HomeMy WebLinkAbout15-15922 CI OF ZEPHYRHILLS
; 3335-8TH STREET j,
�si3��so-oozo 15�2
� � B ILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 15922 Address: 3501 MALACHITE DR
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: RV PARK Lot(s): Block: Section:
Square Feet: Subdivision: EMERALD POINTE
Est. Value: Parcel Number: 24-26-21-0040-00000-1490
Improv. Cost: 1,700.00 OWNER INFORMATION
Date Issued: 1/20/2015 Name: SCOTT DUNCAN T & M JOY
Total Fees: 67.50 Address: 7216 LINE 21 RR 2
Amount Paid: 67.50 STAFFA ON NOK 1Y0 CANADA
Date Paid: 1/20/2015 Phone: (519)272-7230
Work Desc: OPEN PATIO COVER 6' X 2 '
CONTRACTOR S APPLICATION FEES
HOMEOWNER BUILDING FEE 67.50
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In ections Re uired
F OTER 2ND ROUGH PLUMB MISC IN ULATION CEILING
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 omply with Florida Statute 553.80 (2)(c) when extra inspection
trips are necessary due to any one of the fol owing reasons: a)wrong address b) condemned work resulting
from faulty construction c) repairs or corre ions not made when inspections called d) work not ready for
inspection when called e) permit not po ed on job site f) plans not at job site g)work not accessible.
NOTICE: In addition to the requirements of this p rmit, 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 m nagement, state agencies or federal agencies.
"Warning to owner: Your failure to record notice of commencement may result in your paying twice for
improvements to your property. If you int nd to obtain financing,consult with your lender or an attorney
before recordi g your notice of commencement."
Complete Plans, Specifications Must Accom any Application. All work shall be pertormed in accordance with
City Codes and Or inances. NO OCCUPANCY BEFO C.O.
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CONTRA TOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 M NTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPE TION - 8 HOUR NOTICE REQUIRED
PROTE CARD FROM WEATHER
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City of Zephyrhills
BUILDIN PLAN REVIEW COMMENTS
Contractor/Homeowner: S C� -�- V N���
Date Received: � - $ - r S
Site: � S 0 J'�l IlLA CH l Te
� Permit Type: O Q E {�AT�p C OV E�
Approved w/no comments:❑ Approved w/ e below comments: ❑ Denied w/the below comments: ❑
This comment sheet shall be kept with the permit d/or plans.
�- l_,�_,
Kalvin S er- s Examiner Date
Contractor and/or Homeowner
(Required when comments aze present)
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a�t�•rao-ao2o Ci��y o1'�� nyrnl��� rc:r„u��r.,�������lv!� .
' Buiiding Denartm�nE
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� �C�1J` �(/��L�/I � Owner P1TOn�Number `�l�-' �7�'- ���
Owner's Name
Owner`s Address 7 b�-r(t l--C f?2 p2.f �. � U �"3`i'- � ���Yfa��NumUer�+ �
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l°ee S3mplo Titlelzalder Name Qwner PI�one NurriUer��
I=�e 5imple TiL•lehol�ler.Acldr�ss �' ' ' '
JOf3 ADDRCSS c�S-C�� �"! . �-C�L I M �/`/G� . ` c.or rt 1�9. .
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� . • (OLi7AlNCD PROM PftOPGRTYTAX NOTIC[j- _ __.�__ _ _
VItORK[�1�OPOSG]] : � NCW C�(�STR ADnlAL.T 0 S(GN � MOVC [�J DGMdL(S}-I ,
lNSTALL � . l�GC'AIR
pI,OFOStI]US�' • 0 SC'R ' . •� GOMM Q OTi-i�R ' �
� TYPG O[=CONSTRUCT[ON Q l3�OCt�C rl�AME ' ,� ST��L � OTI-l�R !I
oescr�inr�oN or-wor��c - �P�t t d' CDG�f�' � � � �
, Qul��ir����ze Io K•� �' � sa raa-rA�- �a�--�� _._f 1-i���rrr �,._^y._._1
� gU��'���� '�' f 7�� � VALUATION Of-'1'OTAL GC7N5TRUCTION
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� EL�CTRlGAI. .� , �( AMP SERVICC � PRO�I�G55�NGPGY • � W.R.E.C.
