HomeMy WebLinkAbout09-9014 •
CITY OF ZEPHYRHILLS
5335 - 8TH STREET
(813)780 -0020 9014
BUILDING PERMIT
--yy
Permit Number: 9014 Address: 5043 10TH ST
Permit Type: RE -ROOF ZEPHYRHILLS, FL.
Class of Work: ROOF REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: ce , ° Parcel Number: 11-26-21-0010-21200-0030
Improv. Cost:
Date Issued: 4/13/2009 Name: JOHNSON, RUTH
Total Fees: 75.00 Address: 5043 10TH ST
Amount Paid: 75.00 ZEPHYRHILLS, FL. 33542
Date Paid: 4/13/2009 Phone:
Work Desc: RE -ROOF - 16SQ - SHINGLES
`€ x= '$a 'i €7 l s K. •4 w •� sz0.s *t:*
HOME IMPROVEMENT SERVI ES REROOF RESIDENTIAL 75.00
ryia
O
k
ig .. •�`"„t e.e 4 ., ax,: :tr9�s•OR . >•;� ...fir, @r j 7,��,,t
DRY IN ROOF INSP
TAPE JOINTS ROOF INSP
FINAL
REINSPECTION FEES: Reinspection fees will comply with Florida 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
from faulty construction c) repairs or corrections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this property that
may be found in the public records of this county, and there may be additional permits required from other governmental
entities such as water management, state agencies or federal agencies.
The payment of inspection fees shall be made before any further permits will be issued to the person owning same
"Warning to owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
before recording your notice of commencement."
CONTRALTO SIGNATURE PERMIT OFFI �R
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 Fax -813- 780 -0021
Building Department
Date Received - /3'e 4. Phone Contact for Permitting --
Owner's Name 1 11111 • ..I 0 nl Owner Phone Number S73 7,2- — '/Q
Owner's Address --CZ f ? 10 -t-42 Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address a
JOB ADDRESS 5-0 3 104 Ft' - LOT #
SUBDIVISION Ti - :7 N Z H-(tt t 1S PARCEL ID# r/-)--6-4).-/— 00/0 --?/ o r 003
I (OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR ADD /ALT I I SIGN I MOVE 1 1 DEMOLISH
INSTALL REPAIR
PROPOSED USE [ I SFR I I COMM I I OTHER 1 I
TYPE OF CONSTRUCTION I 1 BLOC K I `,p FRAME 1 1 STEEL I I OTHER I I
DESCRIPTION OF WORK � 1D O ("' — (j J g- • - 14 64 -- E S
BUILDING SIZE SQ FOOTAGE HEIGHT
l) I BUILDING $ O' 3 f O ' o o VALUATION OF TOTAL CONSTRUCTION
1 I ELECTRICAL $ o AMP SERVICE 1 I PROGRESS ENERGY I I W.R.E.C.
I I PLUMBING $
M VALUATION OF MECHANICAL INSTALLATION (l1
__--
1 1 $ 49
I I GAS I Vr I I SPECIALTY I I OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA 1 IYES I
BUILDER COMPANY til L_ J �
I. LV 1 C--E
SIGNATURE REGISTERED Y/ N 1 EE CURRENT I Y/ N 1
Address I 1 (-( 7 1 (LS. rl w iq J. CL o.. 1, . �3 f 1 `j' License # CC -CA) Sd G1-
ELECTRICIAN COMPANY
1
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N 1
Address 1 License #
PLUMBER COMPANY
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT 1 Y/ N 1
Address License # I
MECHANICAL COMPANY
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y / N 1
Address /� License #
OTHER COMPANY 4 (c..- p V, Sk2vi C 3
SIGNATURE REGISTERED I Y/ N 1 FEE CURRENT I Y/ N 1 l
Address I License # I CC C � d-
OS
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 subdivisions /large 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.
Directions:
Fill out application completely.
