HomeMy WebLinkAbout14-15721 � ` CITY OF ZE HYRHILLS "
" + 5335-8T STREET �
(813)7 0-0020 1572
� • �, � MOBILE H ME SET-UP
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�¢'`��:=":':`";�''`���PERMIT{�INFORMATION � • LOCATI.ON�'INFO:RMATION = "`'��''
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Permit Number: 15721 Address: 37205 NEUKOM AVE LOT 336
Permit Type: MOBILE HOME ZEPHYRHILLS, FL.
Class of Work: MOBILE HOME SET-UP Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: GRAND RESERVE
Est. Value: Parcel Number: 34-25-21-0180-00000-3360
Improv. Cost: 10,300.00 `�`:"�`01NNER�INFORMATION�.:�'F��:�.�`��:��"�°��'��R
Date Issued: Name: HOLT RICHARD
Total Fees: 7,353.94 Address: 69 MERE POINT RD
Amount Paid: 7,353.94 BRUNSWICK ME 04011-7460
Date Paid: 10/15/2014 Phone: 207-837-2002
Work Desc: INSTALL MOBILE HOME SET UP 28 X 52
--- ,CONTRACTOR S APPLICATION�F,EES � ' --
�BMI LLC MOBILE HOME SET-UP 60.00 MOBILE HOME ELECTRICAL 40.00
JAMES O MORTON ELECTRIC CO.,INC. MOBILE HOME PLUMBING 40.00 MOBILE HOME MECHANICAL 40.00
BMI LLC SEWER CONNECTION MOB LE 1,005.00 WATER CONNECTION MOBILE HC 320.50
BAHR'S PROPANE GAS&A/C, INC. WATER METER RES 3/4" 457.18 WATER METER RES 3/4" 457.18
POLICE IMPACT FEE 254.00 FIRE IMPACT FEE 273.00
PUBLIC SAFETY 5% 26.35 PARK FEES MH 573.73
TRAFFIC IMPACT FEE 99% 3,595.68 TRAFFIC IMPACT FEE 1% 36.32
IRRIGATION CONNECTIO � 175.00
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�MO%B�ILE HOME�SET-UP �
MOBILE HOME ELECTRIC �Y'�
MOBILE HOME A/C /- �
MOBILE HOME P UMBING - �
FINAL l� � � -I�
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REINSPECTION FEES: Reinspection fees will comply ith 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 n t made when inspection called d) work not ready for
inspection when called e) permit not posted on jo site fl 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 ther may be additional permits required from other governmental
entities such as water manageme t, state agencies or federal agencies
The payment of inspection fees shall be made before an further permits will be issued to the person owning same
Complete Plans, Specifications a d Fee Must Accompany Application.
All work shall be performed in acco dance with City Codes and Ordinances
C�� '�JO'
CO CTO IGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS ITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - HOUR NOTICE REQUIRED
PROTECT CAR FROM WEATHER
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PERMIT V{tt}RKSHEET t�a�ge� of 2
______.
PERMtT NUMBER '
�,��,��„�,�i.. 1 License# �c�; �i New Home .� Used Hame Q
fnstal�ar �
Homelnsta!!ed#o!he Manufact�rer's tnstellatlon Manua!
Address af hame �����'� ���,.�� ,��{�. Home la installec!in arxordar�cew!#h Ruls'i5-C ['
t�ein�insta#ted .,—
��� r����1� : �—C.�. �°�� 1 si��ia,��g p w��a zon��� ❑ uv��►a��,�i« ❑
Manufau;turer ����',�''("`ti '�,C-� Lengg#h x wldth ,'r_,�,�?'�-�}� Dauble wide � Installat�on tD�ai#
NaTE: lf horne is s s/ng1�v�tda fltl out orr�h�t!ot tA�Wocktng ptaa TripletQuad [� SerEai#
Jf home ls a►frJple or quad wtde sket�h!n ram�lnder af l�ome
I understand Latera[Acm Systems cannot be used on anY home(new or c�sedl PIER SPACING TAB�E�OR USEa HC�lES
where the stdewal!tiss exceed 5 ft 4 ln.
