HomeMy WebLinkAbout16-17075 i ' �
CITY OF ZEPHYRHILLS
: ' 5335-8TH STREET
(sis)�so-oo20 17075 %
,
DRIVEWAY PERMIT �
��
� PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17075 Address: 5018 17TH ST
Permit Type: DRIVEWAY ZEPHYRHILLS, FL.
Class of Work: DRIVEWAY/NEW Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 11-26-21-0010-21400-0200
Improv. Cost: 300.00 OWNER INFORMATION
Date Issued: 2/22/2016 Name: SAILFISH REVOCABLE LIVING
Total Fees: 40.00 Address: 5306 FRONTIER DR
Amount Paid: 40.00 ZEPHYRHILLS FL 33540-7602
Date Paid: 2/22/2016 Phone: 813-997-7731
Work Desc: DRIVE WAY 19 X 10
i CONTRACTOR S APPLICATION FEES
HOMEOWNER DRIVEWAY 40.00
`�G
, �
2�Z
�
Ins ections Re uired"
DRIVEWAY
� FINAL
REINSPECTION FEES: (c)With respect to Reinspection fees will comply with Florida Statute 553.80 (2)(c)the
, local government shall impose a fee of four times the amount of the fee imposed for the initial inspection or
first reinspection,whichever is greater,for each such subsequent reinspection.
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 owner: Your failure to record a notice of commencement may result in your paying twice for
improvements to your property. If you intend to obtain financing, consult with your lender or an attorney
', before recording your notice of commencement."
� Complete Plans, Specifications and Fee Must Accompany Application.
All work shall be performed in accordance with Ci Codes and Ordinances
� �
CON CT PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED �
PROTECT CARD FROM WEATHER
f
�
e •
i
�'9
:.7 '��:
-PERMIT=APP.I:ICATIOPi il
::.,,
DRIVEWAY:P.ERMIT.AP.PLICA'I�ON
�CONSTRUCTtON�WITHTN'�PUBLIC-RIGHT.O.F=WAY
All information must be-filled-in completely
• °.City.of�Zephyrhilis
�5335:8"'Street;Zephyrhiiis,�FL 33542
Telephone.813.780.0000 Fax 813:780.0005
�'i,-: .��y,�� P! 1✓ �'�'�s.A'rsr�'. -v�.51•:.J.f:�: "15.Y" _ ' ��J,,-.w.vrS.:4,'_ "�+4s�: .,
`��V�` '�1444Yniti'�',,' ��j�'�+.�"�>L'.K''. S' ,.�, , ft`�"`,�3"ir.��:.��w�ws-.�, :>nf�;^- 1� #k;,���Pv:�a.;:c-;,;:Kj•:1»�,� ;'�•:;
,. , ,.
.� .� z .s�"'-S..l�€'. �FJ11��: �... :�;,a�s r t.�;... �sa,�c�?:��'
..,..,. P,I�... .. . �s�,:,::.,�<'�.�;; r>-•.i� ':..��1A,�5SP.�s�!,. ,g�.:. - d...�.�..r. �z�-_�: - _� r,' ``'' s,.
:?k'.-+:✓Es<<��^,3'�......y...,r'24.:'�.....y �{^� �'.��i b f' ,a;, N�� ��� `� �t
. �' °:�'ts�'aa;�; �.,.;:,A�..I:.xr,.,,.r��. „:jtS.�,.�i y�y-rS��;it,,�.�;,;a�>.,,� z..�v3�������.t;��.z�'-,�:�k�''3,'�'"��_���*��'�::;}:X�".�s
�,?:': - ";'�l[. 'v.. ..t.�;E:Y�'a°�.tz'�L.s *�,5•'�s�.'^rk'�i+-.�;^t" :.:n"B;''�^- •+��!. ''f0�:5F3�°liSE..",D� !c�r�s�'a�•<,t�,a�?.rA.�`x'✓..'..5,'� :-:a, ,� f"�?�£.'f°�,.
