HomeMy WebLinkAbout08-7758
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7758
Permit Number: 7758
Permit Type: FIRE PROTECTION MAINTENANC
Class of Work: FIRE-PROTECTION MAINTENAN E
Proposed Use: COMMERCIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 7325 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CllY OF ZEPHYRHILLS
Parcel Number: 34-25-21-0000-00300-0020
4/15/2008
25.00
25.00
4/15/2008 Phone:
FPM-HOOD CLEAN-SEMI ANNUAL-SWEETBAY SUPERMARKET-COMPLETE 3/5/08
Name: SWEETBA Y SUPE MARK
Address: 3801 SUGAR PALM DR
TAMPA, FL 33619
fi/lu!2
S_ZS-uS
Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT 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."
....
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
HRii~
81 :i-780-0020
Date Received
OC'7/MON 02: 1:, PM
ZEPHYRHILLS BUILDING
FAX No, 813-780-0021
-lf1~
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: 3Iic
city of Zephyrhills':Fh'et'. ':'..
Permit Application
'Phor!l;l Contactfor Pennlt
,I S u/1;'1:;y ~ It! S (,( "GJW>>~ It" /1 f.J. I Owne~s Phone Number
Ownl;lr'sAddtMs f7325 C;4GA..- "(..vi/) l..t:/PJlYI2I#';(,~ R J)S'II
Fee Simple T1Ueholder Name I ~ Tdleholder. Phone Nwnber
Fee SlmpleTitleholderAddress .,
17'J2.,f CA (,{, 'B(..(./I)
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Owner's NiUllB
Job Address
SubDivisIon
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(.()mp,e'n:'tJ ')/ r/o 8'
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Emergency Generator < 30 I<w
.l:metgency GerMntor > 30 kW
Are Protection Meintenance - ANNUAL .
'D~'~'~~
Sprinkler 0 0 CI L-.J
~ Fi19AlalTl'1 0 CJ 0 CJ [:J
~pu;~ 3h4o Hood Cleaning ~ 0 ~ 0 CJ
~Hood Suppression ~ 0 tY' 0 C:=J
D Are Alann lnetalkltion
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Flammable Application- ANNUAL
FUfilI Tanks
D Other: I
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Address 1/J~.1 ~",~/I'f- 111/4". CAHhUa~~P(. 'lJ~tl
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Signatu....
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Directions:
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--z,.e:P JI'Y/2.Ih ",,,~ F (. :1:1 J'fI /
I Parcel # J
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aio-Hezard Waste Storage -.'ANNUAl
Comm Exhaust K1tehen HoodfOuct
Controlled awn
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o Recreational Bum
o 'Sparklert;
o Sprinkler System Installations
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Fwnigallon Tent
Hazardous Materisl (TIer 11 or RQ Facility) ANNUAl
Hood In:lallation
LPlNatural Gas-Instalkltion
LP/Natural Gall~'ANNUAL Sale
!,>Iaces of Meembly-ANNUAL
Standpipes (Sprinklllr Sys)
Torch RoOflnglTar Kettle
Waste TIre Storage ANNUAL
,~ Valuation of Project
-
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-
Company I 'M:' u:rJl;/}UI" SY.T:Wn oS d "~ "t..
Registered N I Fee Current I Y J N 1
_hicen&B_#_..J I 81 Y1I t;) (J ~ D ,3. e" 7 I
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license tt- I I
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Y/N I
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Y/N
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Y/N I. FeeCUlTent I Y/N I
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All out application completely,
Owner & Contraetor sign back of application. notarizsd (Or. copy of signed contract with owner)
If over $2500, a NotIce of Commencement is roqulred.(Mechanlcal work over $5000)
Supply two (2) Bets of drawings with applicable docl.ImBnlalion
Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax N<;rtic:e (http://appralser.pascolilOV.r.;om)
'NOTICE OF :DEED:RESTRICTIONS: The .undersigned understands .that this permit may .be'subjectfto7.-dead~lri:Jstrictions"-'
.which may be more restrictive.than County regulations. The',undersigned assumes responsibllity.for:comp!iaf.l:ce1with 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 loeal'r~gulations. tf the
contractor is not licensed as required by law, both the owner and contractor may.be clted-for.a 'misdemeanor violation
under state law. If the owner or intended contractor are uncertaIn ,as 10 what Iicensing'requlrements may :apply for the
intended work, th~y are advised'to contact the Pasco County/Building Inspection Division-Licensing Section;at 727-847-
8009. Furthermore, If the owner has hIred :acontractor 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 entltJed:to permitting privileges In .pasco
County.
