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Home My WebLink About14-15646 � CITY OF ZEP YRHILLS 5335-8TH STREET , ; (813)780 0020 15 46 . - ,_ : --'e BUILDING PERMIT - - - -,. . - _�.� -, � j�'�` PERM1TiINF�ORM"ATIO:N' ,.' �. �` � i� .LOCATION�INF:ORMA�TI:ON; :��-�`� .�� Permit Number: 15646 Address: 7886 GALL BLVD Permit Type: COMMERCIAL ZEPHYRHILLS, FL. Class of Work: NEW CONST/COMM Township: Range: Book: - Proposed Use: NOT APPLICABLE Lot(s): Block: Section: Square Feet: _ Subdivision: ZEPHYRCOMMONS Est.Value: Parcel Number: 35-25-21-0130-00000-0030 Improv. Cost: 94,075.42 '"��" `;�'`°``"' 'R_�a��="��''OWNER�INF�.ORMA�TION` �. Date Issued: 9/12/2014 Name: SF ZEPHYR COMMONS LP Total Fees: 11,842.44 Address: 1-2851 JOHN ST Amount Paid: 4,218.94 MARKHAM ON L3R 5R7 CANADA Date Paid: 9/11/2014 Phone: Work Desc: BUILD OUT - AT&T 1,769 SQ FT �� ``�CONTRi4CTOR'S °�� F �F ?'`-. � AP.PLICATION�FEES'. ��'�a��;�`�°_:L�� ,_�� GENEVA CONSTRUCTION I BUILDING FEE 504.29 SEWER CONNECTION COMMERC 640.02 SAM'S ELECTRICAL CONTRACTOR.IN ELECTRICAL FEE 104.63 WATER CONNECTION COMMERC 204.11 JEFF'S ISLAND AIR PLUMBING FEE 69.75 TRAFFIC IMPACT FEE 99% 10,063.02 G&P PLUMBING OF ORLANDO INC. MECHANICAL FEE 48.83 TRAFFIC IMPACT FEE 1% 101.65 FIRE PLAN REVIEW FEES 106.14 �� '3°'r � ' - '� �. _� � so.- - �� . l�- .7 5.. ��- -�F ....,. . . �t*a� e.�.>' i.-� a sy? "d�' i,� »=v if� *s"y`�p�,� y. ,e�.• . ��:�- Y6��,� � � ��Ins ections�Re` uired,� .��s_ .,�.�:��;,.-$�;� � �� .:� FOOTER� 2ND ROUGH PLUMB M SC INSULATION CEILING FOOTER BOND DUCTS INSULATED S WER MISC. ROUGH ELECTRIC LINTEL M SC MISC. 1ST ROUGH PLUMB PRE-METER I SULATION WALL MISC. DUCTS INSTALLED WATER M SC DRIVEWAY PRE-SLAB SHEATHING M SC. MISC. CONSTRUCTION POLE FRAME M SC. MISC. REINSPECTION FEES: Reinspection fees will comply w h Florida Statute 553.80 (2)(c)when extra inspection trips are necessary due to any one of the following re sons: a)wrong address b)condemned work resulting from faulty construction c) repairs or corrections no made when inspections called d)work not ready for � inspection when called e) permit not posted on jo site� plans not at job site g)work not accessible. NOTiCE: In addition to the requirements of this permit, ther 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 managemen , state agencies or federal agencies. "Warning to owner: Your failure to record a notice commencement may result in your paying twice for improvements to your property. If you intend to ob in financing,consult with your lender or an attorney before recording your n tice of commencement." Complete Plan , ecifi tions Must Accompany Appli tion.All work shall be pertormed in accordance with City Codes and Ordinances. O OCCUPANCY BEFO C.O. ONT CTOR SIGNATURE PERMIT OFFI R PERMIT EXPIRES IN 6 MONTHS ITHOUT APPROVED INSPECTION CALL FOR INSPECTION - HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER •,•.'.; - �•.: •' � ... . :� ,. 1 � .,... . ;... � ; ;-;:;i:; -i:,.,•• „ :I.:'�' ... i.�, �T�.l:fril:::�, :i.�. „t.+•. , •�,�; := . .: ,� �. . .. .. , .. .: : :. �.:I::_t•., . {•�,t••s�... ,::..I�•I'�.t. � � ,.F•. • ..s-•i i �:. .. . .