lR8tal18t's itt�tt848 ';�r�,''��,� t,oad Faa6er
� �� 18"x 48" 181/2"x 181/2" 24"x28" 22"x 22" 24"X 24° 28"x28"
TYPICflI pfel'8p8Ndp� • � .���} (2l�} (3�2) {400) {4$4)" (b78)" t�)
f � � atenl
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Shaw locsttons af Lan��iudlnai and i�.ateral8ys�ems
� {use dark lin�to show f�ese lo�tians)
�ea Par�„s`fz�s [`�i, t7CA1�"�A7�IZ�'"1
1-beam Aler t�d�iza K-� a X e�,,,,.�„ _,,�Q,�
5
Perimeter pier pad size }`� x
__���._ __..�._...�____�---___�__.___.._______�_..�...�_____._�__ ..�.._...___.. �_ Other ptet pad sfzes ,�,� X-��' x
(�equ4red by ths mfg.) t,,��; �k.r�:-,��� x
�� Draw tha approximate locatlons ot�arrra,qe x
watt opec►in�s 4 foot or�reater. Use this x
m�ntaye w.e a�s wntrsn r a.�a or noms ve mn ssc sYmbof to shaw the pEers. x
x
l.ist al!marrla�e wa{I oqenin�s�reater than 4 faot x
and their piec pad sizes betaw.
a�c�torts �}
� _ _ Opening Pier pad size
I - _ �� g ,�, � X `��i� A ft `-� 5 ft
„ _�M. .. . FRAME TIE8
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' within 2'of end af�ome
spaced at 5'4"oa�_
'i'IEDBWN COMPONENTB OTiiER TIES�I
Number
Langl,Eud)nat StabJJlzing Device(LSD) Sidewalt _,___._...
- Manufacturer Lon�itudina! ,,,_„____
� tar�ttudtnal StabllFiln Devlce w/l.aferel Arms Marrtage wall ,,,,_._..,_._
- Manufacturer�fi�< <�e �►�r��,�„�^�� ��__ ..
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PERMIT WORKSHEET page 2 of 2
PERMIT NUMBER
S te Prepara on
Debris and organic material removed �
The pocket penetrometer tests are rounded down to' "��C� psf Water drainage:Natural Slwale Pad ✓ Other
or check here to dedare 10001b. soil without testinp.
X��� X�w X�Jr�I'�j — astening multl wide units
�� Floor. Type Fastener: (�-` S Length:.�c��� Spacing: fo���
Walls: Type Fastener: �L� Length: �f} Spacinq; "
POCKET PENETROMETER TESTING METHOD Roof: TYPe Fastener: � �t Length: fr,►' Spacfng:
For used homes a n.30 gauqe,8"wide,galvanized metal strip
1. Test the per�meter of the home at 6 locations. will be centered over the peak of the roof and fastened with galv.
raofing nails at 2"on center on both sides of the cerrterline.
2. Take the reading at the depth of the footer.
Gesket(weathemroaflno requlnmantl
3. Using 500 Ib. increments,takethe lowest
reading and round down to thai increment. 1 understand a properly installed qasket is a requiremeM of all new and used
homes and that condensation,mo(d, meldew and buckled marri�.qe walis are
X�0� a resuit af a pooriy instaited or no qasket bein�installed. I understand a strip
X�C� X�,�� of tape will not serve as a gasket.
Installers initials '
Type gasket � �iA.� �-�'�-'S� Instailed: /
e resu s o e orque pro e
here if you are dedari�q 5'anchors without testing . A test � Between Walls Yes �'
showing 275 inch pounds or less will require 4 foat anchors. Bottom of ridgebeam Yes ✓
Note: A state approved laterai arm system is being used and 4 ft.
anchors are ailawed at the sidewali locations. I understand 5 ft e erpro ng
anchors are required at ail centerline tle points where the torque test
readinq is 275 or less and where the mobile home manufacturer may The bottomboard will be repaired and/or taped. Yes � . Pg.