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0 MCG!-IANiCAL ,�� • VqLUATEON Q1=MGC!-lANlCALIhlSTALI.ATION . �� ����_��
(� �n,s ' C} r�oor-��v� sneciA�.-rY �( or►-�cr� , , ;��r�q�'�'►
l=1NlS!-IED Fi,oOR CLCVATIONS 1=LOOD ZONCAR�A [�YGB �NO '
13U1LI?CR � �� CONtI�ANY (�CU�� .
SIGNA'i'URE � (�GGIS7GI�Ed Y/ N FEE CURRGNT Y/N '
Acidross c�S(�/ � CcC� . C/f`l • ' . Lic�ns��1: �� �
CL�CTCiiCtAN � COMPANY
S1�NATURG rtECisrct�cd 'Y/ N r-ee cuR�rNr Y I N
.Adclress. � • Licenso�t � �
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P�.UMf3CR • CON(PANY
SIGNATURG r�e�jsrE��a Y! N• r-�c cuaa�Nr Y/N
, Acicirass Licenso# �� +�
M�GI•1I�t�lCAL: ' • Ct)MPA�lY
SIGNATURG • rtectsr�r�cD Y/ N rec cu��Er�T Y/N .
Adctr�ss • • ,Lic�nse�t� � l
OT[-iGCt . � . COMPANY � �•
sIGNA'!'URC r��ISTet�eD ' Y 1 N r-GC cuRr��Nr Y i N
A�(dress � , License�t � �
RG5ID�NTlAL Altach(2)P1ot C�tans;(2}SOE6 0(I3LIfICIIl1 Plans;(9}se[of�n�rc�y Forms;f�-O-W 1'ermitfor new cnnsirucFion,
Minimum fien{1 Q)worlting days afEec su mitta!dale. l�equircd onsif�,Construcfion Pians;Sformwaler Plans wl Sllt 1=ence installecl,
' Sanitary 1=acUlties&1 clumpstsr,Sifa rit Parmitfarsuf�d3vlstonsllarge projoci's
CONINfCRCiAC Att�cli(3)completc s�ts o�IIuildinc�P[a s plus a L.ife Safety Pac�e;(1)set ofi Cnerc�y.'1=orms.�i-Q.-W P�rmIt for new eonslruotion.
Minimum ten(10}woricing days afl�r su mitta!daie. Roc{uirad onsit�,Consfruction I'tans,S[armwater Pians wi Sift f-ence Insha!lecl,
Sanitary Faciltfi�s&1 dumpsfier.Sifo . ork i'ormit�far afi new projecks.Al!commercia!requiraments must meeL complianco
' S(�N PERiiltiT Attach(2}sets of Engtneorad Plans.� ,
'`�'`*PROP�PTl'SU1�V�Y r�c�utr�cf�(or A NEW construc(Iort. •
' -i-i-i-t-i-t-i,-i-i-Ff-Ff-f-i-l-i-I-hi-S-i-FI-1-i-1-1-I-i-H-i-l-1-t-l-i-l-1-l-2-l-l-1-l-I-l-l-i-l-l-l-l-J-1-II-1-1-1-I-1-1-I-1-I-I-hI-i-Id-I-1-I-I-i-I-I-2-i-I-I-EI-i-t-i-I-f-I-I-I-FI-i-i-I-i-I-i-I-f-I-I-f-3-I-t-i-FI-1-l-I-l-1-1-I-i-l-l-l-I-l-I-l-I-1-1-1-1-l-l-1-l-hl-l-I-1-1-t-I-1
Oir�ctions:
I=11I out apptic�[ion com(ai�tety. � •
Own�r&Gonlrackor slgn Uacic ai applIcafiun,notarizeci ' �
i�over�2500,a Notic�o�Gomm�nc�ment ts require . (A!G ulac�rades aver:I;5000)
"* Agent(for the contraator)or nower of Atkorn�y{�for thQ wner�w�uld be somoon�wifll nofiarizad lefterfrom owner autl�oriztng same •
•OVCC�Ti-IG COUNTCt-2.P�RMITTING (f-'ronl'o(App(icafi n Only) '
C�aroofs ' Sawers Sorvlc�.iJpgrad�s AIC �'onc�s(!'foi/SUrvey!l�aotage) .
