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HomeMy WebLinkAbout07-6890 CITY-OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 6890 Permit - Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: 166,725.00 Date Issued: 7/31/2007 Total Fees: 5,335.99 Amount Paid: '5,335.99 Date Paid: 7/31/2007 Phone: Work Desc: INTERIOR BUILOOUT - UNITS 102-106- BLOG 2 6890 COMMERCIAL AOO/ALT COMMERCIAL COMMERCIAL Address: 40417 CHANCEY RO #102-106 ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 18-26-22-0010-08400-0000 Name: THAKRAR,JOSH Address: 40417 CHANCEY RO #102-106 ZEPHYRHILLS, FL. 33542 SHARPLE S CONSTRUCTION INC FIRST CLASS ELECTRIC INC COAST TO COAST OF TAMPA BUILDING FEE WATER CONNECTION COMMERC FIRE P-t..AII Fl. .IEW FEES ::r f)<j p f.('C"T\ (JY\..D .j.- \ no.tQ 0 <6 -'\6L,71t~ ~ ?ee /' ROUGHELECT I SEWER 2ND ROUGH PLUMB INSULATION WALL LINTEL MISC PRE-METER INSULATION CEILING WATER MISC. SHEATHING MISC. FRAME MISC. ~~.~mEES:'Relrispection'feeswill-complywithFlorida statute 553.80 (2)(c) when extra inspection trips are 'necessary due to any one of the following reasons: a) wrong address b) condemned work resulting fromifaultyconstruction 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. FIRE DEPT. FINAL ELECTRICAL FINAL PLUMBING FINAL FINAL MECHANICAL BUILDING FINAL FIRE WALL ~~A\OC fjCJ""C'() ~ 10 to +cJ i*- loa 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. " !J~_~~ CONT~C OR SIGNATURE PERMIT OFFI PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER 813-780-0020 City of Zephyrhills Permit Application Building Department Fax-813-780-0021 Owner's Name Date Received . "l-~(,;;-C.7 Owner's Address Fee Simple Titleholder Namel Cfi Ii N CC-il 1<0/1 b Owner Phone Number Owner Phone Number I Owner Phone Number I Fee Simple Titleholder Address LOT # ]' 5- ~ 404 i7 CHrAN CL~ fin I PARCEL ID# I i<3, 'ZL? ..22 - OOlD - 0'-31..\-00. OGO b (OBTAINED FROM PROPERTY TAX NOTICE) o NEW CONSTR c=J ADD/ALT D SIGN D MOVE D D INSTALL D REPAIR PROPOSED USE D SFR D COMM D TYPE OF CONSTRUCTION D BLOCK D FRAME D DESCRIPTION OF WORK I ~t?O/( ASuilcJ ouT ~ UI'l.~'J. /() 2- -IC/O 6 L....v(J a BUILDING SIZE I SQ FOOTAGE I ro J Y 5 ~ I HEIGHT I "II' I' I" I'."" II., 1111111111111111111111111111111".. "II1IIIII r I (" I'" 11111' 1.'.1111111111 t 111111111" 111'1111'.. "11111111111111" III"'.' IIII 1$ I 1$ I 1$ I 1$ I D GAS D ROOFING D SPECIALTY D OTHER FINISHED FLOOR ELEVATIONS I I FLOOD ZONE AREA DYES DNO 1111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I111111111 J;f11#~r'5S (bu-r7 Zvc I I YI N FEE CURRENT I Y/N I License # I C/X:./2S' 2/c<::j I fvftA~~E14=i,;;~~~ I License # ~C-OcJt)A';-;>-cJ I I ~f!: 110 F~lf [11AJ License # ILf Co? to 71r<o I I I I I JOB ADDRESS Ifjl I SUBDIVISION WORK PROPOSED D BUILDING D ELECTRICAL