HomeMy WebLinkAbout11-12125 - � , � CITY OF ZEPHYRHILLS �,,
5335 - 8TH STREET
(si3)�so-oozo 12125
BUILDING PERMIT
Permit Number: 12125 Address: 7864 GALL BLVD
Permit Type: COMMERCIAL ZEPHYRHILLS, FL.
Class of Work: ADD/ALT COMMERCIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: ZEPHYR COMMONS
Est. Value: Parcel Number: 35-25-21-0010-00700-0000
Improv. Cost: 27,875.00
Date Issued: 7/26/2011 Name: ZEPHYR COMMONS LLC
Total Fees: 10,011.94 Address: 3629 MADACA LANE
Amount Paid: 10,011.94 TAMPA FL 33618
Date Paid: 7/26/2011 Phone: (813)927-0011
Work Desc: 2ND BUILD OUT SPRINGLEAF FINANCIAL OFFICE 1,400 SQ FT
.5 1, .4
REGER ELECTRIC SERVICE ELECTRICAL FEE 60.00 WATER CONNECTION COMMERC 538.44
FIRE PLAN REVIEW FEES 84.00 FIRE INSPECTION FEES 30.00
TRAFFIC IMPACT FEES 99% COM 7,358.27 TRAFFIC IMPACT FEE 1% 74.33
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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 any one of the following reasons: a) wrong address b) condemned work resulting
from faulty construction c) repairs or con�ections not made when inspections called d) work not ready for
inspection when called e) permit not posted on job site � plans not at job site g) work not acxessible.
NOTICE: In addition to the requirements of this permit, there may be additional restrictions applicable to this properly 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 er: Your failure to record a notice of commencement may result in your paying twice for
impr6ve _ n your perty. If you intend to obtain financing, consult with your lender or an attorney
,
,��'� fore recording your notice of commenceme "
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C NTRACT R SIGNA U E PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Lai�.
Recreation Account Recreation Credlt Recreation Total
Zone TOTAL AMOUNT $ �) � ,
Exempt � Yes � No How Determined
LIBRARY F�E
Land Account L.and Credit Land Total
Facility Account Facfljty Credlt Facllity Total
Exempt � Yes �] No How Determined Total Amount ��
RESOURCE FEE ERU �
TOTALAMOUNT �
, �
Prepared By -1 ; ��'1-� Checked �y
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;� '� P�1�C0 COUNTY, FLORIDA
, Permit No, l 2!`? 5
Date Permitted � - ��� "�
Builder Name/Owner Name ,rf-t GL`.' ( �l �� " l �'� '� Conirol #
County Parcel No.
"j.� �•l7 1 1_ C:�C� i D -�.0 J�, . �� C�c�� subDiv: �:'f�6• y�- c�c m.v«,�;
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Address/Location 7 � � `� �r �� �� /
Classification/Type of Use �` .�� `G�( ' j`''�"'�C a� C� /n u�'
TRANSPORTATION (MPACT FEE � Rate: Sq Ft Unit:
Exempt � Yes �] No HoW Determined
Impact Fee Amount $ 7� `� � '�' �' Zone No. T�� .--
SCHOOL IMPAGT FEE
Account (056) Single-Family Detached House Amount $ /JA
(057) Mobile Home
(058) Other Residential
123) Collection Fee
Exempt � Yes [] No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Total
Recreation Account Recreation Credit Recreatlon Total
Zone TOTAL AMOUNT $ ,�; f},
Exempt � Yes � No How Determined
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Faciqry Credit Facllity Total
Exempt � Yes ❑ No How Determined Total Amount ��
RESOURCE FEE ERU
TOTALAMOUNT �
, 1
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Prepared By --. /� � ��-'1� Checked py
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NO CERTIFICA7E OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE.OF PASCO COUNTY
Acknowledgement below does not Imply acceptance of concurrenoe, but slmply recelpt of e copy of thls form, plaqing
the building permit owne� on nollce of ihis assessmeni and th� condlfions af payment for seme.
QATE R�CEIVEQ BY
RECEIPT NO DATE By
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u�e-��u-��uzu City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Recefved '�. �—�� t/
Phone Contact for Permitting U U __ T
�
,_ _ Owner's Name Owner Phone Number
' Owner's Address Owner Phone Number �
Fee 5imple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
—� JOB ADDRESS LOT # ��
SUBDIVISION , PARCEL ID# �" ZS' Zf � Oa D"'� �/V 7� � DU UO
(OBTAINED FROM PROPERTY TAX NOTICE)
" WORK PROPOSED NEW CONS7R ADD/ALT �] SIGN [� Q DEMOLISH
B INSTALL REPAIR
PROPOSED USE Q SFR [� COMM � OTHER
TYPE OF CONSTRUCTION Q BLOCK Q FRAME STEEL Q
--� DESCRIPTION OF WORK �
G
BUILDING S12E O� SQ FOOTAGE HEIGHT D�
- �BUILDING $ /� � VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $, AMP SERVICE � PROGRESS ENERGY Q W.R.E.C.
