me or has/have produced
. as identification.
~~~ ~ltui~ Notary Public
NOTARY PUBIJC - STATE OF FLORIDA
Commission No. ......,. .
~~ ~4u;5
Notary Public
Commission No.
N'nTARV PUBLIC - SrAl~ UF FLORIDA
"""'f'
~.., ..... Stacie .
- .
Name of Notary typed, printed 0\ . o~sion #DD652189
'........... Exptres: OCT. 16,2009
BONDED nlllU ATlANTIc BONDING co., INe.
This instrument prepared by:
Kara Hardin, Esquire of
Kara Hardin. P. A.
Attorney at Law
38537 5th Avenue
Zephyrhills, FL 33542
(813) 788-9994
DURABLE POWER OF ATTORNEY
STATE OF FLORIDA
COUNTY OF PASCO
I. AUTHORIZATION AND APPOINTMENT
A. I, Dorothy I. Pike, of38651 North Avenue, ZephyrhiIls, Pasco County, Florida,
donor and principal, hereby make this my Durable Power of Attorney.
B. I intend to create a Durable Power of Attorney (herein referred to as "This
Power") pursuant to Section 709.08, Florida Statutes. This Durable Power of Attorney shall not
be affected by my subsequent disability or incapacity except as provided by statute.
C. I hereby appoint Harold F. Pike as my Attorney-in-Fact (herein referred to as my
Attorney). If Harold F. Pike is Wlable to act as my attorney in fact I appoint La Vera Beunk, as
my Attorney-in-Fact (herein referred to as my Attorney).
D. I give them the powers in this document to use for my benefit and on my behalf.
E. They shall use these powers in a fiduciary capacity and for my best interests, in
both my personal and business matters.
F.
this Power:
My attorney shall use the following form when signing on my behalf pursuant to
Dorothy I. Pike by Harold F. Pike, her attorney-in-fact
Dorothy I. Pike by La Vera Beunk, her attorney-in-fact
G. The effective date of this power is .5/ day Of~, 20qJ.
II. SCOPE OF AUTHORITY.
With respect to any property in which I hold any interest or which is acquired for my
benefit I give to my Attorney the following Powers. My Attorney shall have all the discretion
and authority customarily granted in a general Durable Power of Attorney, including, but not
limited to the following:
A. With respect to any business I may own or operate, to enforce the terms of any
business association agreement, to perform or discharge any duty or liability under any contract,
to determine policy of the business and to carry out such decisions, to change the name or form
of organization, to do all things necessary to pay any taxes for such organization, to hire, dismiss.
or contract with any employee or other personnel, and to conclude any and all other transactions
with respect to such business as appears required or desirable;
B. To vote or represent me at the meetings of stockholders or other meetings of any
partnership, corporation or company, including my own, or otherwise to act as my attorney or
proxy in respect of any stocks, shares, or other instruments now or hereafter held by me therein,
and are that purpose to execute any provides or other instruments.
C. To exercise, do, or perform any act, right power, duty or obligation whatsoever
that I now have or may acquire the legal right, power, or capacity to exercise, do, or perform in
connection with, arising out of, or relating to any person, item, thing, transaction, business or
nonbusiness property (real or personal, tangible or intangible), or matter whatsoever By way of
illustration, and not by way of limitation, such authority shall include the power to effectively
disclaim, in whole or in part, any gift or any property receivable from a decedent by reason of an
insurance contract, a will, or inheritance.
D. To ask, demand, sue for, recover, collect, receive, and hold and possess all sums
of money, debts, dues, goods, wares, merchandise, chattels, effects, bonds, notes, checks, drafts,
accounts, deposits, safe deposit boxes, legacies, bequests, devises, interests, dividends, stock
certificates, certificates of deposit, annuities, pension and retirement benefits, stock bonus plan
and profit-sharing plan benefits, stock option, insurance benefits and proceeds, documents of
title, chases in action, personal and real property, tangible and intangible property, and property
rights and demands whatsoever, liquidated or unliquidated, and things of whatsoever nature or
description which are now or hereafter shall be or become due, owing, payable or belonging to
me in or by any right, title, ways, or mean howsoever, and upon receipt thereof or any part
thereof to make, sign, execute, and deliver such receipts, releases or other discharges for the
same as my Attorney shall think fit or be advised. By way of illustration, and not by way of
limitation, my Attorney shall be empowered to enter and to make withdrawal, either in whole or
in part, from any safe deposit box.