CONSTRUCTlON:LIEN.LAW (Chapter713,'Florfda 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'Mowner", 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 pennit 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 tIle 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.
If I am the AGENT FOR THE OWNER, I promise In good faith to Inform the owner oUhe permitting conditions seHorth in
this affidavit prior to commencing construction. .1 understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included In the application. 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 al'!Y 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 codes. Every permit issued shall become Invalid
unless the work authorized by such permit is cOmmenced within six months of permit issuance, ot if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days 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'N'OTICE 'OF 'COMMENCEMENT MAY'RESUL T 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.
FLORIDA JURAT (F.B. 117.03)
CONTRACTOr' ~ y ~~~ -- ~CJ
Subscribed and sworn to (or affirmed) before me this
by
Who Is/are personally known to me or haslhave produced
as identification.
OWNER OR AGENT
Subscrlbed and SWOrn to (or affirmed) before me ttlls
by
Who Is/are personally known to me or haslhave produced
as Identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed; printed or stamped
Name of Nowry typed. printed or stamped
ZOO'd
lZOO-08L-E18 'ON XVd
:JNIG1Ina SllIH(]AHd3Z Wd S 1: ZO NOW/LOOU60/~dV
04/09/2008 09:37
7043775140
FIRE CONTROL SYSTEMS
PAGE 02/06
STATE OF FLOlUi>A
DEPARTMEN'i' OF PINANCIAL SERVICES
DMSION OF STATE FIRE MARsHAL
TALLAHASSEE, FLORIDA
FlRE EQUD'MENT DEALER LICENSE
TH1S CERTIFJF..s THAT: F1RE CONTROL SYSTEMS OF CHAlU.QTlE INC
1143 COMM!!IUCALAVE
CHARLoTr.E, NC 28205-
QUAUPIER: DAVJD W KRIz n
HAS COMPLJ.ED WITH FLORIDA STA111TES AND HAS QUALIFJED FOR 1HE TYPE AND CLAsS SHOWN HEREON TO SERVICE. REPAlR,
INSTALL OlllNSPEcr All TYPES OF PRE-ENGINEERED FIRE ExTINOUISmNG SYSTEMS. EXC1.UDES ANY S'ERVICE, RECHARGE, REPAIR,
INSTALLAnON OR INSPECTION OF ANY TYPE! OF HALON EXTINGUISHER. .
'~~~
ChlerFlnueitl OfJieer
01 01 2008 07 04 Out of State
Issue Date T)I1)C Class County
18188000012003
UcenselPennit Number
9885690001 12 31 2009
Appliclll:ion # Expire Date
04/09/2008 09:37
7043775140
FIRE CONTROL SYSTEMS
PAGE 05/05
ACORD"" CERTIFICATE OF LIABILITY INSURANCE I DAte (MMIDDIY', 'tV)
04/09/08
PROOU~ :1-701-865-8584, THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMAl'ON
!fatson :II1euranC!o Agency, IDe. ONLY AND CONFERS NO RIGHTS UPON THE CERnFIC)I,TE
245 E. Seeond Ave. HOLDER.. THIS CERnFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POUCIES BELOW.
.0 !lox 87.9
Ga8~OQia, He 28053-0819
INSURERS AFFORDING COVERAGE NAICfI!
1N8U1V5D INSURER A; zv.:r; S t: IruiCMQ,i ty InG\U;'al:lce Co.
P~~e Conero1 Syse~ of Chllr1ot:.t:..., :tile.