�:::+.,... .. : l ��' i..?,1 `,.,-(,,,'I �i i"j"-i .� ('- �.•�. �_�;i'•:� {`��::1(:Ji°.;� .�. �.ii" i. � _.. . � .., . .. . , :,..,,� ., . . ........,..� - L:(:tr�d #'��r��tt.: !(.1i��: :t::;� +,�:.?;:�-�,.�. : ... 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X�PLUMBING $ 3`r�jd �S �,�'(/ �_V� X MECHANICAL $ VALUATION OF M CHANICAL INSTALLATION �� 0 �,,!��C'i �� ` XQGAS Q ROOFING Q SPECIALTY OTHER � FINISHED FLOOR ELEVATIONS FLOOD ZON AREA QYES NO � BUILDER COMPA Y Geneva Construction Inc. SIGNATURE �� REGISTER D Y/ N FEE CURREN Y/N Address PO Box 621858;Oviedo,FL 32762 License# CBC045648 ELECTRICIAN COMPA Y �I�F'�I S .�L�GT��L SIGNATURE REGISTER D Y/ N FEE CURREN Y/N Address License# ��i / v�� PLUMBER � � COMPA Y ll ��1� �� ' d D�lti'�►�0 tL SIGNATURE �� REGISTER D Y/ N FEE CURR N Y/N Address License# �� (�Z (�t'itp MECHANICAL COMPA Y ��J sL��'b �R� N� SIGNATURE REGISTE o Y/ N FEE CURREN Y/N Address License# �� F/ OTHER COMPA Y SIGNATURE REGISTE ED Y/ N FEE CURREN Y/N Address License# � � � � � � � � � � � � � i � � � � � � ii � � � � � � � � � � � � i � � � � � � � � � e � � � � � � � � � � � � � � � � i � ii � RESIDENTIAL Attach(2)Plot Plans;(2)sets of Building Plans;(1)set of En rgy Forms;R-O-W Pertnil tor new construclion, Minimum ten(10)working days after submiltal date. Requi d onsite,Conslruction Plans,Stormwater Plans w/Silt Fence installed, Sanitary Facilities 8.1 dumpster,Sile Work Permit for subdi sions/large projects COMMERCIAL Attach(3)complete sets of Building Pians plus a Life Safety age;(1)set of Energy Forms.R-O-W Permit for new construction. Minimum ten(10)working days after submitlal date. Requir d onsite,Conslruclion Plans,Stormwater Plans w/Silt Fence instailed, Sanitary Facilities 8 1 dumpsler Site Work Pertnit for all ne projects.All commercial requirements musl meet compiiance SIGN PERMIT Attach(2)sels 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. (AIC upgrades over$7500) " Agent(for the contractor)or Power of Attomey(for the owner)would be so eone with notarized Ietter from owner authorizing same OVER THE COUNTER PERMITTING (Front of Application Only) Reroofs if shingles Sewers Senrice Upgrades A/C Fences(Plo Survey/Foolage) Driveways-Not over Counter if on public roadways..needs ROW NOTICE OF DEED RESTRICTIONS: The undersigned unde tands that this permit may be subject to"deed"restrictions" which may be more restrictive than Couniy regulations. The ndersigned assumes responsibility for compliance with any . ' applicable deecl restrictions. UNLiCENSED CONTRACTORS AND CONTRACTOR RE POfdSIBILITIES: If the owner has hired a contractor or contractors to undertake work,they may be required to be li nsed in accordance with state and local regulations. If the contractor is not licensed as required by law, both the own r and contractor may be cited for a misdemeanor violation ' under state law. If the owner or intended contractor are un ertain 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 o contractors, he is advised to have the contractor(s) sign porti�ns of the"contractor Block"of this application for whic they will be responsible. If