Driv�ways-Rinl over Counter ir an puUfic roadways.:ne ds FZOW
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NOTECC OF DC�D RCSTRIGTI�t�ls: The.uncfersic�ned unc(�rst�ncis fit�at�[his permit m�y 1�� subj�ct�[o"cf��ci"resfihiefiions"} ;
wiiicii m�y i�e more resfrictiv��ll��n Ca�infiy r�c�L�l�tians. Th� �mdersigned assum�s r�sponsibilily•�or compliance with �ny
appiic�iale d��d resfirictions. �
UN�.IC�NSCD GO�iTI'tiA.CTORS AND CONTRACTCIP I�.CS�'O�SIQCL�ITIES: (f �Lh� awn�r lias ilirec! � contractor or ;
con�r�clors to uncl�rla!<e worlc, �h�y may la� r�quirec(fio bo 1ic�nseci in �ccordanc�uvith st�t� �nd loc�i r�c�L�fations, i�F tl�e �
cantrac{or is nofi licens�d �ts required by lzw, I�o�lh �l�e owncr ancl confir�ctor m�y'be ciied �ror � misd�mearior vioiation !
under stafi� iaw. i��tii� awn�r or infenciec� canfr�ciar �re unc�rC�in �s fia wh�� fic�nsing r�quirem�Ms �n�y apply�for ih� �
intenclec(woric,i:hey�r� advis�ed to�cont�tet t1�e l��sco County Bttifciing tnsp�ci:ion Division—Lic�nsinc�S�ctian �t 727�g4.7- ,
800�J. 1=+.�rlhormore, if ihe owner has hir�d � can[ractor or contr�c�;or.s, hca is �dvise,d fo i��v� ti�� coMracfior(s) sic�n '
portians o�F'fihe "conir�ctor [3lacic" ofi fihis �pplfca�[ion •for wl�icl� lhey wi(1 1�� responsibie, .if you, as �th� owner sic�n as tiie
contr�ctar, fil�at m�y bc �tn indic�lion i:ha1: he is rioi praperly licensec! �nc( is not �i`�ti�(lec! l'o p�rmi#:Ling privilegos in Pasco
Cotmty. ' .
TI�ANSI'ORTATtON iMPACTILITILITICS IMI'.ACT AND PCSOUPCC I�.�COVCPY�F��S: Th� unci�rsigned underst�►u!s �
tl7a[Transpori��fion Imp�ct C'ees �nd R�cours� I�ecovery F�es m�y�ppiy to i:he consiruciian`a��n�w fauifcffnc�s, ch�tnge oF
tis� in oxisling buildings, or exp�tnsion o�f existin� I�uiidings, �s sp�ci�(i�ci in l�asco County Ordin�nco numi��r 8�-07 �nd �
90-07, as nm�nd�cl. Th� �tndGt'sIgned aIso undcrslands, �th�t such �Cees, �s m�y (�� ciue, wili 1�� identi�ied nfi fh��[ime o�F , ;
p�rmitting. It is �'�trther uncicrsfiooci ti��l Tr�nsporL��ion Imp�tcl 1=��s �nc1 I�,esource C-�.ecovery F��s must be paid J�rlar ta I
recoivinc� n "certiFic�fie o��occup�ncy" or�Fin�i pow�r rc►ease. 1•�fihe p2'aj�c{ dc�es noi involv� �r c�rEl�fic�t� a�f accupancy or ;
•fin�! powor rele�s�, 1:h��re�s ir�ust b� p�id prior fio permit issu�nc�. t=urti�ermar�, i�F 1��sca Cotrnty W�ter/Sew�r fmp�ct ;
•Fe�s ar�due,fih�y must be p�ic! prior�Co•p�rmii issu�nce in accardance wifh ��piic�i�i�P�sco Counfiy ordin�nces.
CONSTRUGT1011i �iCN L.A1f11(Gh��L•ei�7�t�, 1�Ioricla 5tattrt�s, as �m�ncl�c1�: I�Fva1u�tion o�f worlc is ;�2,500.00 ar more, I �
c�rti�y tiiat i, ti�� appficant, h�v� h�en provid�d wiGl� a capy o•C �lhe "F1Qrid� Construction l.i�n l�av�r—l-lomeowner's
Protection G��ici�" �r�p7r�ci i�y�ti�� 1=larid� D��ari:m�nt o�F AgricL�llurc �tncf Consttm�r A�Ff�irs, l�f i!» �ppllc�nfi is som�one �
oih�r 1:h�n ihe `bwner", I cerLify fihafi I 17�vo.oi�fi�ined a copy o���tl�� �bovc descrii�ed documenfi�nci promise in good•faitl�to �
c{eliv�r it to the"owner"�rior i�o comm�ncemenC.