�„�7�f�:z,�'. ,�'H`s,,:.�;: �.a- �'-�`�'"., -- .,r�k:s,....t�':'�.;�",F::�r�y,,,-, ,ri m--t;,;�2..;„;��v�'.�ze;:-;':,s��,',q c>,a-i: �s:.«r!`:� .z�C',c"+':'r`�`s',�,•r _ '+• ,$•� �
"`.`"':g�r�.d"a, ^}s,x, t.s_�•.,�.,a.�;;c . �r« r �`{� {� �y.",'F'.,..�Y.w'-; „�<��:'�fi�,f:,:
tt.'-=�: ���sC�IC�(!}�J;.��[�fll�:�`N:;s.�?� :r:'�.�`s�r�»'R ".a:; s,�: Qll IlC�vYfl .1,.(c,� d�,"-t .
S :Gf.r, 1P, it:., '��a4cli^✓7-' �ifr 5`M� F_!"?Y::: .i!�i�.[.t
o �
:PR07ECT .70B�SITE: �PROPERTY'OWNER
Address: . l'7�''` 'tcee� Name: 5 �ven 0 sz
Unit#: � Address: (o :er .r Unit• -
Parcel Identification Number: Ci S ,7/S F� 3
P e• 13- �-��3 x:
��CONTRACTOR:
Corr�pany: eG �
Name:
Contractor's License#: E-Mail: �
Phone• Cell� Fax• �
ARCHITECTJENGINEER: � ,
Name: Frm Name:
_Address: Citv: State: Zip:
State License#: Phone: Cell: Fax:
Descrintion of Proiect
i �
TY OF DRIVEWAY �LENGTH OFDRNEWAY CULVERTS�NEEDED
RESIDENTIAL DRIVEWAY �WIDTH OF DRI1/EWAY ( )RQNFORCED CONCRE�E.
COMMERCIAL DRIVEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL
PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEET ( )BOX QILVERT
( )OTHER(DCPLAIN)
CONSTRUCTION MATERIAL CURB CUT REOUIRED
PSPHALT YES NO
✓CONCREfE
HEADWALL REOUIRED? YFS NO
NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings
will be required.
UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
Page 1 of 3
� - ---- �
- - --- _ ------ ,—
0
PER.�aT APPLIGRTIOI�➢
UTILI!`IES 40CATE CON�IRMATION N47MBER;
PR01/IDE SKETCH IN THIS AREA, IP ADDITIONI�L SPACE IS REQU�RED, I�TTACH TG 'FHIS
A�P�ICATI011f.
� P
c3' �
E �' ' �
. � � �
�
_ �
� � w
_ _ _ _ �, U•
�
�' �` � � � � . �
�
� � � 3 � + �� b � �
.f � �
� � � � � �--j N � � � � � �
� � � �� �
� � � � �
� � ?
i � 4 �
� � `
� �
�
� V
!�1[1 ����'''��'
1 � - �
�i
�
�
, �
AFFIDAVIT: Applicatian is hereby made ta abtain a pemtit to do wark and installations as indlcated. I certify that all foregoing
information is accurate and that al)work will comply with ail applicable codes. I understand these codes shatl take precedence over all
approved construction documents,and issuance af this permit is verification that I will notify the property awner of Florida Lien Law
req.,FS.713.
The issuance of this permit does nat ensure compliance with deed restrictions and I understand that additiona!deed
res�rictions may apply ta this property.
Ali work shall comply with the current Florida Building Code, Public Work�Desi�n Ma�nual and FdQT Design
Star�derds(if ap�sicable}. (Public Works Design Manual online link:www.ci.zephyrhiHs.fi.usJpublic wortcs.asp)
APPLICATION iS VOID UNLESS SIGNED iNITH PROPER IDENTIFICATION AND WITNESSED SY A PERMiT
TECHNICIAN OR NOTARY PUBLIC.
NOTE; '�he City af Zephyr�si[ts is nat r�s�onsible for mait�tenance or repairs of driveways. Driveways s6aE1�not alter J
interfere with existing�tormwater treatment and/or conveyance.
PROPER7Y OWNERS: By sign�ng this application: I certify that I have read and understand the awnerjtauilder disclasure
� Statement. (please initial)
�)
il
Applicant Print Name Applicant Signature Date
Permit Technician Signature (or)Natary Signature pate
Applicant is( ) personally known ta me or produced as ident�catian.