INSURli;RB:AHCo IlQlNJ:'anoo eo "-
110 C:~C!;l,al Avo. INSURERc:.Ace,;,dl!!lIlt: nmcl IDS Co of AlneZ':!.aa
Charloeec, we 28205 ;NSlJRERO;UUed Proelc:L"tv II: Call. :tile. Co. ..-
INSU~ E: ..-
COVERAGES
THE POLICIES OF INSU~NCE LISTED E11!!1..0W HAVE BEEN ISSUED TO THe INSUREO N^MliD ABOVE FOR THE POUCY peRlOO 'NDICATeb, NOlWlTHSTANDING
ANY REQUIREMENT, TeRM OR CONomON OF ANY COIllTRACT OR OTHER DOCUMENT WITH RESPISCT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PE"TAIN, THE INSURANCE AFFORDED SYTHE POLICies DESCRIElEO HEREIN IS SUBJeCT TO ALL THe TERMS, EXCLUSIONS AND CONDmONS or:: Sl..eH
POLICIES. AGGREGATE LIMITS SHOWN MI\V HAVE BEEN REDUCiD BY PAID CLAIMS,
= . POLICYNIlIllfJliR J'OLlCYEFFEC'I'Ivl; I'OUCY ElCPIU,TfON UMrrs
'.-
A ~RALlIAIiIILfTY 51GLOO,,0.98081 0<V01/0e 04/01/09 -=~ $1000000
x :=iMERCIAl, GeNI!RAL LIABILITY S SOOOO
f- ClAIMS MI\OE [!] OCCljR ..-
'-- MEO!iXPIAltvllflCl_1 S 5000
.
f'ERSONIILIADV INJURY $1000000
GENl!RAl.AGGREGATE S 2000000
..
~'I. AOORen UL1lT Af'Pn PER: PROOUCT'8-COMF'/OP AGG $1000000 .-
POLlCY P,~ LOC "-
B ~UTOI\I08IL.I;LIA8ILfTY ACPBnA7121811002 04/01/08 04/01/0.9 OOMSlNEO SlNGU! lJMlT
S 1000000
~ Arof'f AUTO . (EAAc:ddenl) .-
- ALL OWNEOAUTos BOOII. '( IN.IURY
(F'erporwnl $
- SCHI!DUI.Ec AUTOS
..:.. HIRED AUTOS 1l00IL Y INJURY
$
X NONoOW~D AIJTOS (PorAlldderC)
-
- PROPlimv DAMAGE $
(Per-I)
RIlAQI; LlAIlllJTY AUTO ONt. V .IiAACClOENT $ "-
Arof'f AUTO O'Tl-tER THAN ~1\CC S
AlJToONLY: AGO S
A t:5l!SSIUMBIU!LIJ\ LlIIBlLl1Y nC:COO1341oBl 04/01/08 04/01/01l EACH OCCURRENCE $ 2000000 "-
X OCCUFt 0 ClAIMS MAOE AGGREGATE $ 2000000
S "-
R OEDUCTlBLE S ..-
RETeNTION $ 10000 $
e WORKE!RS COMJIENaAT1ONANO HCI1600e4S2 04/01/08 04/01/0l! X we STATU- I IO~
liMPLOYER$' LlA81L1tY ~- $UOOOOO ..-
/IH'f PflOPfllfrrORlrARTNERlEXECUT1ve e.L, EACHACClDIiNT .-
ClFFI~EXcLullED7 E.L. tlISl5ASE. EA EMPLOVllIi $1000000 '-
~J~~~tiNs_ E.L OISEAS!;'POI.ICYUMrT $1000000
0'Ttt1lft ACPCIMP7121811002 04/0.1/08 04/01/0.9 jr.<<!IIIiIAd or Rent:e4 50000L/SOD%>
D ~~~nt Floato~ DEaCRII'TlOfl OF OPeRATlDNllI LOCATIONS IYl!HICLES IEXCLU8IOMB ADIlED BYI!NOORaEIII;IU I $l'ec'N. I'ROVl!lIONS
CERTIFICATE HOLDER
CANCELLATION
USA
SItOUUl Al'lY OF THI! MOVE DI!8CR1BISJ POLICIES 8E CANCE;I.I.F.D f.leFORl! THE I!XI'IRA"",'"
D..TIO THliiREOfI. THE ISSUING INBURF.R WILL I!-"'~ TO MAli. -!L DAYIl VVRlTT!IN
NOne!! TO THE CI!fmFlCATE HOUll!ll NAMI;D TO TtfI! LEFT, BUT FAlI.lJlVj TO 00 SO SItJl.u,
IMros6 NO OILlGATlON DR UAlllUTY OF IUtV ~p UPON TH! INSUltER, m AGeNTS ,~
REl'RI!SI!NTA.TlYQ.