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OPLUMBING $
C� � � - �� � �
S
QMECHANICAL $ VALUATION OF MECHANICAL INSTALLATION `Z �UC �
QGAS Q ROOFING Q SPECIALTY � OTHER �
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
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BUILDER + OMPANY
SIGNATUR I�EGISTERED Y/ N FEE CURRE� Y/ N
Address , License # ��,�
ELECTRICIAN � ` COMPANY � � "
SIGNATURE REGISTERED / FEE CURRE� Y/ N
Address License # —�
PLUMBER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License #
MECHANICAL COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License #
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/ N
Address License #
RESIDENTIAL Attach (2) Plot Plans; (2) sets of Building Ptans; (1) set of Energy Forms; R-O-W Permit for new construction,
Minimum ten (10) woricing days after submittal date. Required onsite, Construction Plans, Stormwater Plans w/ Silt Fence installed,
Sanitary Facilities 8 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 FoRns. R-O-W Permit for new construction.
Minimum ten (10) working days aRer submittal date. Required onsite, Consttuction 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.
Dtrections:
Fill out application completely.
Owner 8� Contractor sign back of application, notarized
If over;2500, a Notice of Commencement is required. (A/C upgrades over;7500)
"' Agent (for the contractor) or Power of Attomey (for the owner) would be someone with notarized letter from owner authorizing same
aVER THE COUNTER PERMITTING (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A!C Fences (PIoUSurvey/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" vf 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. c�r#ificate of occupancy or
final power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County WateNSewer 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'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 cenify 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 vf 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, Attering
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 NV" 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
prope�ties. 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
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 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 INTFND TO TAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOU OTIC MM CE T. �
FLORIDA JURAT (F.S. 117.03) i� �
OWNER UR AGENT_ CONTRACTOR � -- / � �
Subscribed and sworn to (or affirmed) before me this Subscribed and swom to r a ed b or,e�ne
by "7-C� - ! ( by � ���,1�", dL/��'��
Who islare personally known to me or has/have produced Who ls/are personally knovm to me or has/have produced
as IdenUficatfon. ( � c �2>�3F- as identification.
`1 J
Notary Public '"' Notary Public
- - ' "'• JACQUELINE BO�ES
Commission No. Co m' si =� �'_ '' F �
�; � ; Expires December 12, 2014
TMu T Fain I�urarwe 8�0-385-70 �C ;
Name of Notary typed, printed or stamped Name of �"'��`�'
J � � j GOf�'°
Pawela Builders- 7864 Gall Blvd- 2nd buildout for �ie�+l:aaa�a!
Office- Permit #
SQ. FEET PRICE
MAIN OR LIVING: 1,400
OTHER AREA UNDER ROOF: -$ 88.00
OTHER: - $ -
VALUATION $ 27,875.00
FEE SHEET $ 175.00
ADDRESS
DRIVEWAY
BUILDING: $ 178.50
ELECTRICAL: $ 60.00
PLUMBING:
MECHANICAL:
SUB-TOTAL $ 238.50
RADON:
TOTAL S 238.50
SEWER: $ 1,688.40
WATER: $ 538.44
IRRIGATION: $ -
TOTAL: S 2,226.84
WATER METER: n/a
IRRIGATION METER $ -
FIRE DEPARTMENT FEES � �� /
PLANS TOTAL: S 84.00 � p� �
INSPECTION TOTAL: $ 30.00 � ���
PERMIT TOTAL �i�i
TOTAL: S 114.00
PUBLIC SAFETY IMPACT FEES
POUCE i'�
FIRE � _ ,----
5°�6 S -
TOTAL: S ' n!a O � � �� �
SUB-TOTAL $ 2,579.34 ��C,��' � �
PARK IMPACT FEES n/a
SIF'S:
100.0% $ -
1.0°k $ -
TOTAL: S - Na
T I F'S : 7,432.60 per 1000 @$5309
-- 1 % $ 74.33 0. � � ( � � / f ��
--- t
TOTAL: $ 10,011.94
Zephyrhills Fire Rescue
(907 Dairy Road, Zephyrhill5. l�'L 33542
I�ire Marshal L3us (813} 7�0-0041
Kerry I3arnett I�ax ($I �) 780-U0��4
E-mail: kbarnett(u)tire.�ephyrhills.f7.us
Plan Review #: 1 I-094
Project: 2nd Build-out
Number of Pages: 2
July 14, 2011
I have received and reviewed the plan for the 2" build-out located at 7864 Gall Blvd and will
allow it to move forward. Paying for permit contractor acknowledges complying with the items
listed below. Should anyone have any questions, please do not hesitate to contact the Fire
Marshal's office
1. Ensure there are certified fire extinguishers within this space. Extinguishers shall
be within 75 feet.
2. At building final a key to the business shall be made available so it may be placed
in the knox box outside.
3. Ensure egress is not obstructed going through break room.
4. Ensure exit and emergency lighting is installed and working. Ensure there is an
emergency light in the rear room and rest room, if not currently there.
5. If there is to be any single change to the fire alarm or fire sprinkler system a
permit will be required. Depending on the change plans may be required to obtain
the permit.
6. Ensure any penetrations to firewalls are properly sealed with rated fire caulk.
Inspection Required:
l. Firewall penetration check
2. Final
KERRY ARNETT, FIRE MARSHAL
***Please be advised this review of plans submitted is a cursory review to assist the contractor in
compliance with applicable fire safety codes. This review is not intended to be a final approval of the
submitted plans. It is the contractor's sole responsibility to ensure that the plans are in complete compliance
with all applicable NFPA codes and local ordinances. In the event that further examination or site
inspection reveals areas of non-compliance, it shall be the contractor's sole responsibility, at their sole
expense to bring those areas in compiiance. The City assumes no responsibility for the contractor's failure
to be �n compliance with all applicable NFPA codes and local ordinances.