Owner & Contractor sign back of application, notarized
If over $2500, a Notice of Commencement is required. (A/C 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 A/C Fences (Plot/Survey /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 clone 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 "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 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 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 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
may permit is suspended or writing, from the Building i Off Official for 5 a period not to exceed t n ninety days and e will demonstrate
may be requested, in g,
justifiable cause for the extension. If work ceases for ninety (90) consecutive days, the \ j ob is considered abandoned.
WARNING TO ILURE
TWICE OWNER: YOUR F FOR IMPROVEMENTS TO YOUR PROPERTY. T IF YOU INTEND E TO OBTAIN FINANCING, CONSULT
PAYING TIC
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT (F.S. 117.03)
OWNER OR AGENT CONTRACTOR
and sworn to (or affirmed) before me this
Subscribed and sworn to (or affirmed) before me this by
by Who Is/are personally known to me or has/have produced
Who is/are personally known to me or has /have produced as identification.
as identification.
Notary Public
Notary Public
Commission No.
Commission No.
Name of Notary typed, printed or stamped Name of Notary typed, printed or stamped
1iG IMPROVEMENT SE1. , ICES
• 14377 U.S. Hwy. 19N • Clearwater, FL 33764 1951 Porter Lake Road, Suite A • Sarasota, Florida 34240
Phone: 727. 5304412 • Toil Free 1-871- 8454880 Phone: 941-377-6100 • Toll Frog 1- 877-374.6775
Fax: 727-5394912 Far 9414774133
LIc. No. CCCO58227
SALES CONTRACT
Name Im reverent Services agrees to furnish all materials end labor to do the modernization work at the following address:
Name o > t� __ Phone 13 7& - 4 O2)Phone (w)
Address .5O '13 L O Z'ti` Date
ay_ "Ley' 11 0 State )i" t • ,, Zip 33 SVa
in accordance with a specifications given below:
A.SHINGG LE ROOF 3 D r 0 / Sh kncr1-e- 3O1 r- 1 0-\:1 or c ,wo rkr s
A. SHINGLE
1. REMOVE OU) ROOF TO WORKAB • SURFACE wQae -rt
2. RENAIL ROOF DECK wml RING SNMIK NAILS. 11
3. REFIACE ANY ROTTED WOOD WITH STANDARD SHEATHING • 97,05 PER FOOTANO M0A0 PER SHEET OF PLYWOOD, F AreffrillIsh
4, INSTALL S,A, WATERPROOFING UNDERI.AYMEt1T R ENTIRE ROOF.
A. INSTALL FHANA EAVES GRIR. COL
G. INSTALL NEW VALLEY METAL AND FLASHINGS AS NE BART.
7. INSTALL BOOTS OVER VENT PIPE+ AND RESEAL S.
0, INS YEAR FIBERGLASS SHINGLES, COLOR_ „_•
9. INSTALL OF RI00E VENT A T 36.00 PER FOOT L••• l
10. CLEAN•UPJ SITE OF ALL WORK DEBRIS AND HAUL AWAY AU_ RELATED DEBRIS AND LEAVE, JOB SITE CLEAN.
11, CONTRACTOR WILL COORDINATE REMOVAL AND REINSTALLATION OF ROOF RELATED PERIPHERALS SAC$ AR (OUT NOT LMIITE0 701 SOLAR UNITS, SKYLIGHTS, TV. DOH
AND AIR CONDTIONERS, ETC. REMOVE AND REINSTALL examen SOFFIT AND FAOIA 0 $A,75 PER FOOT N A00IT)0N TO CONTRACT PRK:F„ F RECOPIED. THE COST FOR
SUCH WORK WILL 9E N ADDITION TO CONTRAST PRICE AND HEREIN APPROVED BY HOMEOWNER.
B. PLY ROOF SYSTEM
I. - 1 • OLD ROOF TO WORKABLE SURfADE
2, R' IL ROOF DECK WITH RING SHANK NAILS.
9, REP ANY RO71® WOOD WITH STANDARD SHEATHING e 97.00 PER FOOT AND 39040 PER SHEET OF PL • . •, F ANY *Nab
4, IISTALL WATERPROOFING IIIJDERLAYMENT OVER ENTIRE ROOF.