GaNTRAGTOR'SlOINNCP'S AF1=il�AV1T: ( certi�y�h��l•al! �Ll�� in�formation in fil�is applicatIon is �ccur�fie and ihat ail worlc !
wiii i�c done in compiiance with aff ��piic�ble l�ws regul�ling eons�ruci:ion, zoning �nd lancl ci�v�lopmenl. A�plic�tion is �
her�Uy m�de fio obG�iin � p�rmit fio da waric �nd inst�iiation �s indic�t�d. 1 c�rfi�y �Lh�t no woric or insfaif�tion l��s ;
commenc�d nrior fio Issu�nc� o�( � p�rmit �nd �tti�fi afi wori< wiil i�e perrorm�ci to m��t sfi�nci�rds o�F aii iaws r�guiating �
cansirucfiian, Co��ttiy 7nc! Ci1y eod�s, zoni�7g r�c�ul�fiions, �ncl Jand development regui�fiions in fi1�e juriscifcfiian. f aiso �
a
e�rtify that i unclersi�ncl�h�f [I�� r�gul�tions o��other government �gencl�s m�y apply i:o fihe infi�nd�d worlc, �ncl fih�l it is �
my responsiUi(ity fio icienfiiFy wi��t�cCions i mus�t�ic�fo b�in com�ali�nc�. S�[c!� agenci�s includa but�re not limit�d to: i
- ''`�.°'';.D,�p7rCmenfi o�F•Environm�nfi�1 �Prot�ction-Cypress i3�yh��ds, W��tl�nd Are�s �nd Cnviranmenialfy S�nsillve �
L'alicls,W�terNi/astewater Tre�tm�nt.
- 5authwest Floricla Vlfzfi�r Managem�nfi bis�iricfi-We![s, Cypress B�y1�e�tds, W�tl�nd Aro�s, Alfi�ring j
W�fi�rco�.trses.
- Army Corps a�F Cngin�ers-Se�w�iis, Docics, Navigabl�W�t�rways. i
- Qe��rtri�enfi o�� I-1e�lth & Rei�abiiita{iv� Servic�s/Cnvir.onmentai (-fienffii� Unit-Vl/eifs, Vtl�tsfiew�ter Tre�fiment, '
S�p�ic Tanlcs,
- t!S �nvironm�ntai I�rat�ction Ag��cy-Asb�s�:os ab��t�m�nt, j
- 1=�der�i Aviation Aufihority�Rttnw�ys. ' , I
! uncl�rsfi�nd ih�t fihe fo(lawing r�strictions a�piy�to��the us� o�r��iii:'
- Use af'fi!! is not allav�r�d iri I=IoQC(Zone"V"unloss exprassiy p�rmitfied. , ! �
- I�f (he �fil! m�t�ri�1 is 1:a b� used in 1=laocl Zonc "A", it is undersiood (hat• a c(rain�ge n1�n �ddr�ssin� � �
"comnensafing volume" wiil b� st�bmilfed a1: iimG a�f permitCing wl�icl� is �arcp�red by � prof�ssion�l engineer �
(ic�nsed Uy i:i�e S[�te o�T F(orici�. • . �
- lfi th� •fiil m�teri�l is Co b�-us�d in Fiood Zor�� "A" in connaction virith � permitfiecl GtTflding using stetrz wal! ,
' consir��cl:ion, ( cerCi�Cy fih�fi•(il1 wi]! b� us�d•only fio•li(1 th� �r�a wifii�in fii�e stem w�i1. ; �
- if..'iifl material is �a 1�� us�c{ in �tny �r��, !•cerLi�fy �L•hal us� a•T suc1� �[i1( wi1( no[ �dv�rsefy a•��ect adj�cent ;
' properli�s. ir.�us� o�`�Fiff is :�ourid to �dvcrseiy��fi�ec[�dj�c�nt nrop�rti�s, �f�t� own�r m�y be cited �Tor viol�fiing
th� conditions o��t1�e Uuilciing permit issuad ua�ci�r•the �tfiacf��d permit app(ic�tlon, �for lo[s less f(zan an� (�) �
�cr�whicl� �re elev�fied I�y�ri1(, an engin�ered drainage plan is reqt�ir�d. � I
(�F f am ihe AGCNT F�P 7I-IC QWN�P, 1 Jaromis� in gaod�C�it1�1:o in��orm�L1ie owncr a�rihe p�rmitting candifiions sefi�Forti� in
fi�is af�ici�vifi �rior to comm�ncing consfirucfiion. 1 und�rsC�nd th�l• a sep�r�fi� permifi m�y Ue r�quir�d��or eiectric�i wortc, !