Z���.1��'��i9�L� FIRlE D�F��4��'�iAEi�`�
6907 �airy Road. Zephyrhilis, FL 33542
�=ere C;hief Ke�th 1Niliiarns �us (8�i3)7g0-Uti�1 �ax (8�3)lso•ac��a
FIRE SERVICE USER FEES
Occupancy No.:
Plan No.: �- 6 Contractor: � �w �,; �, � S
Business Name� �� r w, -- Billin g A d d r e s s: _3 1:�� �.,� z ff�
Business Atldress�� �� �i��i
Bus�ness Phone No Billing Phone No.: - c j- ��
Business Fax No Billing Fax„t�o..
Contact Contact: �.� �,� �
� PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE
Site Plan N/C Annual N/C Sprinkler �SO 1 st Alarm
N/C
P Multi O6 sf t st Re N/C Standpipes $50 2nd Alarm
' (Mirnmum Charge $25 00 2nd Re-ins tion NiC
` P� 3100 Fire Pump a50 3rd Alarm NIC
•❑ Plan Revisions OBL 3rd Re-inspection $250 Hoods $SO 4th Alarm
$100
4th Re-Inspection $500 Fire Alarm $SO Sth Alarm $150
SPRINKLER SYSTEMS (Busmess closed until LP Gas $50 6th Alarm
0 - 25 Heads $�
$50 violations corrected) Natural Gas $50 NON COMPLIANCE $�Sp
26 plus Heads $100 SPRINKLER SYSTEMS Fuel Tanks- Pe� ��k $50
STANDPIPE SYSTEM Hydro Undergrounds a45 Sparklers g�pp
� Per Riser $50 Hydrostatic Test E65 persystem Fire Works a50p
FIRE PUMP Acceptance Test �S per system Camp Fire $25
� Per Pump $t 00 Hydrant Flow $75 Controlled Burn g� pp
FIRE ALARM SYSTEM Hood/Ouct $50
0- 25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Annual
26 plus Devices $100 System Acceptance S50 Fire Protection $�,
SUPPRESSI�N SYSTEMS Recall Acceptance $SO Flammable Application $50 nnnuai
wet $50 OTHER �� Waste Tire Storage $50 qnnual
�ry $50 ire WaH/Smoke Wall $15 per Wan Generator < KW g�pp
CO2 $50 LP Gas $25 pertdnk Generator>30 KW �Sp
Other $50 Natural Gas $25 per system Bio-Hazard Waste $1pp A ,,,,,, ai
KITCHEN EXHAUST Fumigation Tenting $Sp
� Hood/Ducts $50 7ent 10'x10' or greater $15 Pe� tent ToICh Pot/Applied $5p
OTHER Fire Pump a45 Haz. Materials
$�� Annual
LP Instaltal�on per tank $50 Fire Suppression $30
fuel Tank Installation $Sp System Acceptance
(Per Tank) S50 8 Exhaust Hood/Duct g30
� Natural Gas Installation $$0 Re-iI1SPeCtIOn DBL
(Per System) (other than annual)
� Spray Booth $50 � Inspection scheduled DBL
and cancelled less tAan 8 �
24 hours
� Construction Insp. N/C
s � Emergency Vehicle Ac� $50 FALSE ALARM
PLANS TOTAL�'7F�.� INSPECTION TOTAL�� PERMIT TOTAL I TOTALI I
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GRAND TOTAL
Comments
Date `7 �' ll
Insq,�ctor C�Y� �rZ. ° �°-_° �.`(
SUBMfI'I'ED PLAN(S) HAVb EEN Rt,v.�Wt K
IlY ZEPHYRHILLS FI HA ' OFFICE
Date: /
Roviewar:
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� ' the co�tra�tor in compliance with
ap licable fir s�fe,y c,4d�S. VhiS r���ie�,�, is no; intended
be a fina app fOV?! O the ���bmit i.i3�1�. �i 'S'ri2
clor's s I res;�or::i� iiity to e��.sre t�,at tt��� ,.d�ns are in
compleie cor. ��li..^,.e �, ��•.i� �'; �r N ''='� ^'�''•' codes and
, ,, ��s Ir ., � eve �; ?�;�; � •� �xar.,��a?;un or
site insp�ct�on re•, :.y!:: �:rc�' _ r,.., �liance, �;.5�ai! be
the contractor`s �ole re�pa,�,;. .>, „sc,:: e::{.�r�.� to
bring tho ;.3 �:'c�:S {"1 CC^' � ,3�CE. � !1F: v }' :.. �t:" i ;S f10
responsib�lity for ihe con�ructcr s �u:lure to be in comp!iance
with a{I applicab p NFPA Codes and loc�i ordinances.
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r�ty vf"Zep�yahills
R��:di:rg Department
i335 �;ightl� Stre�t
C.ephyrhills, �'L :i 4542
Rr.: Zepr,yr Ccrr?mons
?a64 Ga�l �31vd.