you,as the owner sign as the coniractor,that may be an indication that he is not properly icensed and is not entitled to permitting privileges in Pasco County. TRAMSPORTATIOTI IMPACTIUTILITIES IMPACT AND RE OURCE RECOVERY FEES: The undersigned understands that Transportation Impact Fees and Recourse Recovery Fe s may apply to the construction of new buildings,change of use in existing buildings,or expansion of existing buildings, s specified in Pasco County Ordinance number 89-07 and 90-07,as amended. The undersigned also understands,th t such fees,as may be due,will be ident�ed at the time of permitting. ft is further understood that Transportation Impa t Fees and Resource Recovery Fees must be paid prior to � receiving a"certificate of occupanc�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 is uance. Furthermore, if Pasco County Water/Sewer Impact fees are due,they must be paid prior to permit issuance in a rdance with applicable Pasco County ordinances. CONSTRUCIIOId LIEN LAW(Chapter 713,Florida Statut ,as amended): If valuation of work is$2,5Q0.00 or more,I certify that I, the applicant, have been provided with a py of the "Florida Construction Lien Law—Homeowner's Protection Guide"prepared by the Florida Department of A 'culture and Consumer Affairs. If the applicant is someone other than the"owner",I certify that I have obtained a copy o the above described document and promise in good faith to deliver it to the"owne�'prior to commencement. CONTRACTOR'S/OWNER'S AFFIDAVIT: I certify that all e information in this application is accurate and that all work will be done in compliance with all applicable laws regulatin constniction,zoning and land develapment. Application is hereby made to obtain a permit to do work and installati n as indicated. I certify that n� work or installation has commenced prior to issuance of a permit and that all wo will be performed to meet standards of all laws regulating construction, County and City codes, zoning regulations, d land development regulations in the jurisdiction. I also certify that I understand that the regulations of other govem ent agencies may apply to the intended work,and that it is my responsibil'ity to idenCrfy what actions I must take to be in mpliance. Such agencies include but are not limited to: - Department of Environmental Protection-Cypre s Bayheads,WeUand Areas and Environmentally Sensitive Lands,WatedWastewaterTreatment. - Southwest Florida Water Management Dist i�t-Wells, Cypress Bayheads, Wetland Areas, Altering Watercourses. - Artny Corps of Engineers�eawalls,Dacks,Navi able Waterways. - Department of Health & Rehabilitative Servic /Environmental Health Unit-Wells, Wastewater Treatment, Septic Tanks. - US Environmental Protection Agency-Asbestos batement. - Federal Aviation Authority-Runways. I understand that the following restrictions apply to the use o fill: - Use of fill is not allowed in Flood Zone"V"unles expressly permitted. - If the fill material is to be used in Flood Zo e "A", it is understood that a drainage plan addressing a "compensating volume°will be submitted at tim of pertnitting 