requires anchors with 4000 Ib holding capacity. Sidinq on units is installed to manufacturer's specifications. Yes�—
Installer's initiais Fireplace chimney instalied so as not to allow intrusion of rain water. Yes �'�
ALL TESTS MUST BE P�RFORMED BY A LICENSED INSTALLER Miaceilaneous
Instafler Name l�o t C�� I� S�� �`i� J`S^' Skirtinq to be instalied. Yes f No
�� i Dryer vent installed outside of skirtinq. Y� �llA
Date Tested �[__���� 1 (�--� ' � Range downflow vent installed outside of skirti�� Yes �—N!A
Drain lines supported at 4 foot intenrals.�es
Eledrical crossovers proteded. Yes ✓
Other:
ElectriCSl
� Connect electrical conductors between multi-wide uNts,but not to the main power
source. This includes the bondinq wire between mult-wide units. Pg. Insta{le�verifiss ail information given with this permit worksheet
Plumbing is accurate and true based on the
Connect all sewer drains to an exis8ng sewer tap or septic tank. Pg. manufac#urer's installation instructions and or Rule 15C-1 8�2
Connect all potable water supply piping to an existing water meter,water tap,or other Installer Signatun����r"��'-�°-- Date 1� �( ��'
ia�dependent water supply systems. Pg. •
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, , 2014158291
pemritNa �o►� ay-a 5��-0►�6-c�0000 - 3��
NOTICE aF CO MENCEMENT
smm a1 "�L C5 C';(1�_ nty of �Ol r��
THE UNDERSIGNED he�eby gfves rwdca that improvemmit w91 ba made to real P�Pe�X a�������P�713.Florida Stehdes. �N A
the tollow4ip NhrtnaGm is Ptovided Yn Cds Notke of Cammencemant/� ,�+► a
�. ���P�Yn Panoei IdanL'tication No.` "A �"��� � W — J�� �..�
Street/lddtesx
/' � � . �� � J m01
2. (3eneral Des�iptia�a6lmprwemerd \I 1 . A�Wp
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3. Umer IMormetlon w Lmsae Iraom�e0on H the cantraefed tlre Imprwement: �
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" ��.ns����e.�1 +� nU o i 1 ... .. „
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Intenast in P�opeAY G B r
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Name ot Fae S4nple TIDeholder: e� •
(H d8termrt fran Owner liated ► `G �
4. Contrada: � 1..�.� � Stsfe �
� � , . L��3sy� '
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5. Su�ety: `
Name
Address �Y S�
p��{g�: t Telephare No: " f..D
8. lender. �
Name
��a
v y
Addfess �Y `S� x F�O
Lenders Telephcne No: �/��m
7. Pmamo wdhin U�e Slele af Flai�desigim0ed Dy the awnar pon whom notices or othar documerds may be caved aa pevideA by '�i/��
semm�»a�a(»�a�.�ortaasma,mx ;��J
Name '�/OD v
.�3 a
aaaress qty smie c`",
Telepteare Number af Oeaig+�eted Pe+son: �~�
r
8. In admtion lo himself.the ar�rdesi�ates �— 0 �
to reeeire a y of tice Llemla Notice ae pfovided�Seefion 713.13(1xb1.Florida StahAea. ��
Tdephone Number ot Petson ar Enbty Dasfgna�d by Ownar. �F+w
n
8. E�hatlon date of Notim af CanmercemeM(the e�callon maY rot be beTae Me mmpletlm�d m�stru�tc��td fuml paymeM tn the N v
eonhador.but wDl be ana year from tlie�te oT reooding istesa d'dfereM data b spedGedJ: � �
z
WARNING TO OWNER IWY PAYMENTS MADE BY THE R AFrER THE D�iRAT10N OF THE NOTICE OF COAIMENCEMENT �
ARE CONSIDERED IMPROPER PAYMENTS UNDER C 713, PART 1, SECTION 713.73, FIQRIDA STATUiES, AND CAN r
RESULT IN YOUR PAYING 7WICE FOR IMPROVEMENTS 70 YOUR PROPERi`f. A N0T10E QF COAi91AENCEMENT MUST BE �
RECORDED AND P03TED ON THE JOB SfiE BEFORE THE IRST INSPECTION. IF YW INTEND TO OBTAIN FlNANGNG,CONSULT •
W(TH YOUR LENDER OR AN ATTORNEY BEFORE COMMEN ING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
under p�y or perywy.�eeda,e e►�as�Imve read aie roregdn0 or canmencane�d ena a�ac n,e racb s�ea n�n ere aua m ure nese
ot my hwwladge and bef�l. ,
STATE OF FLORIDA
COUNTY OF P0.4C0
af Owner a s a Lessae's
' ,. �lParh�(M�eBer
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The twego6�g Iratrumm�t was�aelmowled9ed befoie me tltb�daY m 2014 bv ►�5� f7�('1�.r
as (hPe of a�oAtY.ag..ollicer.trustee.efmrt�eY in ted)tor
� � (�ne paAy an b�4ial whwn 1� ent was axeaAed►.