7ephyrhills, FL 335��
Ti � �4Jhoa�t It Ma� Cc,ncern;
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2011111446
ZEPHYR COMMONS PHASE 1
LOT 14 PB 6 5 F�G 13 2
PARKING Er'�SEMENT AGREEMENT pER SUBJECT TO & TOGETHER WIrH
OR 8496 PG 817 OR 8046 PG 413
NOTICE OF COMMENCEMENT Repf.: 1378824 Rec: 10.00
DS: 0.00 IT: 0.00
07/20/11 R. Cervantes, Dpty Clerk
Permit No.
PRULR S 0'NEIL,Ph D PqSCO CLERK & COMPTROLLEF
Property IdentificationNo._,�.�=�j' =„�/-Qf,��_�rj_�l�/'� 07/20/11 02:17 m 1 of 1
OR BK g5�5 P � 3���
THE IJNDERSIGNED hereby give informs you that the nnprovement 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 NOTIeE OF COMMENCEMENT.
I .Description of property (legal description:)
a) StreetAddress: `_�� � �
2.C3eneral description of improvements.
'�" i �{ o ro�s
3.Owner Informahon -� , ,
a) Name and address: J/,P�%J " �//l�i1r�/�?� �� D/ /ylrJ. ��°�3�/�'� s'�
b) Name and address of fee simple title der (if other than owner) `
c) Interest in property �,(,o t� ,Q`
4.Contractor Information �
a) Name and address: �'!' �q�,�,'s � f�� ��'/� � �
b) Telephone No.: -S Fax No. (Opt.)
5. ure Information
a) Name and address: �/�
b) Amount of Bond:
c) Telephone No.: Fax No. (Opt.)
6.Lender
a) Name and address: /y��
Phone No. �
7. Identity of person within the State of Florida designated by owner upon whom norices or oth r documents may be served:
a) Name and address: j�i �y'iy��_� j'���'fj� -. �j ,q�� �4�
b) Telephone No.: �3�'� - �g}? - .����f Fax No. (Opt.) �� �_��,s�s� -, �S/�
8.In addition to himself, owner desi�ates the following person to receive a copy of the Lienor's Notice as provided in Section
713.13(1)(b), Florida Statut�s:
a) Name and address: ,/�y' �
b) Telephone No.: t- 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 QR RECORDING YOUR NOTICE OF COMMENCEMENT.
STATE OF FLORIDA � � �`
COUNTY OF PASCO � �� ��,����
Si of Owner or Owner's Authoriud OfficedDinctor/ParhiedManagcr
jS' � �� i � flS
Prmt Name "'
The foregoing instrument was aclaiowledged before me this �"l day of_ �--a�L� 20� by�'���. i l-��yy�t4S
as �E - �ti� p� (type of suthority, e.g. officer, trustee, attorney
in fact) for name of party on behalf of who instrument was executed).
c-�
Personally Known � OR Produced Identification Notary Si�ature .�C. `� ���C`�� t��
Type of Identification Produced �',� C;'�. : ; �, lf y /-( �d c c.- �,., , Name (print) � G � � 4. �c : ,^u V ( /`i (Cfvc .t..s�'
Verification pursuant to Section 92.525, Florida Statutes. Under penalries of perjury, I declare that I have read the foregoing and that
the facts stated in it are true to the best of my lmowledge and belief.
,..��.
'�� ��� Signature ofNatural Person Signing Above
FORMS/NOC,rvsd2007 � �
My CommiNion Expiros � 1271Z415
�Commissior► No EE 59287
.1� i �`' f:
�, � , �
.,2.
STATE OF FLORIDA, COUNTY OF PASC�?: ;'`�
THIS IS TO CERTIFY T�iAT THE FO�C�ING�MS� ` ,. i � ;
TRUEAND CORRECT COPY OF THE'Df�CUMENT „
ON FILE OR OF PUBLiC R�QE�� IN �1-�S O�F(CE ,; �
WIT SS�Y HAND AND�O� .IG,IAL SEA� THf� . �'.'
(� DAY OF Ul/� 2 � • -� �
P ULA S O'NEIL, CLE & , R P20LtER +
Bl , � ��� �.Ct�r/li- DEPUTY CLERK
City of Zephyrhills
Water and Sewer Impact Fee Calculation
Land Use Type:
Office
No. of Square Feet �,�
Impact Fees
Within City Limits Outside City Limits
Water Distribution System $ 538.44 $ 673.05
Wastewater Collection System $ 1,082.26 $ 1,352.83
Wastewater Treatment Plant Capaci $ 606.14 $ 757 67
TOTAL $ 2,226.84 $ 2,783.55
SQ. FEET PRICE
MAIN OR LIVING: 1,400 VA
OTHER AREA UNDER ROOF. _
OTHER: - $ _
VALUATION $ 27,875.00
FEE SHEET $ 175.00
ADDRESS
DRIVEWAY
BUILDING: $ 178.50
ELECTRICAL: $ 60.00
PLUMBING:
MECHANICAL:
SUB-TOTAL $ 238.50
buildin surcha e
TOTAL S 238.50
SEWER: $ 1,688.40
WATER: g 538.44
IRRIGATION: $ _
TOTAL: 5 2,226.84
WATER METER:
IRRIGATION METER $ _
FIRE DEPARTMENT FEES
PLANS TOTAL.