D PLUMBING D MECHANICAL DEMOLISH OTHER I STEEL D OTHER I AMP SERVICE VALUATION OF TOTAL CONSTRUCTION PROGRESS ENERGY D D W.R.E.C. VALUATION OF MECHANICAL INSTALLATION Address MECHANICAL I SIGNATURE . Address I OTHER I SIGNATURE Address I License # 11111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I11111111111111111I111I111111111111111111111I111111111111 RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Plans; (1) set of Energy Forms; R-O-W Permit for new construction, Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans wI Silt Fence installed, Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisions/large projects Attach (3) sets of Building Plans; (1) set of Energy Forms. R-O-W Permit for new construction. Minimum ten (10) working days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed, Sanitary Facilities & 1 dumpster. Site Work Permit for all new projects. All commercial requirements must meet compliance Attach (2) sets of Engineered Plans. ....PROPERTY SURVEY required for all NEW construction. BUILDER SIGNATURE I ~/?(&Cd?~ rl COMPANY REGISTERED Address ELECTRICIAN SIGNATURE Address PLUMBER SIGNATURE COMPANY REGISTERED COMPANY REGISTERED COMMERCIAL SIGN PERMIT Y/N Y/N FEE CURRENT License # Y/N Y/N FEE CURRENT DI~~~ii~~~': I I . . . . . I I . . . I . . . . I . , . I I I . . . I . I . . . I I I I I . . I , , . . I . . . . I . . . . . . I . . . . . , , , . . . I . I . . . . I I I . . , , , . . . . , , I I I I I . . . . . . , , . I I . . . . . I I , , , , I , , , I I I . I I . I I I I I I I Fill out application completely. Owner & Contractor sign back of application, notarized If over $2500. a Notice of Commencement is required. CAlC 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 Fences (Plot/Survey/Footage) Driveways-Not over Counter if on pu~OadWays..needs ROW 'f" 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 WaterlSewer 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. 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, 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, WaterlWastewater 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 authon~y !o. vlol~t~, cancel, alter, or set aside any provisions of the technical codes, nor shall Issuance of a permit prevent the BUlldrng OffiCial from thereafter requiring a correction of errors in plans, construction or violations of any codes. Every permit 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) months after the time th~ work is commenced: An extension may be requested, in writing, from the Building Official for a period not t~ exceed mn~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 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 OTICE OF COMMENCEMENT. FLORIDA JURAT (F.S. 117.03) OWNERORAGENT ~~ ~ ...,.. l ~t:;~b~~ndb~wom_t~.