ParsortaUy Kmwn�4$Produeed Idanh7ketion❑ Si�ahue I 0
Type ol Wm�tlfieabon Prod�ced (Prl�) � � C� �.
;�''�;.: LISA BOOKER
'� •'= MY COMMISSION�EE864958
����� ' �,.��.. EXPIRE�S Jam►ary 13.Z017
(�'39&Ot63 mm
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�,���: , �i,� s�ra�°�o� �����oA,c�ur��Y c�� Qasco
� TH1S fS 1'O CERTiFY THAT THE F4REGaiNG IS A
� ' � 7RUE AND CORRECT COPY OF THE DOrUMEN7
.
� a QN FlLE QR QF Pl1BLIC R CORD 1N THIS�FFICE
tn�otrtiverrurr . ir WiTf�! �Sf�S,,MY HA(�4DA FICIA SEALT!-!!S
� � ` °'"'Q°} `* `'�"� DAY OF > u/
�� PAU A S.O'N�IL,G $.�OMPTROLLER
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1887 �
n$*j.� � • � � � .,�.---- DEPUTY CLERK
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City of Z hyrhills
BUILDING PLAN VIEW COMMENTS
Contractor/Homeowner: � �� L
Date Received: � -- � �
Site: 20� /�l �t-c�
Pertnit Type: �� � �� �� �1�SZ
Approved w/no comments: Approved w/the below omments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit and/or lans.
�-j�-�
Kalvin S 'tzer= s Examiner Date Contractor and/or Homeowner
' (Required when comments are present)
tl��-�tl�-���� C:ity of Zephyrh Ils Permit Application Fax-813-780-0021
Buildi g Department
L
pate Receieed Phone Contact f r Permittin ; (� -- �U
> • .
Ovbner's fdame � � Ovvner Phone Idumber �� ��'�V
Owner's Address `(' � �(�' Owner Phone Mumber
� r\
1�er�lame � O v ` O�nrner Phone idumber
Fee 5lmple T.itleholder Address
JOB d1DDRESS �. - 1 S '"l LOT# �
SUBDIHISIQ�fd �`(_(�� �Q�1�_�('�� . PARCE ID# 'Ot�" I '�� r' "3 (�O
(OBTRINED FROAA pROPERTY TAX NOTICE)'
WO�t�t PROPOSED � NEW CONSTR 8 ADD/A � SIGN Q Q DEMOLISH
INSTALL REPAI
PPtOPOSED U�E � SFR Q COMM � OTHER
Tl(PE OF CO�STRUCTIOM Q BLOCK Q FRAME 0 STEEL Q �Q ' � '.}�(�{'�
i D�SCRIPTIOM OF MlORF( � 1 � l� ��Q � � � � ��
�UIL.�II�G SIZE � SQ FOOTAGE �� HEIGHT
OBUILDING $ VALUATION OF TOTAL CONSTRUCTION
�9,OQO
QELECTRICAL $� AMP SERVI E a �jO .� PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $ � ��
� � ���
QMECHANICAL $� ��� VALUATION OF MECHANICAL INSTALLATION � �
QGAS Q ROOFING Q SPECI TY � OTHER �(����
FIMISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER ' C i�IPAMY �'rnZ � � ( '—
SIGfdATURE RE ISTERED Y/ IV FEE CURRE� Y/N
�address r ,��-+� License# J-� �(� ��
ELECTRICIAfd C MPARIY � �� y�-S i
�IG(dA'II'URE RE ISTERED Y/ N FEE CURRE� Y/N
Address Q , `Q� - � `o� License# � /��5
�LIDIHIBER C MPAMY (��
�sIGR�e��UR� f `� RE ISTERED / N FEE CURRE� Y/N
�lddress i �� 3 u� License# (T � /V
MIECHAMICAL C MPAIdY
SIGRfATU1tE RE ISTERED � Y/ N FEE CURRE� Y/N
Address `i��} S License# �-i' �
OYFdER C MPAMY
SIGIdATURE RE ISTERED Y/ N FEE CURRE� Y/N
6lddress License#
RESIDEMTIAL 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. qufred onsite,Construction Plans,Stormwater Plans w/Silt Fence instalied,
Sanitary Faclllties 8 1 dumpster;Site Work Permit for ubdivisions/large projects
COiiAMERCIAI Attach(3)complete sets of Building Plans pius a Life afety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minlmum ten(10)working days after submittal date. quired onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facitities&1 dumpster.Site Work Permit for II new proJects.All commercial requirements must meet compliance
SIGId PERNIIT Attach(2)sets of Engineered Plans.
