HomeMy WebLinkAbout08-7819
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7819
Permit Number:
Permit Type:
Class of Work:
Proposed Use:
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
7819
ADDITION/AL TERATION
434-ADD/AL T RESIDENTIAL
NOT APPLICABLE
Address: 5849 19TH ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
31,725.00
5/01/2008
169.85
169.85
5/01/2008
GARAGE ATTACHED
MULL T, RIA
5849 19TH ST
ZEPHYRHILLS, FL. 33542
Phone:
6.35
(irJ
5- 5-05
M
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME 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 recordin our notice of commencement."
~
TRACT . SIGNATURE PERMIT OFF I
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPBYRBILLS PERMIT APPLICATION
BU:ILDING DBPAR'l'MBN'r 5335 Oft at, Z..phyrhills, I'L 33542
013-700-0020 FAX: 813-780-0021 / / t/
DATE RJ:CJ:IVJ:D /,)./ f7Z IV
. vll.~ '.
PHONE CONTAC'l' FOR PEmc'TTI.~~:-t/;~ . bg? -I ~5 )
<-..~-'~'--_.'-'--_.,
PHONE 8'1-3 -77<1- '6110
OWNER'S NAME 6.bne'v -1Y)u.-tl-e:I-
JOB ADDRE8S '5"r"-1Q 1'1-H... ~ Z ~'1 v L' I Ls- . -R
.
......
LEGAL DESCRIPTION: LOT(S)
PARCE~ I~)
-:=-..- ." --" ..-'-
WORK PROPSED: []NEW CONSTRUCTION
o SIGN
PROPOSED USE: ~AMILY DWELLING
o COMMERCIAL
BLOCK
~TION
o MOVE
3~<:l/~
SUBDIVISION
IORTAIN FROM PROPF.RTY TAX NOTTr.F.1
o ALTERAT ION
o REPAIR
o INSTALL
o DEMOLISH
OMULTI-FAMILY
o INDUSTRIAL
O. OF UNITS
o SWIMMING POOL
o MOBILE HOME
o OTHER
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
DBSClUP'l':ION 01' WORK. GQ(Cl-~ adM'ln-
BUILDING SIZE <l-S"{ X 28/ SQUARE FOOTAGE /L7() 5"11 rf-
HEIGHT
RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
.-
PBRMITS REQUESTED
(0
/
~'JILDING
g' ELECTRICAL
o PLUMBING
o MECHANICAL
$ /tJ - /~. coO - VALUATION OF TOTAL CONSTRUCTION
AMP SERVICE
o Progress Energy D
o GAS
D ROOFING
o SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
D OTHER
~~E
$
TYPE OF CONSTRUCTION: D BLOCK
FINISHED FLOOR ELEVATIONS
D STEEL
D OTHER
jo
IS PROJECT IN FLOOD ZONE AREAD YES
r;d~ 9 <-{ljud
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zucnuc,," ~ ~ .. _I
SIGNATURE . . ~
BUiLDBR
SIGNATURE
() /.)...JA.LV
COMPANY
STATE CERT OR REGIST *
COMPANY
~
STATE CERT OR REGIST I
******************************************************************
~.
COMPANY &)l.4~ ~
/' .........
STATE CERT OR REGIST #
MIlCHAN:ICAL
******************************************************************
SIGNATURE
*****************************************************************
COMPANY
O'l'HBR
SIGNATURE
COMPANY
STATE CERT OR REG 1ST I
STATE CERT OR REGIST t
813-780-0020
City of Zephyrhills Permit Application
Building Department
Fax-813-780-0021
Owner's Name '...e..-r
Owner'sAddress 1'58~C) J q-rG -9r-cd-
Fee Simple Titleholder Namel
Date Recllived
Fee Simple Titleholder Address
S'-S: l) C(
I O;-I-L' ,s.J-f-i' ~A--
LOT #
JOB ADDRESS
PARCEL ID#I
o
o OTHER I
~- STEEL c==J
DESCRIPTION OF WORK Do' D .z. 0 d cL{ +{ ei.....-J t.. i-I (.1 C U (;/
~~~~?.'~,~,~~'" ,I, ~~~ ~..: ~,:?,~,~,,!,'" ,~~ ~?~~~~~'" e. .?~, ,:.;, !i:,." ,~~I~~~,!""",.""""",., ,I,..."...,...."...'" ,
o / BUILDING 1$ /0/ C(!;'O I VALUATION OF TOTAL CONSTRUCTION
d ELECTRICAL 1$ 1-))( Lt:/U I AMP SERVICE 0 PROGRESS ENERGY
1$ I
1$ I
o ROOFING 0
FINISHED FLOOR ELEVATIONS I I
NEW CONSTR
INSTALL
SFR
BLOCK
I
B
o
o
(OBTAINED FROM PROPERTY TAX NOTICE)
SIGN D MOVE 0
DEMOLISH
SUBDIVISION
PROPOSED USE
TYPE OF CONSTRUCTION
B
o
o
ADD/All
REPAIR
COMM
FRAME
WORK PROPOSED
OTHER I
D
W.R.E,C,
D
D
D
PLUMBING
MECHANICAL
VALUATION OF MECHANICAL INSTALLATION
GAS
SPECIALTY 0
FLOOD ZONE AREA
OTHER
DYES
DNO
BUILDER
SIGNATURE
MECHANICAL
SIGNATURE
License #
Y / N FEE CURRENT
License #
Y/ N FEE CURRENT
License #
Y/N FEE CURRENT
License #
Y/N FEE CURRENT
COMPANY
REGISTERED
Y/N
COMPANY