5. INSTALL - LEAD BOOTS.
e. INSTALL EAVES DRIP. COLOR
7. INSTALL t JOY • • • COLOR
3, CLEAIwPJOB B • ALL WORK D AND DEBRIS AND HAUL AWAY ALL RELATED DEBPIS LEAVE JOB ' • CLEAN.
1, CeMmet D00anenln, - • • Cmlltla o1 I141 document, oNV0 wouWweod a , 71 ay, 000 - 1 g t D • O�
hereunder in to ha l - • M maiming adaaa
aea, Ne pfenase Omer ban Men speelaaby set • h Me mama Contract Price S_-_...1________
Moses man bs : • . • ... , Other early. The snare undeNtandin9 end 00 9101018 e) Inn pa Is wma1YM In me
conked kanteres 7. une ereleed and eweed Ilal 0 010113901 ot ?Oblong 1999190 Mon Home , • L d 50011 1 t 01 n duly .
M0fOued MOM MAW and 14 <. , • by an elks or ONO of Ina Suter.
3. Work onln job emoted etthe .. . „• Meammenceonappoximmet. mabocompleted Permit e_ __---_ - - - _
on epproMm8Mla .1 • rolled ant• nn .pplodma6ero end 0 11 00 n9 901 41 0 ; 01
Was I10m s4or nos* menages, :. God end olor Mane 011 foramen Seger. Sean mewed the MN to
*piny any sub- weeder for (he mrlpellen l9. work MOM In 1116 • • • de0anals,
4, Hone Improvement Senses mew the dedt • ROOM mMON of • • or new Woe ern Iona Any mWI••d
emo oI au* to We retard* ply3100d, ronpum 010.40 bard, ot . bead m a Pme old mAalol been. *s Mar Total $ .. ... --
chances regaled by Now JeneractIo al 0000 - • .- • 0 L•1wa may • M WWMa* Mamas.
5, W$010 l M ore rate 01 elphlo9n ( per arm pot Wes be • • ' on NI balances not paid 69 OHM lens MEOW
81190aReam*d aeo1112y91ws ell be ramped to I . - • • in neesWxylop0m MN =Veal In Me hands or an
Wormy 1m meelell, and dl0 awe becomes a pod 6I , • - • end 1b11ge60n IS ins Purdoser to pay.
0. Preto agree Mal OM sweemenl sites bn mnewed : • • • , 10 Ne lam d Are d Bda and I1 Y Re10n wok/0 113 Deposit S - _ __ -_ --
aNmnn my be amMt Sol
In eta e d poedn, venue la • A.• , t loo In Pardee courts Fonda
7. BUYERS micro news..0re Cow went the ' - or.- ow you meg rmmlalaegleemanlbyp 19 Wilo
naOre Belem mon, by bleglsm• - maim •.., 4Mal you 0o no wan Medee09 6fV**Ad
most be deemed or peetmarked bolero • • • Oro 6114 • . , • . Mar you NM MN 819000111*,
8. o B 1 M m en w n ore" c o m p e t i t i o n end public MOW • . ere arced by . $eam ere am epptenbb le me work lobo Sub101II S___ ______ -
e. I b uZI itecs Mn wend x110) Me bumf • d Nyman, Herne 1 • . . S0M6de, Mr Any somagc NM may occur*
Me burr's mummy* d16109016» . d moxlakl snider Ale ra ove1 of • *Ned de1N Net maybe required to 1 0 0 .
warm OMs tam Improvement •. Furthermore, me buyer hen* Owe • .. • for 'pawl deem "Maw and BALANCE DUE S 1
typing Wage rOmONet veNaet 10 , - r NM 011. Byte) fee me pupae el •• • • 0as Wes coramd. Pitts TDIBI hole Item No. 3 strove)
10. Common* 07 ldnee • . eraIMM .Nnnol1oo11debedpelpnelwalntle nmMNroa to) ednulYC.**lite
Iv. doe end or .. . . . . . . . 4 1 31c Tn. cm for mlduwool NAe be la addll*nla .. , wd approved by honleownm, UPON COMPLE'T10N
11. Home kmevemen ` • • 01471 not be hell rompmlalle ler domme 10 AMAIN Ines. • Nos, *errant Mu or
Mier rnedw6* • . • . • that wl h been Monks* IMldod new roe Moans and • _ clammed ANN p00om4rl
Ow n a ,Edo rowel e l ti a d H M O Im49nwmnn S o m m e small nor De Rlpadble IN any . . . .90 14 16 1 0 16 1. 0 !