E. To commence, prosecute, discontinue, or defend all actions or other legal pro-
ceedings in any way affecting my estate or any part thereof or affecting any matter in which I or
my estate may be in any way concerned; and to have, sue, and take all lawful ways and means
and legal and equitable remedies, procedures, and writs in my name for the collection, recovery
and any item or matter in which I have or may acquire an interest, and to compromise, settle, and
agree for the same, and to make, execute, and deliver for me and in my name all endorsements,
acquittances, releases, receipts, or other sufficient discharge for the same.
F. To lease, purchase, exchange, and acquire, and to bargain, contract, and agree for
the lease, purchase, and exchange and acquisition of, and to take, receive, and possess any real or
personal property whatsoever, tangible or intangible, or any interest therein, on such terms and
conditions and under such covenants as my Attorney shall deem proper.
G. To enter into and upon all of my real property, and to let, manage, and improve
the same or any part thereof, and to repair or otherwise improve or alter, and to insure any
buildings or structures thereon.
H. To sell, either at public or private sale, or exchange any part or parts of my real
estate or personal property for such consideration and upon such terms as my Attorney shall think
fit, and to execute and deliver good and sufficient deeds or other
instruments for the conveyance or transfer of the same, with such covenants of warranty or other-
wise as my attorney shall see fit, and to give receipts for all or any part of the purchase price or
other consideration.
l. To sign, endorse, execute, acknowledge, deliver, receive and possess such
applications, contracts, agreements, options, covenants, deeds, conveyances, trust deeds, security
agreements, bills of sale, leases, mortgages, assignments, insurance policies, bills of lading,
warehouse receipts, documents of title, bills, bonds, debentures, checks, drafts, bills of exchange,
notes, stock certificates, proxies warrants, commercial paper, receipts, withdrawal receipts and
deposit instruments relating to accounts or deposits in, or certificates of deposit of banks, savings
and loan, or other institutions or associations, proofs of loss, evidences of debts, releases, and
satisfaction of mortgages, judgments, liens, security agreements, and other debts and obligations,
and other instruments in writing of whatever kind or nature as may be necessary or proper in
writing of whatever kind or nature as may be necessary or proper in the exercise of the rights and
powers herein granted. By way of illustration, and not by way of limitation, my Attorney shall be
empowered to exercise any and all rights to ownership on insurance policies upon the life of any
person or persons (other than any policies on the life of my attorney-in-fact), annuities, pension
and retirement benefits, stock bonus plan and profit-sharing plan benefits, and stock options,
including specifically the right to change the beneficiary thereon to any person other than my said
Attorney.
J . To assign and convey all or any part of my assets (consisting of any property, real,
personal, or mixed, tangible or intangible, of whatsoever kind and wheresoever located and
whensoever acquired) into such trust or trusts as now in existence or hereinafter established. My
Attorney shall be authorized to establish any such trust, on such terms as my Attorney shall deem
to be in my best interests.
K. To deposit any monies which may come to my Attorney as such Attorney with
any bank or banker or other person, either in my or my Attorney's own name, and to employ or
expend as my Attorney shall think fit any of such money or any other money to which I am
entitled which now is or shall be so deposited; to withdraw, in the payment of any debts, or
interest payable by me, or taxes, assessments, insurance and expenses due and payable or to
become due and payable, on account of my real and personal estate, or in or about any of the
purposes herein mentioned or otherwise for my use and benefit; or to invest in my Attorney's
own name or any nominee in any stocks, shares, bonds, securities, or other property, real or
personal, my Attorney may think proper, and to receive and give receipts for any income or
dividend arising from such investments, and to vary or dispose of such investments. By way of
illustration. and not by way of limitation, such authority shall include the power to purchase
government obligations which are redeemable in payment of taxes.
L. To borrow any sum or sums of money on such terms and with such security,
whether real or personal property, as my Attorney shall think fit, and for that purpose to execute
all promissory notes, bonds, mortgages, deeds of trust, security agreements, and other
instruments which may be necessary or proper.