(type of identification)
P�ge 2 a�3
e
�ERMrr ap�u�anon�
CDFPICE USE O1�I.Y �
_- �r- ,3.�.h- - -_ - - - :%� ;,;� =- =t:: - _
- ,,,,_r
�:{.: :t:�.
_ ;,:�:.h�
:�
;:�., _
_-:tsi� '4�:_`.�:
N
{'7:,
",ri:;.�..
, ~:� �: -�wa
�U Er.' LY�:
ua ��c. rt�s s
C�1`: u'y�:'
' �_•i�,.
:_L'
.:J. .4L.-.,..-
Cancrete (min. 6"� Y N
i Asphalt Base(min. 6"} Y N
� �
Asphait(min. 11/2"� Y (V
Length (min. 19� Y N
Width(10`min—20'max) Y N
Existing sidewalk. Y N
', New sidewalk. Y
�
I'
ADA compliant. Y N
' Expansion materiai required. N q,.'C ��jG�" 0 � R�C
Contiguous parking pad. Y N
Triangular fiare(3'W x 7'L) Y N
Visibility triangle a.k.? Y - N
Side set back(3'min. R.O.W.) Y N
Plan Review Fee
`;a' - -'z`, -:.sGT."`r� '�rx^:-s� .,ns^,;::rx ';z' -.Tc'' "A4.._, ..,.�y>• - - - >.i:. :z'y.s' .�F." ' ::�•., ..�.:.�Y.�� - -
I __ _ �.,,.N " �,.+i",.f'.•i'M'.s 1;;,;';.
< . . �i t, 3 `. - -�h`,nS " '';,.tnu,:,:���;�!^ :;::�:,.
;4,, � , .�. :,,., . .. .
- ` �,.�
.. . , . •v
� ��Addil�onal:�descri .t�on.ofi:anrark:aS:tlefin. ,b, .��!abiic�Worlcs�D�rec�or�a'rid:.orrrdesi`nee:.,:��-_:E::^4;;:,•<;��;;.w;�,:y;;:;�:: _
� � �� �" � -t��� 2 v� c +��' c fZv��"'
'J�E-� S
�
Permit application appraved by: pate:
�'�ge 3 af 3
!
�- �
� �
' _ - .r`��—- �. � '4 � `
r- �. �� �' � '��� �S' ,
'! .�� %y y -
` w ..t `� •,�
'i
:��.."'^{ � . " `0'.'S. , t�� t1
> � j �i� i.
�' . i ` l S
t, � i�
r•`•. � '.� �'� M
' • �` �, �=-' '� M
� :iS� �4'��
� - - ;J.; �'j�tjy��,
' - .� �;i�� �'^
, �� ar-�: 1 �r k � a 4�n �`r
�- ; .,� � `a z r u
11 ;T ..'"�� a.}.��z.. �,� -
t "j--�' < < :� '
t ,._
1 i � '�'3 :',��• '+t a�''�;
;f�, �, ��.�' :�..✓ i�t;
; �, �.le 4�; "Kg�'¢ �'�
i, � a��=! '4' F} •
ti `4'.��.. �' �,�' ,1�v L� i_ ��1 . r
, �� u� ,` � �� + ;i•
y 4fiF `� ;:,III y(`� t ,� 'i� �ur J' s
' � ` ��1 4���Y i�� .S�'r�t
. . ' h>, ��i
� 4 r,r ,j� �� ,S�r t� r. ��
t . ,_ ; : � ,�;..y. i.�.
ti. - �r '.L .t ''S {� ,P 'h
�t :1 � .�y �1�+��i''i1i,r yi�i7{,`117 s�! .�•
� _ :�„t=����� ����'.�� l;u
i , �`�;�,c ha�+�" �'� !;t,��}.�� ��.�,:i � ,.�'' � k,
'�s•;>
t 'a "'iw •.it;=�4•c' ' ^y���-"�' '�` t�t "�
• �' ' ,,}i�� �4���. )
i ,Q.. •L' �', .. ,�. rlx�^�i��'� ����w��4�y�� ',�t.,?i.