~~~.~~rrl1~.d) before me this Who isJ~ersonally known to me or as/have produced '_..______._.._________ dentification. me or has/have produced as identification. Notary Public ORBITAL - 40417 Chancey Rd - Unit 102-106 Interior BIO SQ. FEET PRICE MAIN OR LIVING: 5,850 $ - OTHER AREA UNDER ROOF: - $ - OTHER - $ - VALUATION $ - FEE SHEET $ - ADDRESS $ - $ - DRIVEWAY $ - BUILDING: $ 1,081.50 ELECTRICAL: $ - PLUMBING: $ - MECHANICAL: $ - SUB-TOTAL $ 1,081.50 RADON: $ - TOTAL $ 1,081.50 SEWER $ 1,940.15 WATER: $ 1,124.95 IRRIGATION: $ - TOTAL: $ 3,065.10 WATER METER I $ IRRIGATION METER $ I W.Mtr paid on Unit 106 FIRE DEPARTMENT FEES PLANS TOTAL: $ 257.40 INSPECTION TOTAL: $ 15.00 PERMIT TOTAL TOTAL: $ 272.40 Corrected from 54.00 for Permit 6891 Corrected from 45.00 for Permit 6891 PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% TOTAL: $ - Already Paid Already Paid Already Paid SUB-TOTAL $ 4,419.00 PARK IMPACT FEESI I Not Applicable SIF'S: 100.0% $ - 1.0% $ - TOTAL: $ - Not Applicable TI F'S: $ 3,667.95 99% $ 3,631.27 1% $ 36.68 25% Due at Permittil $916.99 75% due at C.O. $2,750.96 Permit TOTAL: $ 8,086.95 I ~~'tP/Ll;f~l~J;~~~:;f~~3~;it~1 (01590 ORBITAL - 40417 Chancey Rd - Unit 102-106 Interior BIO SQ. FEET PRICE MAIN OR LIVING: 5,850 $ - OTHER AREA UNDER ROOF: - $ - OTHER: - $ - VALUATION $ - FEE SHEET $ - ADDRESS $ - $ - DRIVEWAY $ - BUILDING: $ 1,081.50 ELECTRICAL: $ - PLUMBING: $ - MECHANICAL: $ - SUB-TOTAL $ 1,081.50 RADON: $ - TOTAL $ 1,081.50 SEWER: $ 1,940.15 WATER: $ 1,124.95 IRRIGATION: $ - TOTAL: $ 3,065.10 1~ - I W.M', pa;d on Un' 106 . l< b'6'l~ 0<' Y ''1/ -(,~ () orf ;.Y' en r- ~ ( ] 0.~(l.-"~ ~e;!~c WATER METER:I $ IRRIGATION METER $ FIRE DEPARTMENT FEES PLANS TOTAL: $ 2-4!'lor> 54.00 INSPECTION TOTAL: $ ~ 45.00 PERMIT TOTAL L? IS.ot TOTAL: $ 99.00 PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% TOTAL: $ - Already Paid Already Paid Already Paid SUB-TOTAL $ 4,245.60 , PARK IMPACT FEESI ~ Not Applicable SIF'S: 100.0% $ - 1.0% $ - TOTAL: $ - Not Applicable TIF'S: $ 3,667.95 99% $ 3,631.27 1% $ 36.68 25% Due at Permittir $916.99 75% due at C.O. $2,750.96 Permit TOTAL: 7,913.55 S3?>S.99 -'I"S "':1~J.'S-.~ ~~C2r-: -2t~.j!t; :,:c;::..:;:ar:C:i ?~an ~Cu 3Lsir.ess,.l\ccrsss: 3L.s;ness .::~c::e\lc.: 3Ls;neS3 =3X .'JC.: Z'.= j= :-r"rR~~J~__S =1;;,'= f'"\';:".:A ~-J '-1 iJ:: \.J-J' ...., \........ .., _d ... ~u;"",,\ tV~." :'~t~ :2H-1 ~CCC. :.s~r::fr1Hls. =~ 3254-2 =~S ,;JA3' :-5C-.XJ.'~ '3 -: :3 ~ 780--':;0d4 =}RE SE~'i!CE "'-...l.M .~EJ!E':V .'''==3 ':Cr:T2C:: ,'jiC \liC ~' "jle."lar - :UliGing ,"'ans ""::.&'_IISICr: ...J'- .,;..j .::6 -~f 57 "":"1\iCP'P5 3";'S-:=~.n .::'~r :;;scr 325 3?~.~~~'~!K:"'-=? 3''/:T~:=:~iS -' - _= ~S3CS ;::c _ '--' :l11s-eacs 5c(} .