12. Coo a p on •- omrely Fuld AMMO may be..v *M 11 e require n Me DARK II you lom 'm0* • a Propel preformed
wow wpm, . pm kw mom Irom epedited *ankle It 01 Florroa new by a stren.M0Cea con • . Fer
Infannelon . so term* rum end IMp a deem, eonma1 Me Fetch Carraaj0dl l)4uwy Worming - • • al me
wimp : phone nAdlreand address: 7960 Mallon Expressway, Suite 900 Jadun1Re, FL 77'71.70. of 9111 Iwo)
727 •,
13. • EN, Fbnde Slo otoc contains Implant requl mmonte you rnue110NON b4faa you may bring a legal
e • , ter an Molted constivellee defect In your home. Sixty days belie you Ming erg MOM salon, you
- Mlle other p6M to ink canine! a wmNn nonce relenkp to ChM* 6513•01199y MOW Mnsnudlbn de . -. •
ad10 wnddsmakMgenoff rto MOb orpayfortheMetted csesbuctiondef ects. You Am not obligated to newt
. maw seem may be made, Thom we and deadline under Florida Lew which mud b0 Mel and Idbwed lo
protd your Ilereele.
Executed In triplicate, one copy of which was delivered to. and receipt Is hereby acknowledged by Buyer, this
g , day of 1P1i;I ", , 20 fl9' .
Approved and Accepted:
NOTICE TO OWNER
a. Do not sign thls home improvement contract In blank.
b. You are entitled to a copy of the contract at the time you sign. Keep it to protect your rights.
(Seal) (X) - "- - -4 4Q G
V (Seal)
i (Dealer- SOlier) (Pure r Sign Here) •
BY - (X) ,(Seal)
U , ) (Purchaser Sign Here)
/- �/" IL- ~
s. ESMAN
HI 0700063 NIS 3 • 4124106
RS 0701530
NOTICE OF COMMENC MENT
•
LCS
Permit No. 12.-y/111,1i4
Tax Folio No. ;1- 34 - D-1 — 00/ 0 - 0 03o 111111111111111111111111B1111111111111141
2009050 027
THE UNDERSIGNED hereby gives notice that improvements will be made to certain real property, and in accordance with Section
713.13 of the Florida Statutes, the following information is provided in this NOTICE OF / C ' O � MMENCEMENT.
1.Description of p r o p e r t y ( l e g a l d e s c r i p t i o n ) : 1 `g W ( Z 4141 c (i S 3 J �'K I
a) Street (job) Address: ID 3 " (- , rL . _
2.General description of improvements: + (7 F 1
3.Owner Information --��--
a) Name and address: RU /((. ,Jp ( +PICO N )0 3 I O S t . 2 /4tf f &l CL F _
b) Name and address of fee simple titleholder (if other than owner) l
c) Interest in property (1) W fi
4.Contractor Information HOME IMPROVEMENT SERVICES
14377 US 19 NORTH CLEARWATER FL 33764 :P
a) Name and address: � � �
b) Telephone No.: 727- 530 -0412 FaxNo.(Opt.) 727 - 539 -6912
5.Surety Information
a) Name and address: pep 0 0 7353 Ree : 10.00
IT: 0.00
b) Amount of Bond: 04/13/09 Dpty Clerk
c) Telephone No.: Fax No. (Opt.)
6.Lender PAULA 5. 0•NEIL, PR5CO CLERK S COMPTROLLER
a) Name and address: 04/13/09 16gg 1 PG 1042 Phone No.