REGISTERED
PLUMBER
SIGNATURE
Y/N
Address
COMPANY
REGISTERED
Y/N
Address
COMPANY
REGISTERED
OTHER
SIGNATURE
Address I ' I License # I I
111111111111111111111111111111111111111111111111111111111111111111111111111111111;111111111111111111111111111111I111111111111111111111111111111111
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 w/ Silt Fence installed,
Sanitary Facilities & 1 dumpster; Site Work Permit for subdivisionsflarge projects
COMMERCIAL Attach (3) complete sets of Building Plans plus a Life Safety Page; (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
SIGN PERMIT Attach (2) sets of Engineered Plans.
....PROPERTY SURVEY required for all NEW construction.
111111111111111111111111111111111111111111111111111111I111111111111111111111111111111111111111111111111111111111111111111111111111111111111111111I
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 AlC Fences (Plot/Survey/Footage)
Y/N
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 witli 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. 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, 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 "An, 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 ~all. .
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 properti~s, the.ow.ner 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 ~f the permlttln~ conditions s~t forth In
this affidavit prior to commencing construction. I understand that a separate perm~t. may ?e reqUlr~d for elect:lca.1 work,
plumbing, signs, wells, pools, air conditioning, gas, or other installations not speCifically 1n?luded. In the application. A
permit issued shall be construed to be a license to proceed with the work a~d not as authorr~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, construction or violat~o~s o~ any codes. Every ~ermlt Issued. shall become. invalid
unless the work authorized by such permit is commenced Within SIX months ~f permit Issu~nce, or If work authorrzed. 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 perrod not t~ exceed nrn~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 O~AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.~~ ' "'I'
, I CONTRACTOR
~=~~~~~dG~T r affirme b or /Tle Subscribed and sworn to (or affirmed) before me this
~"I-(Yi3 b ,d by
Who is/ar~ pers:nallY known to me r has/hav~ produced Who is/are personally known to me or ha~:~~:~[~:~en~
L. CCASoe as Identification.
Notary Public
Notary Public
Commission No.
Name of Notary typed. printed or stamped
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780-0020
BUILDING PERMIT
7819
Permit Number: 7819
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
31,725.00
5/01/2008
169.85
169.85
5/01/2008
GARAGE A IT ACHED
Address: 5849 19 H ST
ZEPHYRHILLS, FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
MULL ,GLORIA
5849 19TH ST
ZEPHYRHILLS, FL. 33542
Phone:
RADON
~yJ
Lt)- 5/05
D MI
FOOTER BOND DUCTS INSULATED SEWER MISC.
ROUGH ELECTRIC LINTEL MISC MISC.
1ST ROUGH PLUMB PRE-METER INSULATION WALL MISC.
DUCTS INSTALLED WATER MISC DRIVEWAY
PRE-SLAB SHEATHING MISC. MISC.
CONSTRUCTION POLE FRAME 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 recordin our notice of commencement."
C~.:-( /k:U2l
V'CO TRACT~ SIGNATURE PERMIT OFF I
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
CITY OF ZEPHYRHILLS
5335 - 811i STREET
(813)780-0020
BUILDING PERMIT
3665
Permit Number: 3665
Permit Type: ADDITION/ALTERATION
Class of Work: 434-ADD/AL T RESIDENTIAL
Proposed' Use: NOT APPLICABLE
Square Feet:
Est. Value:
Improv. Cost:
Date Issued:
Total Fees:
Amount Paid:
Date Paid:
Work Desc:
31,725.00
12/09/2004
339.69
339.69
12/09/2004
GARAGE ADDITION
Address: 584919TH ST
ZEPHYRHILLS. FL.