` ;'"`�+F,��'}? ,.�w<t .e. ,...� .(•%.� .,�r: 1. ��'.S
�,d„"„"�'n�_ �:'�,. ii.. ��.. ,. ��i�7, a
� � .'T _ fi�ti.yi �ti�' ��"�/ '�L+.:.tp' ' Q
I R`� � Y - t ';�}M�F y�t,,� b�'�$"''1 u� ?��'i� ..?�4
� a �f`.1�.� y.���
' 'itr P`-� 2 `'z•,•�1;iti4"+'��x1`:.Z'�i{ '".'�irL',.�:�j, �'i% N;:
�, .yt- ' "i tQ, �,_y � .j `
, ,S:,',`�;�r,`���'':�i. �Z," � t�it�Y "�S'
�\i ':2'.t.Y�xii!\h i1�(,� Y,' ��t�� .5..1� `.
� .y , t :1'+T p;��..t. � '� ,,^ +�"f�,;; .
A . �„ ; t,` ��,1�r2����;� .i;f. ` �.'�A' �
1 �'}� t'�+ `�"` *�`-�• . �''�
•YL . ! ' 'i�+�`�}'V'� ,��j�.��� y � 'a
� �� • ;. �. ;;� i'}i„, ��� �`���' �.
,,�;�-;: "�t �-���_.';�;�'�,.,.�t';;' ',..�.t�'�`�, r5�
I „\.` ^'�?.y r:''. �j „ � ,�� f "•�- ' `�}i:1 '� y� - �.- �/:,j�:'
�,� ��.21#���XtJ' oji� t. n,�+��'!�`;�,.�t..'��� " 3��i� C."
�{''�,y..c ";y� ��� •t���"s����.^.: a't�. '' i� ;Y �
� �r ' r�e.�� •_...'i 4, i.. ,�- r,
,.,sFy• �' I :��� ti{� � ������Y' ("�°v4
�� '« �^��, ��•' }i'; 1�ti�we=N /
't Y f t` ' `. :�.'ti ��"'
• -t''� � { 1l.� 5'!l.. �.
'' "t /F•'�`=;�5`R "� ,t,, , � f
,,��i�ws-r�� r��t+�-�'� , Y , .�x.fiti•: ���} �'_ ��Y
� �F `�t'a< v . �.,.>;,�-��' ,;�.� xa��•r
� � � � � ` ' � : ��' �:
�� ,�.� . }:.; .i� � ,k1�:�:t � �� E
` =��• `f• i�'�ht.� -'t �� "
� s ` .:"�` z`i y � ` ��;..;b'' ' �, r� � s�♦
'' ,� ` ��': r
.t ^��: ,4t;y ;
' ;' ,�• ''���` �`,�� y �3
' ,r� �' � � � �h5,�!i�H3�, ;i
-�_� t � '�'.f�:.ar
� � .
� , :s ;�, „> t�' �'��� l
��� `i., �" .
' '� � � � � � � ti� .��
' .C' �+5, - T� i ' ',t,�J '��
� ' �ri • ~�', �', ','„ �1`� ,
� Y•i( j��,w _ , `(tr� f ., }
�r � t � �� 4�
,� a r. ��,+�Kr�'.r ` ``, ,V, '�n
.- as.a �,�y, ��1 �� � ��
� ',.
•� � � � �,
' `1� '� t '� ;
; ,i' .�sr���:�
� "� �,�,,. ��y��,�, _.
�i, � - � ...�a� �= ��f ,�.
�5 :i� '-�f ��� 'f '���
't �'irk� s,
� ' -��{::.�� a ^ ..��t '� �`� �`
�,��f'-:;,t ;=,� .x ;� '�� �{ ''�w,: .:`-S.
�._:�_�,-� ` ;t��;�;` l�� A' � �1.
' 'v,,s.°�;1-`�J';w'`�/f -F�r�'t�..�'`t'�`#'��'�
�- �K=�4:,, ��'�, �': f4 'r1"�; �,'!1� �
�•��" , • rf },{p �� ,y.� 4. .
,�'y"�e ���rr,�c:� e�.-F '��5�',y,,.t?_'i itl�^
, � al .
�.��v',',7��.k ���•Ci d+t`• � • ,
�:�'f`;_ �ir ��
�,; '� i
:,
,;,.4.�,- -_
Y", 'a-- �—�'
�-„'r��—� �
—:�. -
.
r .•�t`� ��
��
�,�X„
_ .�r
.N
.��' ��� .z;:
ti tt
�=�'`�_.:�i'�1;�
_ �,�`,���k.