7. Identity of person within the State of Florida designated by owner upon whom notices or other documents may be served:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
8.In addition to himself, owner designates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statutes:
a) Name and address:
b) Telephone No.: Fax No. (Opt.)
9.Expiration date of Notice of Commencement (the expiration date is one year from the date of recording unless a different date
is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF
COMMENCEMENT ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART I, SECTION 713.13,
FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY.
A NOTICE OF COMMENCEMENT MUST BE RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST
INSPECTION. IF YOU INTEND TO OBTAIN FINANCING, CONSULT YOUR LENDER OR AN ATTORNEY BEFORE
COMMENCING WORK OR RECORDJ) UR NOTICE OF COMMENCEMENT.
��pL1C,5TA1E O5li
STATE OF FLORIDA li F" ` r L+• Vv . 652*Vg l /� /�
COUNTY OF PINELLAS �': T U$St0C1 # D �4, 2011 pq, e " ` —
a C,am Y
;# � � 6 •F tNQ� gnature of Owner or Own Authorized Officer/Director/Partner/Manager ,
6 Print Name
The foregoing instrument was acknowledged before me this to day of /0/2/1 L , 20 D9, by jei. A
/ 1.4 , J Li 111 r't as 0 CV (Y (type of authority, e.g. officer, trustee,
attorney in fact) for (name of party o, I if of who instrument was executed).
Personally Known OR Produced Identificatiol. -- Notary Signature , t
Type of Identification Produced 4 , 9 �t c Name (print) `C ( Q-- . v" 2 ,,'
/73 - 2o - o
Verification pursuant to Section 92.525, Florida Statutes. Under penalties of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my knowledge and belief. .
FORMSM(K'.rvsd2007 f ,J / / / /� �./1. .._,.�
ignature of Natural Pe Signing (in line # 10.) Above
STATE OF FLORIDA, COUNTY OF PASCO
THIS IS TO CERTIFY THAT THE FOREGOING IS A
TRUE AND CORRECT COPY OF THE DOCUMENT
ON FILE OR OF PUBLIC RECORD IN THIS OFFICE
WITNESS MY HAND AN Pt !FFICIAL SEAL THIS
3 _ DAY OF !V.. 2 CO 1
PAUL •'NEIL, CL ' ". & CQMPTROLLER
BY L / �` v DEPUTY CLERK
•
HOME IMPROVEMENT SERVICES
14377 US 19 N. Suite 101 LIC. #CCCO58227
Clearwater. FL 33764 Certified Roof Contractor
Telephone (727) 530 -0412
Fax (727) 539 -6912
APRIL 13, 2009
CITY OF ZEPHYRHILLS
BUILDING DEPT.
To Whom It May Concern:
This is to give John Presy and Peter Wozniak authorization to obtain permits for Home
Improvement Services.
JOSEPH E. RAY
CONTRACTOR - do,
LIC: CCCO5$227 a/
Swom_to, subscribed d sworn before me this day of , 2 /L , 2009, by
S e. 1 who is ersonally known me or has produced
identific.J ion
My Commission Expires:
Oti
0 -&-X
Notary Public
��`"."•�: CARRIE COHEN
_ * MY COMOISSON a DD 796742
11 4 EXPIRES: August 22, 2012
'T9, `° omoike Bonded Thai Budget Notary Services
Pasco County Parcel: 11- 26 -21- 0010 - 21200 -0030 001 Page 1 of 2
Search Again Show Map Generalized Building Schematic Frequently Asked Questions Estimate Taxes
Other Agency Data: Tax Collector School Board Supervisor of Elections
I Data Current as Of: I Weekly Archive - Saturday, April 11, 2009
Parcel ID II 11- 26 -21- 0010 - 21200 -0030 (Card: 001 of 001) I
Classification 1 01 - Single Family
Mailing Address Property Value
JOHNSON RUTH M Ag Land $0
5043 10TH ST Land $27,280
ZEPHYRHILLS, FL 335422129 Building $38,033
Physical Address Extra Features $1,197
5043 16TH ST
ZEPHYRHILLS, FL 33542 -2142 Market Value $66,510
Assessed (Save Our Homes) $63,761
Homestead 196.031 - $25,000
Legal Description (First 4 Lines) Non - School Additional Homestead Exemption - $13,761
TOWN OF ZEPHRYHILLS AKA CITY
OF ZEPHRYHILLS PB 1 PG 54 LOTS Non - School Taxable Value $25,000
3 & 4 & NWLY 30 FT LOT 4.A School District Taxable Value $38,761
BLOCK 212 Warning: A significant taxable value increase
may occur when sold. Click here for details
and info. regarding the posting of exemptions.