M. To engage, employ, compensate and dismiss any agents, clerks, servants, attor-
neys at law, accountants, investment advisors, custodian, or other persons as my Attorney shall
think fit in the performance of the powers granted my Attorney herein. This authority shall
include employment of firms and companies in which my Attorney owns an equity interest and in
which my Attorney is otherwise pecuniarily interested.
N. To exercise any powers and any duties vested in me, whether solely or jointly,
with any other or others as personal representative, administrator, or trustee, or in any other
fiduciary capacity, so far as such power or duty is capable of validly being delegated.
o. To make gifts and to institute gift programs to such activities and persons as my
Attorney shall deem appropriate.
P. In general, to do all other acts, deeds, matters, and things whatsoever in or about
my estate, property, and affairs, or to concur with persons jointly interested with myself therein in
doing all acts, deeds, matters, and things herein, either particularly or generally described, as fully
and effectually to all intents and purposes as I could do in my own person if personally present
and competent.
Q. To prepare, sign, and file federal, state, or local income, gift, or other tax returns
of all kinds, claims for refund, requests for extensions of time, petitions to the tax court or other
courts regarding tax matters and any and all other tax related documents, including, without
limitation, receipts, offers, waivers, consents (including, but not limited to consents and
agreements under Internal Revenue Code ~2032A, or any successor section thereto), powers of
attorney, closing agreements; to exercise any elections I may have under federal, state or local tax
law; and generally to act in my behalf in all tax matters of all kinds and for all periods before all
persons representing the Internal Revenue Service and any other taxing authority, including
receipt of confidential, information and the posting of bonds, and to represent me in all such
proceedings.
R. To make any election or election and agreement referred to in the Florida Probate
Code, Florida Statutes, Chapter 731 through 735.
S. If proceedings are initiated for the appointment of a guardian of my person or my
estate or both, I hereby nominate Harold F. Pike as guardian of my person, estate, or person and
estate. If Harold F. Pike is unable or unwilling to act as guardian of my person, estate, or person
and estate then I nominate La Vera Beunk as guardian of my person, estate, or person and estate.
I request that, if the person(s) named above is appointed guardian of my estate, the Court make
an order granting to that person all or as many ofthose independent powers listed in F. S. ~
709.08 as the Court deems appropriate.
T. To take any action not specifically described above that is necessary or desirable
to carry out the intent of this document.
U. If at any time joint agents are acting hereunder, the agents may exercise alone or
jointly the powers set forth above. Notwithstanding the power granted to any agent to act alone,
each agent shall have no power to perform any act to which another agent objects. Any third
person who receives a written objection signed by another agent before acting on the instructions
of one agent shall not be entitled to rely on such instructions. Third persons who do no receive a
written objection from another agent shall, however, be entitled to rely on the instructions of only
one agent without further proof of another agent's joinder.
III. CONSTRUCTION.
This instrument is to be construed and interpreted as a general Durable Power of
Attorney. The enumeration of specific items, acts, rights, or powers herein does not limit or
restrict, and it is not to be construed or interpreted as limiting or restricting the general powers
herein granted to my Attorney.
IV. REVOCATION.
This general Durable Power of Attorney revokes any previous powers of attorney granted
by me. This general power of attorney may be voluntarily revoked only by me at any time by my
written revocation entered ofrecord in the deed records of Pasco County, Florida. Any grant of a
Durable Power of Attorney made by me subsequent to the date of execution of this Durable
Power of Attorney shall revoke this Durable Power, unless the subsequent Durable Power
contains a statement to the contrary and specifically refers to this Durable Power of Attorney by
its date.
V. NO BOND REOUIRED.
No Attorney shall be obligated to furnish bond or other security.
VI. COMPENSATION.
My Attorney, and any successors, shall be entitled to reasonable compensation for
services rendered.
VII. LIMITATIONS.
A. Any authority granted to my Attorney herein shall be limited so as to prevent this
general Durable Power of Attorney from causing my Attorney to be taxed on my income (lIDless
my Attorney is my spouse) and from causing my assets to be subject to a general power of
appointment by my Attorney, as that term is defined in Section 2041 of the Internal Revenue
Code or any successor section thereto.
B. My Attorney shall not use my funds or property to pay for his/her own debts or
obligations, except as provided by law.