INSPECTION TOTAL:
PERMIT TOTAL
TOTAL: E .
PUBLIC SAFETY IMPACT FEES
POLICE
FIRE
5%
TOTAL: S -
SUB-TOTAL $ 2,465.34
PARK IMPACT FEES S -
SIF'S: $ _
100.0% $ -
1.0% $ _
TOTAL: E -
T I 99% $ 7,358•27 ��j 0� �2f ( r�
1 % $ 74.33
TOTAL: $ 9,897.94
���� \`� �? tl (, ��
. /3 .�, �
• ���, �#1�'�'� �(�Y��
.�,�"'.
- �:.
+ e.,.
�
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: ���Gv�2 ��(l�G�� •rS
Date Received: �" � —l�
Site: �7L��o � �� l� �f �!�
Permit Type: 2 n d �, �G1�Ok ��j'it �., ` � C� ��� �"�
Approved w/no comments: Approved w/the below comments: ❑ Denied w/the below comments: ❑
This co ent sh t sh be kept with the permit and/or plans.
/ b �
Ka in i — Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
m:The Valleon Group To:GITY OF ZEPHYRHILLS.pdf - Adobe Acrobat Profess (18137800021) 16:20 07120/11GMT-06 Pg 01-02
CERTIFICATE NO. / DATE
,A�QB�. CERTIFICATE 4F LiABILITY INSURANCE 7/2G/20i1J039-22�07PM
PRODUCER THIS CERTIFICATE IS ISSU£D AS A MATTER OF INFORMATiON
Highpoint Risk services �.I,C ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
5501 LBJ FREEWAY, svi� 1200 HOLD£R. THlS CERTIFICATE DOES NOT AMEWD, EXTEND OR
Dallas, TX 75240
(800) 728-0623 (972) 404-0380
Fax: (972) 404-0380 INSURERS AFFORDING COVERAGE
INSURED: �S i/C/f: INSURERA.
REGER ELECTRIC SERVICE INSURERB:
1624 ABSHER RD
INSURER C:
ST. CLOUD, FL 39771
(407) 957-7017 Fax: 1407) 557-071b INSURERD:
INSIfRER E.
THE POLFCIEB OF INSURANCE USTEO BELOW HAYE BEEN ISSUED TO THE IN8URED NAMED ABOVf FOR TNE POLICY PERIOD INDICATED. NOTWRHSTANOlNG
ANY REQUIREMENT, TERM OR COI�RION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTiFICATE MAY BE ISSUED OR
ARAY PERTAfN, THE INSURANCE AFFORDED BY THE POUCIES OESCRIBED HERENI 18 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONORIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
$R TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLtCY EXP{RATIO UMRS
GE ERAL LIABILIT/ 'cACH OCCURRENCE S
COMMERCIAL GENERAL LIABIJTY =1R£ DAMAGE (Arry One Fre) f
GLAIMS MAOE � OCCUR MED EXP (/ury one person) S
'ERSOWIL 8 ADV INJURY S
GENERALAGGREGATE S
GEML AGGREGATE LIMR APPLIES PER: ?ROOUCTS - COMP/OP AGG S
POUCY PRO- L�
AUTOMOBILE LIABILITY COMBpdED SINGLE LIMR
ANY AUTO � Ea acddenq s
ALL OKMED AUTOS
30DILV INdURY S
SCHEDULED AUTOS �Per person)
HIKtU AU 1 US
90DILV INURY g
NON-OWNED AUTOS �per yccideM)
�ROPER7Y DAMAGE s
rPer accidenq
GARAGELIABILITY AUTOONLY-EAACCIDEN7 S
ANYAUTO EAACC S
OTHERTHAN
AUTO ONLY A � S
EXCESS LIABILITY ,:ACH OCCURRENCE S
OCCUR ❑CWMSMADE AGGREGATE S
S
DEDUCTIBLE
S
RETENTION S s
WottKERSCOMPENBA'nONAND WC3E^727900 09/O1/201i 04/O1/�012 X �STATU - n+
EMPLOYERS' LIABILITY
EL.EACHACCIDENT S lOOOOOO
A
E.L. DISEASE - EA EMPLOYEf f 1000000
cL.DISEASE-POIICYLp�AIT S lOOOOOO
OTHER
�IMRS $
:fMRS g
. This certificate remains in effect, provided the client's account is in ood standin with AMS.
overage is n�t provided for any employee for which the c2ient is not repor�ing uaqes to AMS.
pplies to 1008 uf the employees of AMS leased to REGER ELECTRIC SERVICE, effective 04/O1/2011. ^
nsured is afforded Workers Compensation � Employers liabi2ity as a co-employer under the policy for
mployees leased from AMS.
* PLEASE SEE ATTACHED EMPLOYEE ROSTER.***
CERTIFICATE HOLDER A�mONAI INSURED iHSUr�R �rreR: CANCELLATION
DATE TXEREOF. TiEE ISEUIN6INSURER YY�I ENDEAVOR TO MAIL 30 DAYS WRRTEN
CITY OF ZEFHYRHILLS .. NOTICE TO THE CERTIfICATE HpLDEA HAMED TO TIiE IEFT, BUT PA�LURE TO DO 80 SHALL
CONTRACTOR LICENSIt7G IAAFOSE NO OBLHiA710NOR LIABILITY OFANY KM1D UPON THEINSURER, RSAOENT80R
2 $13-730-0020 F 813-780-0021 REPRESENTATiVES.