plumhing, signs, weiis, poois, �ir conciifiioninc�, g�s, or aLher insiall�+fiians not�sJ�ec�fica!]y included in ih� applic�tion. A �
��rmit issued s1»i( he consfirueci fio b� � 1ic�ns�fo proc�ed witi� the woric�ncl not�s ���iilority to,uiol�fi�, cancel, �lfi�r, or ;
set�sicl�any�rovisions o�F t1�e fi�chnicat cocies, nor shaii issu�nce o�T� p�rmit pr�vent�t•I�� C�uilding O�fici�i��rom iher��fC�r ;
roqti�irinc� � carr�ctlon o�f�rrors in �al�ns, cansirucfiion or viol�iions o�F�ny codes. Cvcry�ermi[isstieci s1��1f becam� inv�iici �
uniQSS fih�wor4c�ufhoriz�d by sucl� {��rmit is commencec! wi�hin six moi7�Lhs of�ermiL issu�nc�, or i�F wor(c aufii�orized by ;
fihe permit is sus�on�Ied or ab�ndoned°For a p�rioci a�six(�) moM11s �•C�:er ihe �ime�[h�worlc is commenced. Ai� exlension �
may be requ�sted, in wrifiing, ��rom fihe Builciing'O�P�icial ��ar � periocl not fio �xc��d nin�ty (94) d�ys and wil{ d�monstr�te �
justlfinble cause�for�LI�e ext�nsion. I�f worlt ce�s�s�For ninc�y. (90} cons�culi�e ci�ys,i;i��joi� is consic(ored abanclon�ci. ,
WARNINC TO OWNCr: YOUI�.C.taELUI�� TO I���nPD .Z1. NC�TICC OI= �OMM�NC�M�NT M�l`�° I��SULT IT�•Yt3UP �
PAY[�IC TWIC�FOI�IMt'I�.t}V�IUICNT�TC3 YOUI�f'I�CIP�i�TY'. I�Y(��J INT�ND TQ ORTAIN t'IN.+�,NG1N�, CONSUL.T I
WiTI-T YOUR I.CND�P OR AN I�.TTC7l�NCY 13�T"CtR� I�CCORDINC YOCJ.R N071�� OI= COMMGNG�MrNT. ,
r-�.or�i�a�ur�,�-r{r-:s.��7.o3a - _ _
_����� .-� �_����- �
OWNCR ORA�CNT,��'��;�� Ct�RfTC,ACTOi� ��1� — �
SuUscribed nd sworn�p�or nffirmed bejo re this 5ubsci'ibed anci sworrt to or�ffrmed (�Coro e ll�is . �
/el-3-/ 6y ►Il u,/t�CU+ cl�d'�� !a2-.3/�/ (�y k1.��/ZG'r,� ��1 L'O�' i
Who is/arc�nerson�(�y icnown Eo m�or iias/r,�rTm��r�s, Who Cs/ar�p�rsonally Icnown to me or has/have�roelueed i
/�-� as identi(ic�iiott. ��� as identiiica(Ion. i
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Noiary i'uUlic • Nofary nul�lia� `
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Commission No, Gamr 'ssi No. �
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t�lameof ot�t���..� c�orsamp. (Va ebfA�al�Y '���'!'����j��lG �
:�° G�:.��i�C1E LYNN HARTWIG =.�. ' MY CQMM1SSroN#FFas4es� '
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'- "•;F',o��oQ:�•� EXPlRES fJatober 27
<�� '�°� ,2017 �
''.'��oF�;?Q,�' EXP(RES October 21,2017 (�o� ��g'�id� Fi�ridqNota BANIce.c�,m .
(407)3s8-o153 FloridallotarySeroice.com ,
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! _
DISCLO STAT��'�' FOR 06JNSR
, ; . - CITY OF ZTP LLS HIIILDING DBPAET�SNT
_. �l 'L�/� V �� - have read and fully nnderstaad and
agree to the provision.s of this ias t_ �
The uadersigaed states aa.d affixme t he or she is deairous of constrncting,
renovatiag, adding to os reroofiag 's os her cwa domicile, �hat he or she
actnally occupies, or 9r111 occupy b said domicile, and same is not fo�c -
reat, lease or sale. That he or s ahall comply with the following coada.tions:
1. That the owaer aad he or she al e shall act as the bnilder for a17. phases of
� construction..