.�
, `, t..�
� �'.,`{,�,;��
.. •i., =� --
-il'`; �c, _ _
,dr.; ��'Y��
�+ `�:
� �l ^' �`,?�-A"�.,+�� ;
- .y 1dr -�V Zhrti�`'1..
;i-\ s `, .,_� __-4.'-c=�k$= ,
�� ,-r,�y.. . .
,� �_`S_. 1i.\ �r.-s-,...",�,.t;�rl -y �gr
,t � _,.r:.%„�� �,
���V'� �j= . • �w. �• 1�;�' ��
;r,���r '<.� - :: . -�:-:,, ,
j"•��t,_I.T`t�y'i �,M. a , . ,.y�'•� .1
` a f V'=*�f t�� 1�`1��: 1 -
�""GS J� � .:�!� ��1 . + ,���1
'" ��7'i-0�li✓ ,1 'C y��
- ,�', • ' ��: ` t ,'3'.
'�i��I t7
I u'T
( ./�'
�� ''I ij .1
. �:`.._,_��+ t �I��'�@ �, { 4',^r1'���7 '� �,:��i+ �!
� „ _,`�:.:--� � ' (i'i���(� . ,�,)�1;f,`�` `:1:�'•
,,� t.��
- ,,� ,,,,, _s � �,r ,;�� `=�;�; _ -`�,k r
� . �� . � '.�� �, ,�,,�.,;�II - �;,.a,� :. �-.
�; 4�� , .. � I,rili ��, 'I � I�il II �y' �[��III Q. � „
i�+ r _ - '� ���II� � '�
F�^`� �+. .{�—,�'-'3�I. I ''�ill.11� (,rtrr
��i.. 'fis..IYP,�_I I�Iill��'� I I " '.f . .
'S,.� -,�,{`-+ r.�r, � i i I I � �' ��;. ::,.
�': � `' T`",��.;~`;�) ��I ,��,��, d �1� ,`
;x�*."'Y�. ,, '�I-,���, I� ' i 9'�' �' �,t
ry' - "� ��I ��i���'I�� � �'`�J',.
►'^ ,�t' „'� I ,�1� .r;- �n "d-
�rn . � �I✓'II ,'� .y.t!7,�.r.
,4'' ''il';�jl�,��i�l� 1 �,.� ':!',��-.�� .
~`ti»75`��R- �� � ���•il�I � 1 � � t y
p�'+�� � I fl � , S� '�•` r't
,i ,i III;�I'I�'',II�III ' i`�� '�i�v3 rr1�k`r
I� ' I I'I f,�'�rv.'„� ��4[13"{;J,'
ti A'�" . ;i I II', � �I i ���, . .{ i �.1. -fl �,�f�.
�1;'" ` . �,,I„� �II i,I,' '
—i � '�c. .• ( ,I I � � I;'I� �',����. ,��., � •+�;;
� � ��I "I��I� 'II ��{i �, ri r'R�
��,2_ " � i��i� �� (I,i[ �. '[ _ �� �
"'-",�t-�� �",�i i,�I I'�i���I�� (' t :,:!'+ 44 ��
t__ ; ; .
��;_�: ,,� �� ''�I;I, �', '?�', ;�;�
�`� I . �
� ;�, '�i��ii�i` '�`�: .4,�- ��,�� �►�
�
i ;� 1. ';
.�,,,
,� � ',I I I�� �Q
r �� I����'I���I�I � �� it�, � �4't^',i
;1.
'��� �''i II��i�����i���l. ;r. " •`� ' � " y�'� ,
t �) , r.� '' $• ,v.. f�'., ,,
i I il���+ifi IIIIII I .1:,� � `���.d��(�.�� i��:t`i� .�J� f,'f.
1 �; II II l�' ��?� � ,ti�,��".� ,
'' ';'�' IJ l;'���. z' , - fY.t i ^.�.•,}':f
, ��C'I'i��l� 1 i ' ��.44 "1 M
�j� !��',1.����l���l�l � r; r . .�:i`"�<t � ,�' , a �!'� '•<�a{.;,.