VIII. CONFIRMATION OF ATTORNEY'S ACTS.
I hereby ratify and confirm all that my Attorney-in-Fact; or his/her successors shall
lawfully do or cause to be done by virtue oftrus general Durable Power of Attorney and the
rights and powers granted herein,
IX. INDEMNIFICATION OF ACTS OF ATTORNEY WHILE CARRYING
OUT AUTHORITY.
I hereby bind myself to indemnify my Attorney and any successor who shall so act against
any and all claims, demands, losses, damages, actions, and causes of action, including expenses,
costs, and reasonable attorney's fees which my Attorney at any time may sustain or incur in
connection with his/her carrying out the authority granted hirn/her in this general Durable Power
of Attorney.
X. HEADINGS.
The headings used throughout this instrument have been inserted for administrative
convenience only, and do not constitute matter to be construed in interpreting this general
Durable Power of Attorney.
XI. SEVERABILITY.
If any part of this general Durable Power of Attorney is determined to be invalid, the
remaining provisions shall be given full force and effect.
IN WITNESS WHE:~!, :h~rincipal has signed this durable power of attorney on
this 5' day of ~ ,2007.
STATE OF FLORIDA
COUNTY OF PASCO
On this 5th day of April, 2007, I attest that the preceding or attached document is a true,
exact, complete, and unaltered photocopy made by me ofthe DURABLE POWER OF
ATTORNEY OF DOROTHY I. PIKE, simed on the 5th day of April, 2007, and, to the best
of my knowledge, that the photocopied document is neither a public record nor a publicly
recordable document, certified copies of which are available from an official source other than a
notary public.
(SEAL)
~~"y ~"
4" .......t1(0 ANTOINEllE L MATHIS
>\-..~ * MY COMMISSION # DD 209381
"'~,.. EXPIRES: May 5,2007
"!'(!"OFflO~<:J Bondell Thru Budget Notary Services
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----
NOTARY SIG f\.TURE
4iZ<f~//I..~zt.o L- .. /Vkl hi/ (
/
PRINTED NAME OF NOTARY
STATEMENT OF WITNESSES
I declare, under penalty of perjury, that the Principal produced h ~. :t::I-
as identification and is personally known/not known to me, that the Principal signed or
acknowledged this Durable Power of Attorney in my presence, that the Principal appears to be of
sound mind and under no duress, fraud, or undue influence, and that I am not the person
appointed as Attorney-in-Fact by this document.
--~
~. L.i4~
Printed Name of Witness
37537 .?- /JI.<.
~~h;I(:S1 Fe ~/,L
Address of Witness
~ ~j!~d-lPdJ
~~ess Signature
Date: 1/5/t/1
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S~,ef4rp 11A ~VLcP {Cj
Pri . ed Name ofWlt)\eSS
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Z-Cpl (Jrt 1 C i.l~ ~ L- ~~s~<fo<
Address 0 Witness
STATE OF FLORIDA
COUNTY OF PASCO
~fOregOing instrument was acknowledged before me this S day of
.' ,2007, by DOROTHY I. PIKE who identified this instrument as her
Durable Power of Attorney and signed the instrument willingly, and _ amed
witnesses. DOROTHY I. PIKE and the witnesses have produced Drivers License r
as identification.
NOTARY PUBLIC,
AT LARGE
:\f>.RY PUll
~o ....... r0 ANTOINETTE l. MATHIS
*o/l..~ * MY COMMISSION 1100 2093Bl
~~.,. EXPIRES: May 5 2007
.. ~~ Of F~o'i'''' Bondell Thru Budget NOla~ Services
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PRINTED NOTARY NAME
MY COMMISSION EXPIRES: *)7
DURABLE POWER OF ATTORNEY
IF ,5. & 709,08),
NOTICE TO PERSON EXECUTING DURABLE POWER OF ATTORNEY
A DURABLE POWER OF ATTORNEY IS AN IMPORTANT LEGAL
DOCUMENT. BY SIGNING THE DURABLE POWER OF ATTORNEY, YOU ARE
AUTHORIZING ANOTHER PERSON TO ACT FOR YOU, THE PRINCIPAL. BEFORE
YOU SIGN THIS DURABLE POWER OF ATTORNEY, YOU SHOULD KNOW THESE
IMPORTANT FACTS:
YOUR AGENT (ATTORNEY IN FACT) HAS NO DUTY TO ACT UNLESS YOU
AND YOUR AGENT AGREE OTHERWISE IN WRITING.