AUTHOllIZmlMl'RIESENTATIVI! J" ~/ / _
/~~.......
@ACORDCORPORATlON1S~
'.-
Ciey of ~~pb~h:l.l1e
5335 11th S!:.2:'I'lel;
Zephyr.A111e, FL 33542
ACORD 25 (2oo1IOB) hmeraeZ'
BS08~80
04/09/2008 09:37
7043775140
FIRE CONTROL SYSTEMS
PAGE 04/06
CIty-County Tax Collector
P.O. Box 31677
Charlotte, NC 28231~1577
City of Charlotte &/or Mecklenburg County
Privilege. License
#BWNFWQR -~*~********~AUTO-*3-DIGIT 282
#00476176# .
I.. I .11..1.. .1.111., ..1.1,.. .fI.I..III." ...11.'..'..".1'...'
FIRE CONTROL SYSTEHS OF CHARLOTTE INC
1143 COMMERCIAL AVE
CHARLOTTE NC 28205-1401
license is not tpansfe~able. This includes Changing from SOle-proprietor to a
Corporation or a Limited Liability Corporation (LLC). This would also include a
corporation changing their. Federal Identification NUmber. GS 105-366(dI111Ial
reqUires notification to the Tax Collector forty-eight (48) hours prior to gOing
out of business, the transfer of or pending sale to another party_
POST IN A CONSPICUOUS PLACE. Must be posted in a Vi$1Dle public area, where it can
De inspected at all times.
DO NOT REPRODUCE. OOCUNENT VOID IF NOT DUAL COLOR PRIIfT.
Changes in tbe Ticense dUPing the yeap; The business shall report a Change in the
information contained in the license to the T~ Collector within ten (10) business
days after, the Change occurs. The 11cense must be surrendered to the Tax
Collector w1th payment of a five dollar ($5.00) fee, for each license tha~ needs
a change. The license Shall be SUDject to cancel~ation for failure to comply with
this sect10n Of the Ordinances. Fo~ Beep/Nine Licenses, we AYST see new ABC Pepmits
~efTect;ng cbanges,
THIS IS NOT A BIll.
(1) 000260
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04/09/2008 09:37
7043775140
FIRE CONTROL SYSTEMS
PAGE 03/06
STATE OF FLORIDA
DEP ARTMEN'i' OF FINANCIAL SERVICES
DMSION OF STATE FIRE MARSHAL
TALLAHAssEE, FLORIDA
FIRE EQUIPMENT DEALER LlCENSE
THIS CERTIFIES THAT: FlU CONnOL SYSTEMS OF CHARLOTTE JNe
1]43 COMMERICALAVE
CHARLOTTE. NC 2820S.