;i, ���� iI���I�� �;aZ'=`Ay;��' b, ,i y '� •'R�`•3
'f.,��'I,'�� ;� s'"..�,� ;jy�.:.� ,y�4�"� , .a���� f�,� .7
� i� i III,II it4i�w. t.!r+'�c,3,,�; �;w. �`�: :� .�1�.
�, ;I�r Il�,I'�� � +"f�l�.�X+. c( �ryt� '� :f; t� '+��F, . ,�, � ''
, �.�i;- .," 9
.r i ,��,I. `I I ;r�,:<<;;��E r � y.�. d.�, /�+ `t �.�:
�il�i�'II�"�� y��� 4'yi�,it•,(t N;i.,?��i�'�.. 1 ;�,`,�! `��
'',ill�' „t`t',""��f�24�.:��,�3`�' �� }•�,•����.'•i•., r''�+''.
_ � ','I,' li l li �,;:�4�. �.,�,%S?�.F.., � }� �� :
�' :1f�1` '• 4
� ��,�' � ; t.�,4�t��;� �. ���. �,�.
� ,d. . , ��!i�� ,i:�,�,�..��-;� , t� �;�•, � �,�
".,d`���i�,i��i��� 1"'{ �;''F���^.^ .Y >�'�°r•<�`f' �`'��:
+,i, , ��; � �';�Y`"��'�; .,�,.� � "� �;�f��ti' a ';�.�' ��
1' r� k �
•t� �I��I�"��Iil!� �;'�4' ��',t�. �j��� � a}`r iP./r, t�.z! 1�� 4t3'�'r a(�, t,
,:�i, ll,,���ll� +# 7.�,��Sl�i�}�i� ' a� � �J:.t4 71 .l''�4 f•
i, �����j:�II�II i ! ,�R ti�y i��.t`�,''� •t�k����r':,�" ' ;�'r,� .
� '�� ' � ' f�;�`�:fy'• k�i��.,� �k i �� �,�'?:r,.,,,'y
��„i,��I�l�ilf� '�`, t�;��;;ll>�:;'�� � r� ,, ���it,.
i, '���t �) �,,.� '��' :::Y rt����� �,� �
e� w 'f p1�,1` 'H�•�� ,>> ;. ,�I.�iu
1 .. ���,��I{i ''I�L 11�����''�'�,',:�f�'����' . { ', i �i.,�"„+�;,+t.
- ��� '�4f�'� G�f' �9.��h 1,4. �%� i�l�y; 7� �` �ri}'�, cr�. '.4*�it�,
�;� '�i, :'' ��,L` �i. �` y�',i7,.! ;� ��,�.,.:.��tY.�1.
�,rr�l` �a� �i ��I � ,�"; �.,� � M11 � : �i�dit'�7
{ u:���i '}�i�'�f� �.-'�.�' ;1�� , ,-.�ti.
��' f� ��, �i� '. ��3. 4 .ti
.+�6. �� � � •�;�!,'-�\. e� g{ a .ti, t.
�����f� � � i' j � g ti'�i� �' J•tl��,'' ! ..i� .,�.:...{ . i,Y.��t., �� �Ai..:,
,�,r�t,�1��1'� ''0' C'�� ":, ��: r. - G� a
i � ���,
:.� �I.I�+�'h� _ �'f� i q y � . • �
>Y'4'P;H��',A'il�� �j•� ��ri��-'`�1S�;i',•j;<' r✓• 't 'I�d.� ,7' : ,I' •
� ��e�.�z.i�� �•,j ,� �,��° ��� - ,��il� v ..,✓. � •,�'��' ,.`4
!N� i i . � ;.,��t,.; �ira ' ,,�, .
��� i d��ii.p F,�i !.h� i; k�
c (.i��t ,°I{ si'i,�„?i' ��' �r;�., '�� � ►' i `,';�' •' `,ti!'
���'� 't:l � i .y C�i`�y', �, i�,, �, , �ti, : ;
' ��v4�,ir �`,,]1`1f ._ ;�i�l�l �� , � '`�� .r� �5, ,r'i r .���
, ♦,,' Y��F{a ��j:• t,� 1 t�� f� f� ;'.� CI. s� �' ;y�
r. �4`,, . �rN�+L�r{'�p '�� {�i.F, �I, dq�,��T.j,�,y����� ��'.�1-` , 21� Z�b. ,1 , �, ,.4
? � i� I �pj,��PYi'� �� ,�. 1.•�,` Z 7y' . `-' ' � .