2. That the awaes v�ill c 1 wi a1Z rovisions of the Cit of Ze hi11s
� Y P Y PhYr
o��ra*+�es aad codes pertiaeat o the bnildiag.
3_. That ia the eveat various phas of constructioa are subcontracted, he will,
engage onZy properly liceased s coatractors and mill. personally supervise
such mork.-
4. That in the eveat the Buildia.s Inspector ehall reqaire �orrections to be ma@e; j
the owner wiil asaume full res oasibility to insure they, are made, and upon �
' completion ovill call for _a r spectioa before proceeding with the building:
5. That the ownea shalZ assnme ]. responsi.bility for the construction and m:i7.1
aot expect e�ervision of his ork from the City of xephyrhills Bnild�.ag
Departmeat.
6. That prior to final i.nspectioa aay add:itioaaZ fees, including reiaspection
fees, must be pa3d ia full_ A Mritten reqnest from this office sha1l.
constitute aa official notice o pay addit3.onal fees.
7_ That the ooPaer shall comp].y wi all City,' State and Federa3. lav�a ia regard to
social security, worinnaa's c easation, liea laws, etc., where applicable.
8. That the owaer shall comply avi all the safety aodes iasued by the Flori.da ,
Industxial Commiseion_ "
9. 3tate law reguires constrncti to be da�e by liceased coatractors. You have
� applied for a pesmit under an. emption to that law. The exemptioa allows
you, as the owner o£ your prop , to act as yonr owa contsactor arith certain
restrictions even. thougli you d aot have a license. You must provide direct
onsite supervision of the cons tion yourself. Yon may build or i.mprove a
one-farni.ly or tmo-family resid ae or a farm outbuildiag_ You may also bua,ld
or i.mprove a cozmnercial bni.ld' g, provided your costs do aot exceed $25,000. , ,
The buildiug or resideace mnst be fos your owa use or occupaaey. It may aot
be built or substantially imp ved for eale or lease_ If you sell or leaee a
� .buildiag you have built or sub tantially impraved yourseZf vvi.thti.a 1 year after
, the construction is complete, ' e Iaw will pres�e that you bui3t or
snbstaati.ally improved if £or aZe or lease, which is a violatioa of this
exempfia.oa. You may n,ot hire unlicensed person to act as yovr contractor or
to supervise people �orking your bui:lding_ It is your reaponsibility to
make snre that people employe by you have licenses sez+,;red I�y atate law aad
by county or muaicipal licens' g ora3„a_„�HS. You may not delegate the
� responsibility £or supervisin work to a licensed coatractor who is not
licensed to perfoxm the �vork iag done. Any pessoa. wozking on youx building
� who is nat licensed muat �vork er your direct supervisioa and must be
employed by you, which means t yon must dednct F.I.C_A_ aad wi�hholdi.ag tax
and psovi.de warkers' campensa "on for that emplayee, all as preacr3.bed. by law_
Your cons�ruction. must comply _ 'th a11 appl'icable laovs, ordi.aaaces, bni.Zdi.ng
codes, aad zon3.ag regulat3.ona.
awrisa.•s s=�su8s z i nezs /eL-��1�
, p,nnRESS c�S�� ./ cc� �-
�$oRS r a.� - v
WITNESS• � PII2MIT #
��� ���t� �
Name
d�d/ �1���� �r •
Address
Ze � l� �� ��f'D
To Whom It May Concern,
Please be advised that:
Stacie Hartwig, Kathy Mim and Spenser Bahr of Pasco Permit Service
have my permission until fu her written notice to act as my agent to sign and pick
up permits.
Sincerely,
�
Signature
`�—/�
Date
NOTARY
STATE OF FLORIDA, COUNTY F PASCO
The foregoing instrument w sworn to and subscribed before me this c3�day
of �C'eh�-�r' , /
Personally known or P oduced identification V ,
�o�'a�P�e��� SUZANNE BAHfl
= o= Notary Public-State of fl rida '
;9� �;:My Comm.Expires Nov 22, 018 � '
° Commission�Ff 1696 4
',''',a11,OP,, L�4�
Bonded through Hationa!Notary sn.
Commissioned Stamp otary Si tuxe
and Expiration Date �
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