THIS DOCUMENT GIVES YOUR AGENT THE POWERS TO MANAGE,
DISPOSE OF, SELL, AND CONVEY YOUR REAL AND PERSONAL PROPERTY, AND
TO USE YOUR PROPERTY AS SECURITY IF YOUR AGENT BORROWS MONEY
ON YOUR BEHALF.
YOUR AGENT WILL HAVE THE RIGHT TO RECEIVE REASONABLE
PAYMENT FOR SERVICES PROVIDED UNDER THIS DURABLE POWER OF
ATTORNEY UNLESS YOU PROVIDE OTHERWISE IN THIS POWER OF
ATTORNEY.
FLORIDA LAW NOW ALLOWS YOU TO DECIDE WHETHER THE POWERS
YOU GIVE YOUR AGENT WILL BECOME EXERCISABLE IMMEDIATELY UPON
SIGNING THE DURABLE POWER OF ATTORNEY FORM, OR WHETHER THE
POWERS WILL BECOME EFFECTIVE ONLY AFTER YOUR PRIMARY PHYSICIAN
SIGNS AN AFFIDAVIT STATING THAT HE/SHE HAS PERSONALLY EXAMINED YOU
AND THAT, IN HIS/HER OPINION, YOU ARE UNABLE TO MANAGE YOUR
PROPERTY. IF YOU DECIDE THAT THE POWERS WILL BECOME EFFECTIVE
IMMDEDIATL Y, THE POWERS YOU GIVE YOUR AGENT IN THIS DURABLE
POWER OF ATTORNEY WILL CONTINUE TO EXIST EVEN IF YOU CAN NO
LONGER MAKE YOUR OWN DECISIONS RESPECTING THE MANAGEMENT OF
YOUR PROPERTY.
YOU CAN AMEND OR CHANGE THIS DURABLE POWER OF ATTORNEY
ONLY BY EXECUTING A NEW DURABLE POWER OF ATTORNEY OR BY
EXECUTING AN AMENDMENT THROUGH THE SAME FORMALITIES AS AN
ORIGINAL. YOU HAVE THE RIGHT TO REVOKE OR TERMINATE THIS DURABLE
POWER OF ATTORNEY AT ANY TIME, SO LONG AS YOU ARE COMPETENT.
THIS DURABLE POWER OF ATTORNEY MUST BE DATED AND MUST BE
ACKNOWLEDGED BEFORE A NOTARY PUBLIC OR SIGNED BY TWO
WITNESSES. IF IT IS SIGNED BY TWO WITNESSES. THEY MUST WITNESS
EITHER (1) THE SIGNING OF THE POWER OF ATTORNEY OR (2) THE
PRINCIPAL'S SIGNING OR ACKNOWLEDGEMENT OF HIS OR HER SIGNATURE. A
DURABLE POWER OF ATTORNEY THAT MAY AFFECT REAL PROPERTY SHOULD
BE ACKNOWLEDGED BY A NOTARY PUBLIC SO THAT IT MAY EASILY BE
RECORDED.
YOU SHOULD READ THIS DURABLE POWER OF ATTORNEY CAREFULLY.
WHEN EFFECTIVE, THIS DURABLE POWER OF ATTORNEY WILL GIVE YOUR
AGENT THE RIGHT TO DEAL WITH PROPERTY THAT YOU NOW HAVE OR MIGHT
ACQUIRE IN THE FUTURE. THE DURABLE POWER OF ATTORNEY IS IMPORTANT
TO YOU. IF YOU DO NOT UNDERSTAND THE DURABLE PWER OF ATTORNEY,
OR ANY PROVISION OF IT, THEN YOU SHOULD OBTAIN THE ASSISTANCE OF AN
ATTORNEY OR OTHER QUALIFIED PERSON.
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City of Zephyr hills
BUILDING PLAN REVIEW coIvIIvIENTIS
Site:
j(,~r /Jluml'/I(Un
5- 8-07
3A(;5/ fIoNA- ~
(Urz>rf C{/ CUt I 2- X ? 7
/
Contractor/HomeDwner:
Date Received:
permit Type:
Approved wino comments: 0 Approved withe below COlIIlllOIlts: 0 Denied withe below comments: liiI"'"
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s~t);d do( ill pevY'J 5~I-01
This comment sheet shall be kept with the permit and/or plans.