'"'•PROPERTY SURVEY required for all NEW cons ction.
Directlons:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over 52500,a Motice of Commencement is requlred. (A/C upg ades over 57500)
•• Agent(for the contractor)or Power of Attomey(for the owner)would e someone with notarized letter from owner authorizing same
O!lE6t THE COUNTER PERRAITTItd63 (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fence (PIoUSurvey/Footage)
Dr6veevays-Not o`ver Coun,tec if,on•public roadways:.nee'ds ROW - - � ..- .-.. ___. .._,._., . ....__ ....r. .
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NO'�ICE OF DE�D RESTRICTIORIS: The undersigned understands that this permit may be subject to°deed"restrictions"
which may be more restrictive than County regulations. The undersigned assumes responsibtlity for compliance with a�y
applicable deed restrictions.
UNLICENISED CONY12�►CTO�� �►PJD COPITRAC7'Oft RESPONSI�ILIYIES: 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 vr 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(.$) sign
portions of the "contractor Block" of this application for which they will be responsible. If you, as the owner sign a� the
� contractor, that may be an indication that he is not properly licensed and is not entitled to permitting privileges in Pasco
County. � -
TIR�IFVSPOitYAl'ION III�i�AC�lUYILIYIES INfiP�►C7 APID R��OURCE Rf�COVERY��ES: 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�e paiii-p�ior Co permit-issaance. =Far�herrriore;-if-?asco County Water/Sewer-Impac,t -- -
fees are due, they must be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
GOINSTRUCTION LIEFI LAW(ChapteP'P13, �lorid�Statutes, a�s amend�d): If valuation of work is $2,500.00 or more, I
certify that I, the applicant, have been provided vvith a copy of the °Florida Construction Lien Law—Homeowrner'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.
COP17RbCTOR'SIOVYNER'S AFFI�AVIT: 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 fimited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, WaterNVastewater 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 Nealth Unit-Wells, Ifllastewater T'reatment,
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 AG�N7 F012 YHf� OIAIN�IR, 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 pe�mit is suspended or abandoned for a period of six(6) months after the time the work is commenced. An extension
may be requested, in writing, from the Building Official for a period not to exceed ninety (90) days and will demonstrate
justifiable cause for the extension. If work ceases for ninety(90)consecutive days, the job is considered abandoned.
1A1�►ftF111VG TO OIAIfVEtt: YOUR FAILIJ�E TO R�CORD �► Fl0'�ICE OF COYWBflE1dCEflflEFV7' fWAY R�SUL7' IiV YOUR
PEIYING TViIICE FOR IfMPROVEAflENYS YO YOUR �ROPEFtYY. IF YOU INY@ND TO OBTAIN�IFIP►NCINC, COWSl1L7
WIITH YOUiZ-LEIVDElt-OR HN A�YOi�IVfEY��[�0��-�ECO��lBdG YOL!!2 B�OTIC�OF-COflA�fdEWCEiifdERlT:-
FLORIDA JURAT(F.S. 17�03)
OWWER OF2 AGEN I�J_ CONTRACTO
S scribed and swor to(or affi ed)b ore thls Subs rtb d an swom to( affirmed� efore e this
fU by � ��l�by�,�1 !�� ��C�O�_t l�
o i /are personally known to me or has/have produced Who Is/a e personally known td me or has/have produced
as IdenUficadon. " as idenUfication.
Notary Public Notary Public
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Name of Not r�fy ' print��r��j g�pN#FFOas05s Name of Notary typed, 'irted s►a�np�d COMMISSION#FFOaso58 ,
`;'��� '���� °' EXPIRES Au ust 15,2017 �
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" ' F'ermit No. f J��Z-j
, " Date Permitted /D-tS-t�
� Builder Name/Owner Name �� � Control#
_ ___County F?arcel No. 3�-�5-Z-�- a I 8t�-- i�bp4-- �3(oD SubDiv: �ltsF►n�( �Dr-c�z�
Address/Location 3� Z�5 /�.f�u..�b �b� ��'�
� Classification/Type of tJse .`�-����: �0�4' ��� +`�' T�� °�
. .._.---___._
� TRANSPORTATION iMPACT FEE Raf : � � _ _ _ Sq Ft Unit: ��
f Exempt �] Yes ❑ Na How Determi ed
� Impact Fes Amount $ � tiP��, � �� Zane No. TAZ:
SCHCIOL tMPACT FEE '
Accour�t (056} Single-Family Detached N use Amount $ _��)!