=1R= ?UNIP --~r -'_:,---:C ;): ,";v =:R':= .':'.L..:a.:K;I" 3"(S7:=:'.zi -= 9'JIC2S '25 ::;IUS ':c'JIC2S JetJ 3;~poqESSICi\l 3'(S7=::I15 '.t"/9t 3:5 ~r./ ;-.~-=- ,,-~ ~25 : ether ~:5 3REA SEiVENTJU TIC N i;OCdJCucIs .3:5 ,"L-\NS TC;.~L r~ ?v;" ~ -ok :..;mn;ents: NS?EC-:-:CN ='=::3 ....i_nnual ~ sr .~e-.nSi:ec::Icn 2nc ;:;,e-inscec:icn Jrd :~s-;nsDec:jGn ...Lth ~e-.nsiJec:ion :tn ~e-,'ns~ecIiGll :crslruc:icn :c.~rr.er':::c:1 3?q~~~Kl.....=R 3"!ST2MS ~\,crc ~rcer~rCL.;ndS 545 -:ycr':SlaIic .system Ne[ ,-\cc8clanc2 :::-'. '':'(;~2c;canc:.s .~~/Cr3Gt =:cw -csc 3cGttl :=(t:=3se ~uc: :5~c; ...~ 550 :S-:25 3250 3500 515 ~~c; .,"-~ :545 ~30 ro ,~ .J-v 't--:-r::::. .-d.c:....... 1"')11 ';;~v 515 3'12:8:1'': ,-c;:::z:::nanC8 =;RE AL.~RIVI 3'/S~::::\Il 350 .~ec3i1."CC2Planca :-:-'ER <,\="09 ,/all/SmCKe 'Vall t" _.-i ~2S \Jan.:raJ -..::as '='--O:cJ ~anx.s -ant .55C j;15~j 525 <~c; ""'v .~- ':,).c:.~ 515 ~ N"'P"'--'~N -....TA'.~ ; - -!...,', tL.o 'v L.~ GRAND ,OTAL US;';;~~ ~J.rJ~ b!llllig-ccr~: \ 0 ~ '~,lVL '33&,Z,7 3iiling =hone \10.: S C3- 7~~~~ 2iiling ;-~ Nc.: Cc~tac~: ;JERMIT :==E ;=.~LSE ALARM F::E ! sL-\iarm N/C 2na Alarm N/O 3ra rllarm N/O 4th Alarm 525 5th Alarm 550 ~ 3P~!NKL'=:;::: 3'/5T:=:\II5 6th Alarm F5 h 7th Alarm $100 '-J i 3th .-'Iarm $150 II 3th "'\Iarm $.200 i i I lOth .-'Jarm $250 ,.-., i ' ~ ,\jon Compiiance 5150 -':'-~lcmatjc 515 ';'ffio8Vli ,)f ServicelReoalr" :=:RE ."UMP =;re ;:::!lmC S-15 ;::RE AL~RM SYSTEM :: erection :5':5 OTi1E~ 3as 345 I~ .\ialurai I~as , .=ire NarKs L ;:'Jel TanKs .$45 :525 $45 3REASENENTIL~TION L .'-lOCd/Cuc:s '(ilchen Suppression $15 ;l'-tJ::: .;),~ .;:ALSE ALARM TOTAL ; PERMIT TOTAL! jI) 91 I :::are: 7~bf . I r ^1 -.;jAr';# ~ W- ,nspec:cr: Page 1 of 1 Bill Burgess From: Bill Burgess Sent: Monday, July 16,20073:26 PM To: 'josh@orbitalcorp.net' Cc: Kerry Barnett Subject: fees for build outs of bldg 2&3 \~ , ( ~, c " ~. (. \' L' ~/ " I,,': ';~ , ' A , i)'\V , 0',\ Josh here are the numbers we discussed earlier if you have any questions call me, thanks Bill Building #2 units 102-106 (5850 total Square feet) Building Permit Fees: $1,081.50 (does not include tire department review or inspection fees, contact Kerry) III "1\.0 [ .\ \J r, ". Sewer wastewater treatment Fee: $1,940.15 o::..~.. ':1,,\'-:J'-"' Water Impact Fee: $1,124.95 Transportation Impact Fee: $3,667.95 -' Building #3 units 102-105 (4,680 total square feet) Building Permit Fees: $933.00 (does not include tire department review or inspection fees, contact Kerry) Sewer wastewater treatment fee: $1,608.50 Water Impact fee: $899.96 Transportation Impact Fee: $2,934.36 The fees quoted are based strictly on square footage as per applicable ordinance. Public safety impact fees are not applicable as they were paid at time of shell permit. An additional $180.00 water meter fee will