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,1 certify that fill will be used only to II the area within the stem wall. - If fill material is to be used in any area, I rtify that use of such fill will not adversely affect adjacent properties. If use of fill is found to adversely a ect adjacent properties,the owner may be cited for violating the conditions of the building pertnit issued un er the attached permit application,for lots less than one(1j acre which are elevated by fill,an engineered dr inage plan is required. If I am the AGENT FOR THE OWNER,I promise in good fa th to infortn the owner of the pertnitting conditions set forth in this affidavft prior to commencing construction. I understa d that a separate permit may be required for electrical work, plumbing, signs, wells, pools, air conditioning, gas, or oth r installations not specfically 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 is uance of a permit prevent the Building Official from thereafter requiring a coRection of errors in plans,construction or viol tions of any codes. Every permit issued shall become invalid unless the work authorized by such permit is commenced ithin sbc months of permit issuar.ce,or if work authorized by - the permit is suspended or abandoned for a period of six(6 months after the time the work is cbmmenced. An extension may be requested,in writing,irom the Building Official for period not to exceed ninety(90)days and will demonstrate justifiable cause for the extension. ff woric ceases for ninety(90)consecutive days,the job is considered abandoned. WARNING TO OWNER: YOUR FAILURE TO RECORD NOTICE OF COMMENCEME� Y RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROP RTY. IF YOU INTEND TO OB ' IN INANCING,CONSULT W(TH YOUR LENDER OR AN ATTORNEY BEFORE REC RDIPIG YOUR NOTICE OF C MM CEMENT. FLORIDA JURAT(F.S. 1'� 7.Q3)� `e�Q �.0 -� l�r V ys�= ,,,.-, OWNER OR AGENT CO TRACTOR �°'"' �* $uq&cfiqed�nd sworn[o or ffiqne )bef� me t is S sc'bed and swom'to or a ed)befom me this t�:� r�i h eY ��.F71� jJ�1/Tf� Who is/are ona kn or s/have produce Wh islare personaDy known to me or has/have produced a dentification. esiden6ficetion. Notary Public Notary Public Co igsian l�� Co mission No. /F I�nC�6� J I�., � . uo � � ame of N Na e of Notary lyped,prinled or stamped ='ot'"Y""°L'• JENNIFER MARIE CLARK �(PRY PUB ;_. �: 20�•••,G� RAYNA W.KOESTRING =* *" MYCOMMISSION#FF046316 MYCOMMISSIONtlFF122369 �Q: � * `�"?e��o?� EXPIRES August 18,2017 �, �, EXPIRES:June 7;2018 (40�398�ot53 FtoridallotaryServiee.com j�rFOFF��P�� BondedThruBudgelNotarySEtviCeS . � � � � �:' � � • ' , ' �ILE�7'F�I�G�VL�t�Q� ll:,��1�''ft41�. 712 Wesley Avenue, Suite A � Tarpon Springs, FL 34689 727.787.3533 � F x 727.785.6748 www.Sams lectric.net Email: lnfo@Sa sElectric.net EC-130 1969 To whom it may concern: Please place the following representative of my c mpany on your records as an authorized signer, allowing him to obtain all information needed, as ell as sign for the permit under our company's name for this project. Paul Lyons Thank your for your assistance. Sinc el Hassan Shehayeb, President Sam's Electrical Contractor's, Inc STATE OF FLORIDA \�14�`�vos1efoo� COUNTY OF PINELLAS \,,\�,°ti�H.SHEyq iie,,� es�� `��P,.