Contractor andlorHomeowner
(Required when co:n:ments are present)
PERMIT APPLICATION
..,..',...........,....
. , . . . . ...,'.
DRIVEWAY PERMIT APPLICATION
CONSTRUcnON WITHIN PUBLIC RIGHT-Of-WAY
All information must be filled-in completely
City of Zephyrhills
5335 8th Street, Zephyrhills, FL 33542
Telephone 813.780.0000 Fax 813.780.0005
Ve. Unit:
PL 33542
CONTRACTOR:
Com an :
Name: VI
Contractor's License #:
Phone:
E-Mail:
Fax: 7 7 'iJ'f6-37
ARCHITECT I ENGINEER:
Name:
Address:
State License #:
Firm Name:
City:
Phone:
State:
Cell:
Zip:
Fax:
Description of Pro;ect
TYPE OF DRIVEWAY
\/ RESIDENTIAL DRIVEWAY
_COMMERCIAL DRlV8NAY
_PUBLIC ACCESS DRlVEWAY
CONSTRUCTION MATERIAL
_ASPHALT
_CONCRETE
HEADWALL REOUIRED? _YES _NO
_ LENGTH OF DRlVEWAY
_WIDTH OF DRlVEWAY
R.O,W. EXCAVATION
_DEPlH _LINEAR FEET
CULVERTS NEEDED
( ) REINFORCED CONCRETE
( ) CORRUGATED MATERIAL
( ) BOX CULVERT
( ) OTHER (EXPlAIN)
CURB cur REOUIRED
_YES _NO
NOTICE TO APPLICANT: If actual work exceeds scope of this description, additional permits or drawings
will be required.
UTIUTY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
Page 1 of 3
. PERMIT APPUCATION
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
.-If 5.e e- ~ H tf. e h e ct dr tUU / ~
AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing
information is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all
approved construction documents, and issuance of this permit is verification that I will notify the property owner of Florida Uen Law
req., F.S. 713.
The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed
restrictions may apply to this property.
All work shall comply with the current Florida Building Code, Public Works Design Manual and FOOT Design
Standards (if applicable). (PubliC Works Design Manual online link: www.ci.zephyrhills.f1.usjpublic_works.asp)
APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT
TECHNICIAN OR NOTARY PUBLIC.
NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter /
interfere with existing stormwater treatment and I or conveyance.
PROPERTY OWJjE~: By signing this application: I certify that I have read and understand the owner/builder disclosure
statement. ~ (please initial)
A~i~1h~ !l k f J Applicant Signature Date
s-cr-() 7
(or) Notary Signature
Date
Applicant is ( ) personally known to me or produced
01-
(type of identification)
as identification.
Page 2 of 3
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. P'ERMIT APPUCATION
OFFICE USE ONLY
';"~".'?, .':.'<X ;~~X:~5'f;:~iii:,'~'~;~~~~;'!%~i.;'Jr!{~:~ltlt~~itj__f_.f~f:f;"~~~~W:: ~;:* .'.;;..~1~~;}':.;Y{'~;1(i,~~~'.i';;,;g.~ .' "
Concrete (min. 6")
Y N All tN, b" TM 'c lC '-IJ (T~'AJ ' fl., o. "" .
Length (min. 19')
Y N
Asphalt Base (min. 6'')
Y N
Asphalt (min. 11/2'')
Width (la' min - 20' max)
N
l2.
Existing sidewalk.
Y
New sidewalk.
Y N'
ADA compliant.
Y N
Expansion material required.
AJOJ fJ,eIVGWA Y -
Contiguous parking pad.
Triangular flare (3W x 7'L)
Visibility triangle o.k.?
Side set back (3' min. R.O.W.)
Plan Review Fee
OJ "T "4- C-
Col..) "EYA
S4fALL UO-r IIJTe:-~~ll.e
n.l.E ~rn~G l=i'U'\ ~'U)S
~~~ EXl.fl61T" I A _
Permit application approved by:
Date: S
Page 3 of 3