(057) Mobile Home
(058) �ther Residential
123) Collection Fee
Exempt [� Yes ❑ No Hc�w Determi ed
PARKS AN[} RECREATION FEE
Land Account Land Credit �and Tatal
Recreation Account Recreatio Credit Recreation Total
Zone TOTAL AM(�UNT $ .J�J�• 7 3
Exempt � Yes [] No How Determi ed
LIBRARY FEE
Land Account Land Credit Land Total
Facility Account Facility Credi Facility Tota!
Exempt [] Yes � No How Determi ed Total Amoun� —���!--
RESOURCE FEE ERU
TOTAL AMOUNT
Prepared By Checked By
NO CERTIFiCATE OF OCCt1PANCY ILL BE iSSUED OR FINAL INSPECTION
PERFORNiED UNTIL THE 7 TAL AMOUNTS LISTED HAVE
BEEN AID AND
RECEIPTED FOR BY A CENTRAL P RMITTiNG 4FF10E OF PASCO COUNTY
Acknowledgement below does not irnply acceptance of oncurrence,but simply rece4pt of a copy af this farm,piacing
the building permit owner on notice of this as essment and the conditions of payment for same.
DATE RECEIVED BY
RECEIPT NC}. DATE BY
. �
' ���`���� �Rrint Form
�.�'�'�'�`�
I�
CITY OF ZE HYRHILLS
UTILTTIES ORK ORDER
WATER ACCOUNT NO.: DATE: Oct 15,2014
OWNER/RENTER/BUSINESS:RICHARD HOLT CONTACf PERSON: BMI LLC
MAILING ADDRESS: 37205 NEUKOM AVE LOT 336 PHONE NUMBER: �j 2� �l�rl��r-
�J Y�
ZEPHYRHILLS FL 33541 EMAIL ADDRESS:
SERVICE ADDRESS: 37205 NEUKOM AVE LOT 336
SHUT OFF SERVICE ❑X �X WATER
TURN ON SERVICE ❑ ❑ SEWER
INSTALL MEfER �X ❑ GARBAGE
READ METER ❑ ❑X IN CITY
CHECK MEfER ❑ ❑ OUT CITY
OTHER ❑
DESCRIBE OTHER: 3/41RRIG TION
NUMBER F UNITS
DEPOSIT AMOUNT
AMOUNT LAST BILL
DATE
MISC. C ARGE
METER: FULL
IRRIGATION 3/4
WORK COMPLETED BY&DATE OR ER TAKEN BY: JACKIE BOGES
COMPLEfED
�
OR ER GIVEN BY: (,�,�M, q _
Revised 9/2010
_ �_�L�_
� ' Print Form
. ,
•i
CITY OF ZE HYRHILLS
UTILITIES W RK ORDER
WATER ACCOUNT NO.: DATE: Oct 15,2014
OWNER/RENTER/BUSINESS:RICHARD HOLT CONTACT PERSON: BMI LLC
MAILING ADDRESS: 37205 NEUKOM AVE LOT 336 pHONE NUMBER: �J ��I L���f.�7�
� l
ZEPHYRHILLS FL 33541 EMAIL ADDRESS:
SERVICE ADDRESS: 37205 NEUKOM AVE LOT 336
SHUT OFF SERVICE ❑X ❑X WATER
TURN ON SERVICE ❑ ❑ SEWER
INSTALL MEfER OX ❑ GARBAGE
READ METER ❑ XO IN CITY
CHECK MEfER ❑ ❑ OUT CTiY
OTHER ❑
DESCRIBE OTHER: 3/4 WATE
NUMBER F UNITS
DEPOSIT MOUNT
AMOUNT ST BILL
DATE -
MISC. CH RGE
METER: FULL 3/4
IRRIGATION
WORK COMPLETED BY&DATE ORD R TAKEN BY: JACKIE BOGES
COMPLEfED
ORD R GIVEN BY:
Revised 9/2010