Land Detail (Card: 001 of 001)
I Line a II Use IlDescriptionll Zoning II Units II Type II Price II Condition II Value
Q 0100 I) SFR II 00R2 I) 8,400.00 II SF I) $3.06 II 1.00 I) $25,704
I 2 I) 0100 I) SFR I) 00R2 II 4,147.00 0 SF Q $0.38 I) 1.00 II $1,576
Additional Land Information
I Acres 0.29 0 Tax Area II 30Z1 II FEMA Code II X IlResidential Codell ZHLHLP2
I Building Information - Use 01 - Single Family Residential (Card: 001 of 001)
Year Built 1971 Stories 1.0
Exterior Wall 1 Concrete or Cinder Block Exterior Wall 2 Concrete Block Stucco
Roof Structure Gable or Hip Roof Cover Asphalt or Composition Shingle
Interior Wall 1 Drywall Interior Wall 2 None
Flooring 1 Carpet Flooring 2 None
Fuel Electric Heat Forced Air - Ducted
A/C Central Baths 1.0
Line I Description II Sq. Feet I) Repl. Cost New
1 I I BAS II 1,104 II $45,076
2 I FSA I) 240 $3,430
3 II FCA 1I 216 I) $2,205
Extra Features (Card: 001 of 001)
Line II Description 1 Year 11 Units II Value
1 I DWSWC ) 1974 II 178 I) $167
2 I I CLFENCE ) 1986 640 II $226
3 II UDU -M ) 1989 I 1 II $280
4
11 UDU -M I 1986 I) 1 11 $524
Sales History
Previous Owner ) N/A
Year II Month I Book /Page I) Type I) Amount
11 11
http: / /www. appraiser. pascogov .com /search/parcel.aspx ?sec =11 &twn= 26 &rng=21 &sbb =0... 4/13/2009
•
.�� 9117/07
RE: Permit # 0: =� .
v 9 ?-e '/ ,,C .. ; r ai l ti' °o , ":h, neer/A tbi
I ��' L _ • , .: uiltliti�; •
• (plmacprint name and 4cle Lie. Tykoj
License #; _� ' t, 7
f I1•didper OI3 Y' :ct Loo .
On or about (Date &timel)
deck nailin' an
_ d/or seconda� t' wa ter_.barrier _ work at _
(circle dire)
. (Job Site Address)
• o ' 'S i .� ic.0 R. , 3)J 2. .. O • . ; - >1ady�tdi� to the •
that amina d e ter: ;o ation was •done g
.�� ;� tldril.� have
fro ased;vrl.553:.8 P S.)
•Humcane'Mt _ .�; . fifMatnla� `fB
.
Signature .
STATE' OF FLORID .
- COUNTY OF .240
• oru: d subscribe before mee •this:.` day. of .
By - : lic, State of Florida
Ota iy da
`
Notary Public, SMie •of / . . '
W(y caret eacp. Much 22, 2013. ∎ . coidptw, :1Nsreh - + • n
Comm 140 DD172975 • .conwn..140.1 75. • •
Personally kmwll _ r.. . , . •
Produced- Idtti�itcation
Type: offdentifcationpzoi e ,
photogrephs.of=Address* . .
.u� g ;: ed Under 468 PS . to make such me .
"� General, $�ldiag, Rcsidmtial;�Ut�bottimR �oosddt`�y'ia .,
• •iaspection. lac1 de : eaob•ptene of the 4�oof With:hq: rtnat 1 clearly: shown marked• on :e c .
. deck for;goal inspection.
•