�M�ssio,j,'••.y�`�': Sworn and subscribed before me this 20fh day of May 2014, y Hassq�i� f��io�,�"��Oi: ? e 9 • � ��O° �ct� o � e N o � 07� i �o� i*� a s • � s 2�� #EE 035519 ,'Q� t� • Q` Sig tu f No ubl►c ate o ida rint� �y �,o; p � omrr��6r�°��ry Public B��oar�as6��i la��°e INDUSTRIAL-COMAAERCIAL-HEALTHCARE HOSPITALITY-MULTI FAflAILY RESIDE(VTIAL New Construction- Renovati ns-Design/ Build Services Service Department Retail Maintenance PROVIDING ELITE ELECTRI AL SERVICE SINCE 1974 At&t 7886 Gall Blvd-1,769 sq ft-Geneva Construction Inc o umn SQ.FEET PRICE MAIN OR LIVING: 1,769 $ 53.18 OTHER AREA UMDER RfldF: - $ 88.Q4 OTHER: - $ ' VALUATION $ 94,075.42 FEE SHEET $ 465 .00 ADDRESS $ 3d.Od DRIVEWAY � BUILDING: $ 504.30 ELEGTRICAL: $ 104.63 , PWMBING: $ ��.7� MECHANICAL: $ 48.83 SUB TOTAL $ 727.5Q TOTAL $ 727.50 SEWER: $ 640.02 WATER: $ 204.11 IRRIGATI0IV: $ - TOTAL: $ 84b•13 WATER tvSETER: na IRRIGATION METER $ - FiRE DEPAl2TMENT FEES PLANB TOTAL: $ 106.14 INSPEGTiON TQTA�: PERMIT TOTA� TOTAL: $ 106.74 PUBLtC SAFETY IMPACT FEES POLICE FIRE / (� ' S% $ ' n�^'~l('�� I TOTAL: $ - nla \��'`` �-'`��3� � SU B-TOTAL. $ 1,677.77 �� PAF2K iMPAC7 FEES nla SIF'S: 100.0°l0 $ - 1.0°/a $ - TOT/�t.: $ - n!a T I F'S: $ 10,164.67 99% $ 1Q,063.02 1% $ 10i.85 TOTAL• $ 11,�+42'.� 25°l0 or fuii amount need to pay at permit pick up 2541 17 is 25 0 �th 75%balance$7,623.50 due before pre-meter P� �'!�� p�� ,_8-t� �►o � City of Z phyrhills Water and Sewer Im act Fee Calculation Land Use Type: Re il No. of Square Feet � � T� 1769, Impac Fees Within City Limits Outside City Limits Water Distribution System $ 204.11 $ 255.13 Wastewater Collection System $ 410.26 $ 512.82 Wastewater Treatment Plant Ca acit $ 229.77 $ 287.21 TOTAL $ 844.13 $ 1,055.16 �E�MYF�HILLS Fl�� EP/��,��fl�f�� , 6907 Dairy Road, Zeph rhills, FL 33542 FIRE SERVlCE SER FEES Occupancy No.: Plan No.: Contractor: Business Name: Billing Address: Business Address: Business Phone No.: Billing Phone No.: Business Fax No.: Billing Fax No.: Contact: Contact: PLAN REVIEW FEES INSPECTION FEES PERMIT FEE FALSE ALARM FEE �Site Plan NIC Annual N/C Sprinkler $50 1st Alarm N/C Multi-Family/Commercial .O6 sf 1st Re-inspection N/C Standpipes $50 2nd Alarm N/C (Minimum Charge$25.00 2nd Re-inspection $100 Fire Pump $50 3rd Alarm N/C � Plan Revisions DBL 3rd Re-inspectiori $250 Hoods $50 4th Alarm $100 4th Re-Inspection $500 Fire Alarm $50 5th Alarm $150 SPRINKLER SYSTEMS (Business closed until LP Gas $50 6th Alarm $200 0-25 Heads $50 violations corrected) Natural Gas $50 NON COMPLIANCE $150 26 plus Heads $100 SPRIMKLER SYSTEMS Fuel Tanks- Per�ank $50 STANDPIPE SYSTEM Hydro Undergrounds $45 Sparklers $100 � Per Riser $50 Hydrostatic Test $65 per sys m Fire Works $500 FIRE PUIIAP Acceptance Test $45 persys m Camp Fire $25 � Per Pump $100 Hydrant Flow $75 Controlled Bum $100 FIRE ALARM SYSTEM Hood/Duct $50 �0-25 Devices $50 FIRE ALARM SYSTEM Place of Assembly $50 Mnual 26 plus Devices $100 System Acceptance $50 Fire Protection $25 SUPPRESSION SYSTEMS