be applicable x total number of street addressed units. J" ~" Bill Burgess City Of Zephyrhills Building Official 7/20/2007 Zephyrhills Fire Rescue 6907 Dairy Road, Zephyrhills, FL 33542 Fire Marshal Kerry Barnett Bus (813) 780-0041 Fax (813) 780-0044 May 16, 2007 Plan Review Comments I have reviewed and approved the plans for an interior build-out located at 40417 Chancey Rd (unit 102) under the following conditions. My comments have been placed below. Please contact me if you have any questions with regards to my comments. 1. The type of business/occupancy utilizing this unit may require additional fire protection or a greater fire separation between tenants. 2. Exit lights required above all exterior doors. 3. Adequate emergency lighting shall be installed in open area and restroom. 4. Certified fire extinguishers shall be installed in compliance with NFPA 10. 5. Install knox box on front of building. Application provided. Inspections required: 1. Firewall inspection to ensure no penetrations. 2. Building final. . f~:- \"'" 1'~~ { '. ,<--,\\s I\. 1 , ' .' ., J<.".".;,'u..~__(S' ~ '\' '. . \ ,.\>> n IoU\: I' . ~,....q (. ~,,1t\.\.I.1 r ""'~ 't\tC ' '. ,f\" ')\1 \",e',- v) ."- ~\'" "<l\ID ccr.;.\<; \)J \01 c ~. - ~~ ~~ ~ \ t" ~ ~ ~ ~ - - '1 ~ ~ -$ ~ ~ ~ V) l. -s::: -r - () -:r- ~ :J f .!(!. -.J LC :::> i ''S' '). --T~ ~ .-' '-1-> 'l- a <.....~ "':) -- ~ S~ ,-l ~ {..."") >-lOZ <:r: >-l <( c;') ~S~B ~CQ@z :=><(u<( >--8uC'E .....J c:.:: '-J 0 f:::oP::;c:.:: ..:;?,>-l'""'o o w... &:5 en Uu-5o-...lo-...l _1~ ~ o-...l o-...lOo-...l~ <:r:O-<O::: :::z::uZ>-- C/)OO:::z:: ~;z;ho... o:::~::-<~ 9~Z~ :$ >= ~- 0 ~J~O>- <(c:.::OE-' o...uC 6' , J i/) ~cn~ l....J ....J ~o:: O::w W>-z ~- ~a.~ _W<C ON.....'.! ,'>\ ~ u.. 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H >Zstt 'U "'''3 opea I....IS qlL L(6fl _..r_v"'......__.__ .__ I"-'::'I\I'T'I:;'(.\'- -- . t::l'::44::'M,.1~--=-r'r":':-;:,,:::-~- y~. ....., ...;- ~... '.'~."""."'."'" ri":-;:'" , ~ \ /, i; . "i"" 4'/] ',,; ~~-' V. V . i j ~ 11 i~ ".- ...~-~. :.:-:-:; ....-:~~- ,_________. I '\_: "'l. "-', ,. n (") ~ () PERFORMANCE BUSINESS PRODUCTS. INC. 813-71l1-llOO8 FAX 813-719-7919 n n n n CITY OF ZEPHYRHILLS ZEPHYRHllLS, FLORIDA WATER ACCT. NO. ~~~i:~ Oebl~ (~~ MAIUNG 4b4-'2.-\ 0Y\~ QrG. n n n n DATE 9-- \ Cc _D 7 SERVICE ADDRESS SHUT OFF SERVICE 404\/ (i'y\p\~l'O.i t o ~\u./' 00.-- EJ ~.e\O GY TURN ON SERVICE INSTALL METER READ METER o CHECK METER o o OTHER QX-.cu~ ~ \ Ola -tc> \O~ Pe..\~ - (0%'10 WORK COMPLETED BY & DATE COMPLETED Qc1 ~ \O~ ~ WATER o SEWER o GARBAGE ~N CITY o OUT CITY -L No. OF UNIlS _ DEPOSIT AMOUNT _ AMOUNT LAST BILL -~ 50 ,,~.... MISC. CHARGE P~ci2 8^-( - QJ'l e..clL :fi~3/1 ORDER TAKEN BY ORDER GIVEN BY &~ ~~O-A 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.