Township: Range: Book:
Lot(s): Block: Section:
Subdivision: CITY OF ZEPHYRHILLS
Parcel Number:
Name: GLORIA MULLET
Address: 5849 19TH ST
ZEPHYRHILLS, FL. 33542
Phone:
HOMEOWNER
RADON
12.89
DUCTS INSTALLED CONSTRUCTION POLE 2ND ROUGH PLUMB
DUCTS INSULATED PRE-METER WATER
SHEATHING Mise SEWER
Mise MIse MISC.
MISC. MISC. MISC.
MISC. DRIVEWAY MISC. MISC.
REJNSPECTJON FEES: When extra Inspection trips are nec...ry due to anyone of the following I"8IISOns, ill
charge of Thirty-five Dollars ($35.00) ...... be made for each trip for each biKIe:
(a) Wrong address (b) Condemned work resulting from faulty oonstruction (c) Repairs or OOrrectlons not made when
inSpection 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
The ment of Ins . n fees shall be made before an further rmlts will be Issued to the rson ownin same
"Warning to owner: Your teilure to record . notice of commencement may result In your paying twice for
Improvements to your property. If you Intend to obtain flnandng, consult with your lender or an attorney
before recordl r notice of commencement. ·
Complete Plans, Spedftcations and Fee Must Accompany Application.
All work shall be rformed In accordance with CIty Codes and Ordinances
NO OCCUPANCY BEFORE C.O.
. ~~
NTRACTOR SIGNATURE PERMIT OFFI
CALL FOR INSPECTION - 8 HOUR NOnCE REQUIRED
PROTECT CARD FROM WEATHER
A. NOTICE OF DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions" which.
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, 813-780-0020.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
contractor(s) sign po:rtions 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 indica~ion that he is not properly licensed and is
not entitled to permitting privileges in the City of Zephyrhills.
C.' TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's ,Protection 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 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, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I must take to
be in compliance. Such agencies include but are not limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areas,
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "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, VALUE 00 NUT NEEO TO RECURO ANO POST A "NOUCE OF ""..J""'HENT".
~_1 ~-ZZJ. '
SI ATURE: owijtR OR AGENT SIGNATURE: CONTRACTOR
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _ day of
by
acknowledged
, 2~
(name of person acknowledged)
Dwho is personally known to me, or
Dwho has produced
(type of identification)
and whoD did 0 did not take an oath.
Signature of person taking acknowledgement
Name typed, printed or stamped
STATE OF FLORIDA
COUNTY OF
The foregoing instrument was
Before me this _day of
by
acknowledged
,20_
(name of person acknowledged)
C1ho is personally known to me, or
o who has produced
(type of identification)
and who Ddid D:iid not take an oath
Signature of person taking acknowledgment
Name typed, printed or stamped
n:ISCLOS'D1UI: STATlDDDIT POll 01IRBR
CJ:n OP ZZPH!lUI:rLLS Bu:rLDDIG n3PARTIID'l'
:I, G h rl (L ~'): '1Y\LLd& haTe r.ad ancl fully UZldarstaDd and
agr.. to the provisiODII of this instrument.
'l'he lmdersigDed stat.s ancl affi%1U that he or .he is desiroWl of ccmstructing,
renovating, adding to or reroofing his or her 0WZl doaicile" that he or sh.
actually occupi.s, or will occupy by 'said damicile, and .... i. DOt for
rent, l.a.. or sale. That he or she s~l comply with the follow!:a.g co:a.di ticms:
1.
That the OWZler and h., or .he alone .hall act a. the builder for all pha... of
cOl1lltruction.
That the OWZler will comply with all provisicms of the City of Zephyrhills
ordi:a.anc.. a:a.d codes p.rti:a.ent to the huildi:a.g.
That ill the event various pha... of co:a.struction are suhcozitracted, he will
engage onl.y properly licens.d 8uhco:a.tractor. and will per.o:a.ally supervise
such work.,
'l'hat i:a. the eve:a.t the Builcling :Insp.ctor shall r.quir. corr.cticms to be made,
the ow:a.er will as.ume full rellpo:a.sibility to insure they are made, and upo:a.
completion will call for a r.i:a.8pection before proc..cling with the buildi:a.g.
That the owner shall _sume full r.spODllibili ty for the cODIItructio:a. a:a.d will
DOt exp.ct .upervisio:a. of hi. work from the Ci ty of Zsphyrhill. Buildi:a.g
nepartme:a.t.
That prior to final inspection any adclitio:a.al fees, iIlcludi:a.g r.insp.ction
f..., DrWIt be paid ill full. A writte:a. r.quest from this office shall
CoIl. titutean official notic..to pay additional f_s.