Recall Acceptance $50 Flammable Application $50 nnnua� Wet $50 OTHER Waste Tire Storage $50 Mnual Dry $50 Fire WaIl/Smoke Wall $15 perwa� Generator<KW $100 CO2 $50 LP Gas $25 perlan Generator>30 KW 150 Other � $50 Natural Gas ,$25 pers em Bio-Hazard Waste $100 annuai KITCHEN EXHAUST Fumigation Tenting $50 � Hood/Ducts $50 Tent 10'x10'or greater $15 per ten Torch PoUApplied $50 OTHER Fire Pump $45 Haz.Materials $100 Mnual LP Installation per tank $50 Fire Suppression $30 Fuel Tank Installation $50 System Acceptance (Per Tank) $50 Exhaust Hood/Duct $30 ' �Natural Gas Installatlon $50 Re-inspection DBL (Pe�System) (other than annual) �Spray Booth $50 � Inspection scheduled DBL � and cancelled less than 24 hours Construction Insp. N/C Emergency Vehlcle Ai $50 FALSE ALARM PLANS TOTAL,��: f INSPECTION TOTAL� PERMIT TOTAL� TOTAL� GRIlND TOTAL Comments: Date: Inspector: nin � . o um SQ. F ET PRICE MAIN OR LIVING: 1,769 $ 53.18 OTHER AREA UNDER ROOF: - $ 88.00 OTHER: - $ - VALUATION $ 4,075.42 FEE SHEET $ 465.00 ADDRESS DRIVEWAY BUILDING: $ 474.30 ELECTRICAL: $ 104.63 PLUMBING: $ 69.75 MECHANICAL: $ 60.00 SUB-TOTAL $ 708.68 � TOTAL $ 708.68 SEWER: $ 640.03 WATER: $ 204.11 IRRIGATION: $ - TOTAL: $ 844.14 WATER METER: IRRIGATION METER $ - FIRE DEPARTMENT FEES PLANS TOTAL: � INSPECTION TOTAL: PERMIT TOTAL TOTAL: $ ( PUBLIC SAFETY IMPACT FEES POLICE FIRE 5% $ - TOTAL: $ - S U B-TOTAL $ 1, 52.82 , PARK IMPACT FEES SIF'S: 100.0% 1.0% $ - TOTAL: $ - T I F'S: $ 10,164.67 99% $ 10,063.02 1% $ 101.65 TOTAL: $ 11, 17.49 � � i iiiiie iieii iiioi iiiii iiiii iiiii iiiii iiiii iiiii iiiii iiii iiii ' 2014146257 , , • , Permit No. arcel ID No��`��/"O 1 ��(/��— �C/�� NOTICE OF CO MENCEMENT I State of J�� f[� � /.J,� unty of ,�/7 �� THE UNDERSIGNED hereby g'nres rmtice that improvement will be made lo certain real property,and in accordance wilh Chapter 773,Fiorida Stalules, the following informafion is provided in this Notice of Commencement: � 9 1. Descripfron of Property: Parcel Identification No. ��-�• � � '— � / � 1"� Sllaet Addiess: `� � L �� A� � ��.�-�Gf/ 2. General Description of Improvement O � ( I (� �� r"`I ��S �I r 3 J��`/ � `- - `-r-r--, i 3. Owner Infortnation or Lessee infortnation'rf the Lessee contracted r the improvement: �L 1c.� V L��.J C.t��r�.Q�j� �.11 � ✓✓l me b IJLJ�` 5CJ. � �T 4J�� U)f1 Address Ciiy ' State � N •• e�+� Interest in Property� �.SJ�{' �— ~�" �• F+ �"s�� Name of Fee Simple Titleholder. _ � .A B N pf dif ereni from Owner listed a ove) m � Address C� State • � /� 0� 4. Contractor: � / LA � 3 v am ' I � � ��l G�YC,� � � 3 N Address �`-. City 5� i C �� Contractors Telephone o.: , �L a• �� s. s�rery: /'� t� ; • . Name � �m� Address City State i � � ' Amount of Bond: $ Telephone No.: � 6. Lender: H' � � Name ; � 7�' Address City State Lendet's Telephone No.: 7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by Sectlon 713.73(7)(a)(�,Florida Sfatutes: �—'- i �v Name �c �\D ��"� N Address City State W�N �No , Telephone Number of Designa�d Person: �Z m B. In addition to himself,lhe owner designates of_ �� N_ to receive a co y of the Lienors Notice as provided in Section 