5335 8TH ST
2EPHYRHILLS, FL 33542 AUTHORIZEDREPRESENTATNE �����
�
e
m:The Valleon Group To:CITY OF ZEPHYRHILLS.pdf -Adobe Acrobat Profess (18137800021) 16:20 07/20111GMT-06 Pg 02-02
CERTIFICATE OF LIABILITY INSURANCE Certf[IcateNrtmbe�•:ACll-1150(1031-1029736
EMPLOYEE ROSTER
Attached roster includes employees paid through 07/17/2011. To verify employee's wLo mxy have been added since 07/17/2011
please call 1-800-728-0623.
* Please note employee roster for this client is updated on a WEEKLY basis.
EMPLOYEE LIST:
HABVEY, ROI�iNIE J
7/20/2011
Page 1 of i
STATE O� FLORIDA
DEPARTMENT OF BU9INESg AND PRpFBSSTONAL REGVLATION
]�LBCTRICAL CON'T'RACTOR3 LICEN3ING BOARD � (850) 487-].395
. TALT,,AHAgggE�ONROB' STR��T32399-0763
RE(;ER. JO�IIiT C�AIL
REGLx LLECTRIC SERVICE
SAINT�C
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Con ratulationsl Wlth this li '� .'�';�C;�-d!`f.�,..,, 1, �' •�. '��'',
9 cense you become ane of the nearly one miltion r�,` �••��`•� :'.�:•t''' ,��''
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Floridfens licensed by the Department of Business and Professfonal Re ulation. �`
Qur professionals and businesses rangq from t�rchitacts to acht brok 9 n� Y �:� , � '� � r•�",• '•g�'
y ers, lrom ;..: •.. • � ,
boxers to barbeque restaurants, and they kesp Florida's ecandmy strong, � :�'� .:' `', `�: ;'" '',�: `�:�•�'��� Y . i ; .`;� �'�' • ' � �� �':
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da we woric to i o e�e we we d ; N•:���'"� �_ •',`.:. '� �� �,•
Every y mpr v y o business in order to sarve you better. > s�� �``' "
For i�ormation about our services, teasa l onto www.m ', h • :' - ., . � .' ��� ' "''• ' ':�' � : ``� �' � ' `';" : �; :• `•'; .'• : : •
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There you can find more information about our dfvisions and the regulaoans that �� a,�" �•i=� r � ��'�
d� ' v 4i. �
im act ou subscribe to p etters a�d leam more aboutthe �.�"� ' f '� .:" N „'�{� �;:;,
P Y� de artment newsl ��:�. .>��_� .
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pe s. cense Efficfently Regulate Fairiy. We ',. � 5�s� .�;.: -�-, ,� r . R .��., •^ s" ,;.'•, :
constsr�tly strive to serve you better so that you cen serve your customers. � ;,, ; �: � , :,.;;� *:-� , . ", .°.�' •;�; r � ` •• '..;~ ' ' � � �: ,•:;:; �
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`� S eptB�r 30,1011 r h �'� r t[,L+'FFNER, TA� coL.��cTO�z
OSCEOLA CUCJN'TY, $TATE OF F�,ORII�A ACCOUNT NO
31310
�.ocAr, aUSr�vESS - r� �cErpr
��G�Sr1•BL1EC'�RtGI� CO'NTR (Q8P'R/CMPCRO) PA�S1( HEFFNER REIVtWAI
� Tax Collector NeEW uC�NSE
6150-31310 TRANSFER
17p0262 OftYGINAL TAX $30.p0
07/08/2p10
�11�l�5 R,�rHlltttrfC SenriCe Oper CO AMOUNT NpNEXEMPT p.00
�350 �. Nar�ppssee Rd. TIII i7 pgNAL7Y
, 5l• , pl: 94771 Paid 3Q.00
�� I¢4UN7Y CQLI.ECTIQN COST
TpTAL ;30.00
MAIt�N6 Re9e► �erwoe
M�{ lohn 6.
��etr �. �spe act. . .�f,t�+�'
St. Goud, � , 34y�1 . �` .
PATSY HEfFdVER, TAX COLLECTOR
p.0. BOX 422l05, K[SS�MMEe Fl. 347a2-Zios
407-742-4000
O�It' �11 CIh , OR N p�IM�pl��j TC k�{16itT101K�Oi ZOqNC, up prrr
rtrriert c�wru� �oatrr
THIS LQCAL BUSINESS TAX l�CEIPT IS FURNISHED PURSUANT TO CHAPTER xOS LAWS OF PLpRIpA
AIVD 05CEOLA COUNTY ORDINANCE 95-x0, AS AM�NDED
The iaw requires thls Local Buslness Tax Recelpt to be displayed conspicuously at the plece of buslness in such manner that ic can be
open to the view of the publiC and subject to inspection by all duly authorized officers oF the County.