That the ow:a.er shall comply with all City, State and Pederal la.. ill regard. to
Social .ecuri ty, workman I s compe:a..atio:a., lien la"., .tc., where applicabl..
That the ow:a.ar .hall comply with all the .afety codes issued hy the Plorida
%:a.dustrial Commis.ion.
State law requir.. co:a.structio:a. to he daae by licens.d co:a.tractors. You have
applied for a peX1llit und.r an exemptio:a. to that law. The exemptio:a. allOWll
you, as the OWZler of your property, to act a. your 0WZl co:a.tractor with certaill
re.trictio:a.s even th011g'h you do :a.ot have . licens.. You mWlt provide dir.ct
emsi t. supervisio:a. of the CODlltruction yourself. You may hui1d or impr~ea
one-family or two-family re.ide:a.ce or a far.m outbuilding. You may al.o bui1d
or improve a commercial hui1di:a.g, provided your co.ts do :a.ot exceed $25,000.
The hui1di:a.g ~r residenc. mu8t h. for your 0WZl use or occupa:a.cy. %t may :a.ot
he built or .ubstantially improved for sa1e or l._e. :If you s.11 or 1.... a
buildinsr you have built or.ubstantial1y improved your..lf within 1 year after
the CODlltruction is complet., the law will pr.sumathat you built or
substantially improved if for sal. or l..s., which is a violation of this
exemptio:a.. You may :a.ot hire an UDlicensed parson to act a. your Co:a.t:ractor or
to .up.rvi.. p.ople worJti:a.g OIl your bui1ding. :It i. your r..PODBibili ty to
make sure that p.ople IIIIIploy.d by you have licens.. requir.d by state law and
hy cou:a.ty or mu:a.icipal lic8l18ing ordi.:a.a:a.ce.. You may DOt delegate the
respODllihi1ity for SUPervising work to a licens.d contractor wbe is :a.ot
1.:i.c8l1lled to perf 0%111 the work be:i.ng done. Ally per.on working on your bui1di:a.g
who i. DOt l.:i.ce:a.s.d must work under your direct superv.:i..io:a. a:a.d II1'WIt be
emp1oy.d by you. which mew that you DrWIt deduct P.:I.C.A. a:a.d withholding tax
and provide work.rs' compensation for that employ.., a1l a. pr.scrib.d by law.
Your CD:a.lltructio:a. ZIlUIIt comply with all appl.:i.cable la"., ordi:a.a:a.ce., building
codes, and zoning regulat
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CITY OF ZEPIIYRHI.LLS BUILDING DEPARTHBNT
OWNER
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SHOW ALL EXISTING & PROPOSED STRUC'rURES
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ADDITION PLANS FOR
GLoRIA MUU.ET
PA6CO COUNTY, Fi.ORIDA
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PA6CO COUNTY, FLORIDA
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138Z1. u.s. HWY 91 av PASS II
DADE CITY, R.OMtA 33S2I ' .
OfRcE 3D62:I.2O'77 FAX 3lD8114070 ."
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~~ p~ 13821 u.s. HWY 91 &Y PAIS
GLORIA. N\JL.L.ET D4TE.I~ ~TE~11olC. DADE cnv, R.ORIDA 33S2S
... PAScO COUNTY, FLORIDA .~",I- OPACE 3S2oQ.S.2Q77 FAX H2-U74010
"m WQOU4.~..~-.....2 "'- "'-'
.',' ,. JC:e NO. l''lC/-406U --... ...-- RESIDENTIAL &; COMIIERCIAL DDIGNS
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Gloria Mullet
5849 - 19th St.
SQ. FEET PRICE
MAIN OR LIVING: 1,269 $ 25.00
OTHER AREA UNDER ROOF: $ 50.00
OTHER: $ -
VALUATION $ 31,725.00
FEE SHEET $ 190.00
ADDRESS $ -
DRIVEWAY $ -
BUILDING: $ 285.00
CREDrr: $ -
BUILDING LESS CREDIT: $ 285.00
ELECTRICAL: $ 42.00
PLUMBING: $ -
MECHANICAL: $ -
SUB-TOTAL $ 327.00
RADON: $ 12.69
TOTAL $ 338.89
SEWER: $ -
WATER: $ -
IRRIGATION: $ -
TOTAL: $ -
---------,
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WATER METER:l $
IRRIGATION METER $
PARK IMPACT FEES ( $
- J
- ~
339.69 r
SUB-TOTAL $
SIF'S~ $
97.5% $
2.5% $
TI~~:
- j
- I
TOTAL: S
339.69 J