QUJ\LIFIER.; DAVID W KlUZ n
HAS COMPLIED WIni FLORJDA STAl1JTES AND HAS QUALIFIED FOR mE TYPE AND CLASS SHOWN HEMON TO SERVICE. RECHARGE,
RBPJ\IR, INSTALL, OR INSPECT ALL TYPEs OF FJR.S EX11NGUlSHERS EXCEPT RECHAR.GlNG CARBON DIOXIDE VNlTs AND TO CONDUC'i'
HYDllOSTATIC TESts ON WATER., WATER. CH."6MrCAL AND DRY CH:6MICAL TYPES OF FiRE OOINGUlSHER.s ONi. Y. EXCLt.1DEs ANY
SERVICE, RECHARGE. RCPAlR, INSTALLATION OR-INSPECTION OF ANY 1'i'PE OF HALON EXTINOUIsmJt
.-
~~~
ChicfFinancj=-, ometr
01 01 2008 07 03 Out ofstatc
Issue Date Type Class County
18188000032003
9885680001 12 31 2009
Application # ~irc Date
Lieen,c:/Pcnnit NumbeT
04/09/2008 09:37 7043775140
FIRE CONTROL SYSTEMS
PAGE 01/06
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~_~#I!A FIRE
.-~ CONTROL
SYSTEMS
] 143 CoMMBRClALAVENUE
CJwu.OTTE. NC 28205
dave@firecontrolsys.com
DAvmW.Ktuz
VICE PRESIDRNt . FIELD OPEMnoNS
704-377-3022
800-237-9701
PAX 704-377-5140
CEll 704-577-8092
DATE: 1:,/0 r
SUBJECT:
TO:
COMPANY:
C>~ IfF 4}?h~h~:{. Fc.
AnN:
Number of pages including cover sheet
please call us at (704) 377-3022.
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,
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1143 Ccmnercial Avenue O1ar1otte. North Carolina 28205 1~704-3n-3022
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813) 780-0020
ANNUAL FIRE PROTECTION MAINTENANCE
7759
Permit Number: 7759
Permit Type: FIRE PROTECTION MAINTENANC
Class of Work: FIRE-PROTECTION MAINTENAN E
Proposed Use: COMMERCIAL
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
Address: 7325 GALL BLVD
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number: 34-25-21-0000-00300-0020
4/15/2008
25.00
25.00
4/15/2008 Phone:
FPM-SUPPRESSION-SEMI ANNUAL-SWEETBA Y SUPERMARKET-COMPLETE-3/20108
hf\J
yZ3-0f?
Chapter 633, Florida Statutes, authorizes the City to charge and collect user fees to pay for the costs of fire
prevention and protection related activities such as inspections, plan review, administrative fees, and other
costs related to the aforementioned.
Complete Plans, Specifications and Fee Must Accompany Application. Commencement of work without written approval of
the Fire Department's Fire Marshal or required permits or opening up for commercial activity without an approved final
inspection shall be charged double permit fee per day of operation or a minimum of $100.00, whichever is greater. All
work shall be performed in accordance with City Codes and Ordinances.
"WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF
COMMENCEMNT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS
TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE
OF COMMENCEMENT."
....
P IT OFFICER
PERMIT EXPIRES IN 30 DAYS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
ZEPHYRHILLS FIRE RESCUE DEPT - Fire Marshal Office - 813-780-0041
APR/09/2007/MON 02: 15 PM
ZEPHYRHILLS BUILDING
FAX No, 813-780-0021
-lf1~~
.:3I1c
813-780-0020
City ofZephyrhills':FIr:ei;" ':'.:
Permit Application
.:,~ 'Phor!e Contactfor Pennlt
Date Received
;ttt ~
:I 813 n
Owner's NiUllB :1 S u/1;'1::T ~ It! S (,( "GJW>>~ It" !1:J'.J. I Owne~s Phone Number
Owner's AddtMS ':r73 25 C;4GA..- ,,(..(//) l..t:/PHy,(2I#'A,~' R J)S'II
Fee Simple TItleholder Name t I Tdleholder. Phone Nwnber
l=e6 Slmple'Tltleholder.Address '1
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Job Address
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o 'Sparklel'&
R Sprinlcler "System Installations
D
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Fwnig~lion Tent
Hazardous Materi~1 (TIer II or RQ Faclllty) ANNUAL
Hood Installation
LPlNattJral Gas-Installation
L~NawraIGa~ANNUAL~
. I'laces of Assembly-ANNUAl.