713.13(�j(b),Florida Statutes. �•• s Telephone Number of Person or Entity Designated by Owner: �y� o �\F� 9. Expiration date of Notice of Comme�ement(Ihe expiration dal may not be before Ihe completion of consiruc6on and final payment to lhe , �3 � N contractor,but will be one year from the date of recording unless different date is specified): � 0 WARNING TO OWNER: ANY PAYMENTS MADE BY THE O NER AFTER THE EXPIRATION OF THE NO710E OF COMMENCEMENT �~ � ARE CONSIDERED IMPROPER PAYMENTS UNDER CHA TER 7�3, PART 1, SECTION 773.13, FLORIDA STATUTES, AND CAN RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERIY. A NOTICE OF COMMENCEMENT MUST BE � � A RECORDED AND POSTED ON THE JOB SITE BEFORE THE IRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT �� 7c WITH YOUR LENDER OR AN AlTORNEY BEFORE COMMEN ING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. �Q, Under penalty of perjury,I declare that I have read fhe foregoing otic of comme ent and that fhe facls sta therein are true to Ihe best � o of my knovAedge and belief. e_9 3 � 1� � � STATE OF FLORIDA '"/� V i.,� � COUNTY OF PASCO �Y- \ � ` ° r Sig ature oi Owner or Lessee,or t's or Lessee's Aulhor¢ed � Offi dDirectndPartnerlManager � ig atory's Title/Oflice The fo2going instrument was acknowledged before me this ,,��f . 2(y�by�/!�J+%� �,��/V�� as � (type of authonty,e.g.,o�cer,Wslee,aflomey in facQ for � ^ (name�,/ arty on behalf of whom ins![urt�at executed). Personalty Known�Produced IdentiScation❑ No ry Signa[ure ��5./, %y _ � � Type of Identification Produced Na e(Print) ��x�� io�"�`::;'8�.� RAYNAW.KOESTRING I * * MY COMMISSIQN�FF 122369 EXPIRES:June 7,2018 "'','�oFF��`�O� BondedThroBudgetNotaryServices wpdata/bcslnoticecommen cement�c053048 �s: � < � � �� r� �� .�� Permit No. `��.3�� . Date Permitted .�-z� _ �l/-/5�' Builder NamelOwner M1lame ��/Gt �GM•S�C�J�r� Control# County Parce!No. �� = Z ._-d j '.�c,-(`�t��(}-OU3t� SubDiv: ��yT �Oyvtrr��S Address/Location l�� S�A-� �� ClassificatiaNType of Use ,��e,-ci c - ��, � TRANSPLIRTATION iMPAC FEE Rate: Sq Ft Unit: t 1 /t� / Exempt � Yss � No Naw C}etermined Impact Fee Amount $ (��.fp? Zone No. TAZ: SCHOOLIMPACTFEE Account (Q56} Single-F mily Detached Fiouse Amount $ .,-�� (057} Mobile ome (058) Other R sidential 123} Collectio Fee Exempt Yes � No How Determined PARKS AND RECFtEAT10 FEE Land Account Land Credit Land Total Recreation Account Recreation Credik Recreation Total Zone TC?7AL AMOUNT $ �'' Exempt [� Yes [� No How Determined LIBRARY FEE �and Account �and Credif t�and Total Facility Account Facility Credit Facility To#al Exempt [� Yes [� No How Determined `fotal Amount —�'� � RESdURCE FEE ERU T07ALAMOUNT Prspared 8y Checked By Nt?CERTIFICATE t7CCUPANCY WIL�BE ISSUED Of2 FiNA�INSPEGTIQRi PERFORM D UNTIL THE'TOTAL AMOUNTS LISTED H�VE BEEN PAID AND E2�GEIP7ED FC1R B A CENTl2Al.P�RMITTING{3FF10E CDF PASCO COUNTY Acknowledgement beiow daes n lmply acceptance of concurrence,bat simply receipt of a copy of tfiis form,plactng Rhe building permit ow er on noQce a(this assessmenk and thp conditions of payment for same. DATE ftEGEfVEd SY RECEIPT NO DATE BY I � - L_ __