Pwsuant to State I.aw, all lacal Business rax Receipts shall expire on SepCember 30Ch of the succeeding year. 7hose Local Buslness
Tax Recei�s renewed beginning OCtober lst Shall be delinquent and SubjeCC CO a delinquenCy penalty of 10% for the month of
OCtObel', plus an additional 5�/o pef181ty fOr each month of deli�quenc.y tllereafter unti{ pald; provided Chat the tot�l Qeiinquency
penalty shall not exceed 25% of the l.ocal Business Tax Receipt for the delinquent establlshment. A 25�6 penalty shal! be imposed on
any person engaged in any new business, occupation or profession without first obtaining an Osceola Cou�ty Local Business Tax
Recelpt. PLUS: if delinquent mo� than 15o days, subject to avil actions and penalties, and a pe�afty of up to �250.
ThiS r�aelpt iS a LoCat Business�7ax Only. It does not permit the LoCal Buslncss Taxpayet Co violate any existing regulatory or zoning
IawS of the state, Caunty, or cities, nor does it exempt Che licensee from �ny other license or pe►mits Chat rr�y be requ+r�ed by law.
This famn betomes a r�Ceipt when validated by the Tax CalleCtOr. Npte: Display in dccOrdance With the counCy ordknanCe.
LoCal Business 7ax R�ceipCS a� subject to Change according tp law,
r
Reger Electrfc Service
7ohn G. Reger
1380 S. Narcoosse� Rd,
St. Cloud, FL 34771
JUL-21-2011 THU 07;34 AM FAX N0, P, 02/02
. n �� '�� � � � �' � x DATE (MMJGDKY) :v �
I �.CN1WAh71Ci.� •' kS... DTM m��ft�� � . �r�: ...�,C � �r ' 4:".4 , r, f . � n Q7/21/11 �:
Pnoouc� � THIS CERTIFICAY'E IS 13SU�D AS A MATTER OF INFORMA710N
ON�.Y qNa CONF�RS NO RIGHTS UPON THE CEii71FICAT�
F�pERATED MUTUA� INSURANCE COMPANY HOLbER. THIS C�RTI�ICATE DO�S NOT AMEND, EXTENP OA
Home �ffice: P.O. Box 328 AI,TER THE coVHtAG� AFFORVED BY 7H� PoLICIES BE�ow.
Qwatonna, MN 55060 COMPANIES A�FQRDING COVERA �
Phone 1-888-333°4949 caMPnNV FEpERATEO MUTUA� INSIJRANCE COMPANY OR
A FEDERATF� SERVIC INSURANC� COMPANY
�� REGER ELEC7RIC SERVICE � 2�asn•2 COMPANY M
JOHN R�GER DBA I e -•�•
PO SOX 700965 I COMPANY
ST CLOUD FL 34T70 �
I CQM�ANY '
I p
n +t . R � R R
�1'HIS IS TO CERTIFY 7MAT THE POLICIES QF INSURANCf LIS7E y BELOW HAVE SEEN {SSUED TO YHE INSIJR�p NAMED AnOVE FOR THE POLICY PERIOq
INDICATED, NOTWITHSTANDING ANY REQUIREM8N7, T�RM O CONDITI�N OF ANY CONTRACT OR OTHER DOCUM�NT WITH RESPECT 70 WHICH THIS
CER7IFICATE MAY BE ISSUEQ OR MAY PERTAIN, THE INSUR NCC AFFORp�D �Y THE POLICIES DESCRIB�p HEREIN IS SU&IECT TQ AL� THE TERMS,
EXCLUSIONS AND CONQITIONS OF SUCH POLICIES. LIM� 17� N MAY HAVE BEEN REDUCED BY PAIp CLAIMS.
TYPE OF IN6YRANCE POLCY NYM9k'l) i �UCY EFFECTIVE POUCY P�PIRATION uM �
LTN � DATEfMNIDp1YY) pAT�IMY�OD►YY�
GB�IERAL IJA91Y7Y GENERAL AC�Gp�GA7� A Q��OO
COMMERCIAL GENERA4 LIABILITY ppOpUCT3 - COMPIOP AGG 0�L OOO� �
A:i::i':ii CLAIMS MAPB � OCCUR 9928963 ��Z 7 ��2�1 �r PERSONAI. 6 ApV INJURY 1 ��0
OwNEP'S & CoNTRACTOh'S PROT � EACM OCCUfl�ENCE 4 1 OOO OOO
X flUSIN6SSOwNEF'9 POLICY FIRE AAMAGk fMy onu Ilro! A �O �O
MED EXP {AM1Y 011i OBrioM ?
AuTOMOe11.E uAwU7Y i COMBINED SINGIE I�MIT 4 1�QQQ�OQQ
X ANY AUTO
AI.L OWIVED AUTOS
pOpILY INJURY �
A SCNEDULEG AUTOS 992$�JG4 p$/25/1 � pg/2r�/� 2 tre� Porson►
X HIREP AUTOS BOOILY IN�URY
X NON-0WNED AU706 (Per eCCItlBm� e
' PROPER7Y DAMAGE 6
OARA6E LIABILI7Y AN70 ONLV • 6A ACCIpENT A
ANY AuTO OTHER THAN AUTO ONLY; �"�' �.
•:<.,:
i EACH ACCIpENT 6 y
AGG►IE6ATE A
DcCESS LIABtuTY EACM OCC�flAENCE 9
uMBHRI.I.A FORM I AGGR6GA7E /
OTHER THAN uM9R&LRA FOpM p
WC STATU- OTH• %tj ':�"a:: ,;:E;;�:;"•°
WORKEfl6 GOMP�ATION ANO ' E9 > : ixi#: (`..x ,:t.>i<.i
•>. ...<..:...