Standpipes (Sprinkl8l' Sys)
Torch Ro01IngfTar Kettle
Wa$te Tire Storage ANNUAL
., Valuation of Project
IIIIIIIIL
. .. Address 11J'I3
ELECTRlCIANI
Signature .
Address I
PLUMBER I
Signature
Address I
MeCHANlCALj
Signature .
Addresl'l I
OTHER I
Signatu.... .
AddrB&l> rl
Dlrectloml:
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Company I FI~ G8l/.;f}tJl>c.. $vsJaln..s ~ "~I
Reglstel8d ~ N 1 Fee Current I Y I N 1
Licen~_#_...l 13IYJ't::Jo ~Q /2 .O~
~~:~ I
L1cel1ge ~ I
Company I
Registered . Y I N
License # I
Company I
Registered Y I N I. Fee CUlfent I Y I N
. Ucel1ge # I
:;:':d 1- Y I N I. Fee Currant
Licene # L
J
Y/N l FltBCUrranl I Y/N I
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Fee Current
Y/N
Fill out appllca1ion complelsly.
Owner & ContraelOr sign bac:k of application. notBrizsd (Or. copy of signed contnl<:l with owner)
If over $2500, a Nottce of Commencement ilirequ/red.(Mechanlcel work over $5000) .
Supply two (2) Bsb; of drawings with applicable dooumentation . .
Allow 10-14 days for review after submittal dais. Parcel #. obtained flOn'! Property Tax Notice (http://appralser.pascogov.com)
--~-.~... . .....') - -~_.._- -...
'NOTICE OF:DEEO:RESTRICTIONS: The.undersigned understands.that this permit m~y.be'subjectfto:.~dee:d~!T"astrictionsw..
_which may be more restrictive .than COunty regulations. The'.undersigned .assumes .responsiblliw Jor~mp!iar.lI;e\with any.'
.applicable deed restrictions.
UNLICENSED ;CONTRACTORS AND <CONTRACTOR. RESPONSIBIL:ITIES: If-the owner'has 'hire(l';a>contractor 'or -
contractors 10 undertake work, they may be required 'to be licensed in accordance with state and local.r~gulations. 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 intendedcontrootor are uncertain ,as to what Iicensing'requlrements may ,apply for the
intended work, th~y are advised.to contact the=Pasco County:Building Inspection Division-Licensing Section.-at 727-847-
8009. Furthermore, If the owner has hlred:a . contractor or contractors, he is advised'to .have ,the contractor(s} sign
portIons of the .contractor Block" of this.appllcatlon '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 entltled:to 'permitting .privileges In Pasco
County.
CONSTRUCTlON:LIEN:LAW (Ch~pter713,'Flortda Statutes,.as:amended): tfvaluation 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. tf the applicant Is'someone
other than the'.owner", I certify that I have obtained a copy of-the above described document and promise in goocHaith to
deliver It to the .owner" prior to commencement. .
'CONTRACTOR'SIOWNER'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 regulation~ in tl:le 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.
. tf I am the AGENT 'FOR THE OWNER, I promise In good faith to Inform the owner of.the permitting conditions seHorth in
this affidavit prior "to commencing construction. ./ understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not specifically included In the application. 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 al'!Y 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 codes. Every permit issued shall become Invalid
unless the work authorized by such permit is cOmmenced within six months of permit issuance, ot if work authorized by
the permit is suspended or abandoned for a period of six (6) months after the time the work Is commenced. An extension
may be requested, in writing, from the Building Offioial for a pertod not to exceed ninety (90) days 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'RESUL T 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 NonCE OF COMMENCEMEKT.
FLORtDAJURAT (F_B. 117.03)
CONTRACTor ~ ,.:./ ~??- - ;:::c:.r
Subscribed and sworn to (or aftlnned) before me this
by
Who Is/are personally known to me or haslhave produced
as identification.
OWNER OR AGENT
Subscribed and SWOrn to (or afllnn9d) before me tills
by
Who Isfare personally known to me or ha6lhave produced
as Idenllllcation.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed; printed or stamped
Name of Notary typed. printed or stamped
ZOO 'd
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