� :..„::�.� :.:..... .:.......... .: .
EMPLOYFRS' LIApILITY �
EL EAC ACC�OE 0
7HE PROPRIETORI IkCI. � EL OISEA6R • POLlCY LIMIT 0
rAR7NERS/C)cECUT1VE
OFFICERS ARE: EXCL EL DISEASE - EA EMPLOY�£ S
OTHER
I
pBSCpIPT10N OF OPEIiAYIONS�LOCATIONSN�HIGL£SISPEdAL ITEM3
, �� �, . ,.. �w5. .;$r , ">3�'6.i: �i ��..'�'C�.: � . � c�'��..x: '�'d�iS... .. � r .. •� . . 5 h �5�. �' � � � �� �ti � ..#,.i'i
� x B7 � TH� CITY OF ZEPHYRHILLS 71 SMOULD ANY GF TME A90VE DESCRIBEp POUGIR6 RR CANCELLED BEFORE THE
5335 STH ST acnru►Yioiu asre ��eoF, n�e issuo� coMnaKr NnLL ENDEAVOp To wa�
ZEPHR F� 335A�2 �Q. Dars wfu7T�V NOTIC� To TME cExriflCnTE NOI.PpI NnMED ro 7ME �EFT.
eur FawAE TO MAII. SucH Nonce snau, I�IpOSE NO 09uGaT1qN nR uaaiuTY
OF ANY ItlND UPON THE CQMPaNN. RS AOBiTS OR flrtPNiSF.NT�►'nVES.
AIlTHONIt�p RI�RESENTATNE
^�� � v +ii�� Yi'�. g �+, �'n,:}'i� �MKy`� $,. � •�v�� "�? ,'.Y
.s��� .' Y ��. ��.'.:�r '>� ��.; c�y� t , t� r > �.x �
%.4��4� 7R� ,a5' � ,�rx 'Jai%;��.�''�;�?i���'. ��i � ��'�� � � �. ����;,
i � nv&r. r C;.
`.'�x'� e�a�
Pawela Builders- 7864 Gall Blvd- 2nd buildout for Aa�ar+
Office- Permit #
SC1. FEET PRICE
MAIN OR LIVING: 1,400
OTHER AREA UNDER ROOF: -$ 88.00
OTHER: - $ -
VALUATION $ 27,875.00
FEE SHEET $ 175.00
ADDRESS
DRIVEWAY
BUILDING: $ 178.50
ELECTRICAL: $ 60.00
PLUMBING:
MECHANICAL:
SUB-TOTAL $ 238.50
RADON:
TOTAL S 238.50
SEWER: $ 1,688.40
WATER: $ 538.44
IRRIGATION: $ -
TOTAL: S 2,226.84
WATER METER: n/a
IRRIGATION METER $ -
FIRE DEPARTMENT FEES
PLANS TOTAL: $ 84.00
INSPECTION TOTAL: $ 30.00
PERMIT TOTAL
TOTAL: S 114.00
PUBLIC SAFETY IMPACT FEES
POLICE
FIRE
5°k $ -
TOTAL: S - Na
SUB-TOTAL $ 2,579.34
PARK IMPACT FEES n/a
SIF'S:
100.0% $ -
1.0% $ -
TOTAL: S - n!a
T I F'S : S 7,432.60 per 1000 @$5309
99% $ 7,35827
1 % $ 74.33
TOTAL: $ 10,011.94
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.
� �.�t�IDA ��3 ��-ti_ �ozfl
Permit No. � � �� � 5
�� Date Permitted - 1 � ��/ ,
,-, � 7
; _ ( / -
� � ; ! � Name Gt G�, `: �t �< << `` �'� ' � S Control # '
3.� -�.j Z I- C.'�� f L� - �.t��c1�� �. �'c�`C� SubDiv: ��:��- y ,.- (�E v►z.ti�'��:;.
,
, 7 ���C �{ ��,a Il �`� � L °� �
Jf US8 l G'�1'� F.�','� r'' l� L4 - � d1G�t i'7C I Q� �\ /� lA�
• ,KIz.� --�
�° , N IMPACT FEE � Rate: Sq Ft Unit; J�OE7 s y fi�
❑ No HaW Determined
� `' " nt $ 7� `� �L � �' �} Zone Na. TAZ:
/3
/� S �� • T FEE - . A
- 'z�� S n le a o oun �
) I g F mily Detached H use Am , t $ /
) Mobile Home
�) Other Resldential �
12;i) Collection Fee
Exempt [� Yes [] No How Determined
PARKS AND RECREATION FEE
Land Account Land Credit Land Totat
Recreation Account Rec� Credit Recreatlon Total
Zone TOTAL AMOUNT $ ���
Exempt � Yes [] Na How Determined
LIBRARY FEE � �
l.and Account L.and Credit Land Total.
Facility Account Facility Credit Facility Total
Exempt [� Yes �] No How Determined Total Amount ��
RESOURCEFEE ERU
TOTAL AMOUNT •
Prepared By �� �•�.�1.���_'1,f� Checked py
�`.
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
RECEIPTED FOR BY A CENT�tAL RM NG OFFICE.OF PASCO COUNTY