�� �.• ��'' u �i;�kCP��i���j�i, , � 'I: �1:��t ', •��.?� , -
.f L. i ,�s,,� `r,.
.i '�'�t' �') �� i � �i.i•, �� ,•�i : t� � �.. i
� .,;� ���'fQ�} �"�'V ���,�y���,ip{�` �l ; � Y"!3 ��d •� � '� �•
_ _�.�4,���' ";'�k,f_�:f'_ ,�'t2<!4�?'„. .�lS��..4it,'��;s`t u}. "� ' ..i 't��± ..a ' ,�� ,'i�' «_�
- a�saao-oo2o City of Zephyrhills Permit Application Fax 813-780-0021
� r
� Building Department
Date Recelved vt "- o��-,)(a Phone-Contact for Permlttin ��3 ��� - `7'7 �
Owner's Name S'�'C�/e v� b('o S'y Owner,Phone Number
Owner's Address 53� �R Onl"i'-I e Q �R Owner Phone Number
Fee Simple Tltleholder.Name Owner Phone Number
Fee Simple Titleholder Address �
JOBADDRESS ���S 17h� S"` tE j' Z,�PNy t{��LS (�-L LOT# �
SUBDIVISION PARCEL ID#
� (OBTAINED FROM PROPERTY TAX NOTICE) .
WORK PROPOSED �NEW CONSTR ADD/ALT [� SIGN ..Q Q DEMOLISH
-� INSTALL e REPAIR
PROPOSED USE ., Q SFR �] COMM , Q OTHER
TYPE OF CONSTRUCTION . Q a �BLOCK � Q FRAME Q STEEL Q ' '
DESCRIPTION OF WORK �✓P':V� �n1 0. ��u �' �"i �- ��
BUILDING SI2E SQ FOOTAGE� HEIGHT .
QBUILDING $ 3�� VALUATION OF TOTAL CONSTRUCTION
QELECTRICAL $ AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
QPLUMBING $
�/'1d�,�
[�MECHANICAL $ VALUATION OF MECHANICAL INSTALLATION
QGAS Q `ROOFING. Q SPECIALTY Q OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA QYES NO
BUILDER (� �J lJ COMPANY �Y►ornrr�yS�r_ P�o✓c'%i-�i iM n'lt,
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N :
Addresa �.��1(� F�-o�1�-i�e✓ n•u� v� rh���S License#
ELECTRICIAN COMPANY �
�
SIGNATURE REGISTERED Y/ N FEE CURREt� Y/N
Address •� ' �License#
PLUMBER - COMPANY
SIGNATURE REGISTERED Y/ N FEE CURRE� Y/N
Addreas License# ' `-�
MECHANICAL COMPANY �
SIGNATURE � REGISTERED - � Y,/� N FEE CURRE�- , Y/•N;
Address License# '
OTHER COMPANY ` -
SIGNATURE ` REG�S7e[tE� Y/ N.. FEE CURRE� ,� Y./N
Address - ` Licen§e#
RESIDENTIAL Attach(2),Plot P.lans;(2)sets.offBuilding;Plans;(1)set of'Energy�Forms;R-0=W Permit for new_construcUon,
, ,.,,
; .Minimum�ten(10),working;days after:"subrriittaf date. Required onsite,Constntotion�Plansr°Stormwater`Plans w/Silt Fence installed,
Sanitary Faciiides;&�t,dumpster_Site,Work',Permit for'subdiVi'sions/large.proJects � _ __
COMMERCIAL Attach(3)complete'sets of Builiiirig`Plans plus a Life Safety Page;(1)set of Energy Forms.R-O-W Permit for new construction.
Minimum ten(10)worlcing days after submittal date. Requlred onsite,ConstrucUon Plans,Stortnwater Plans w/Sflt Fence installed,
Sanitary Facilides&1 dumpster.Site Work Pertnit for all new'project's.All commercial.requirements must meet compllance
SIGN PERMIT Attach(2):sets of Erigineered Plans.�, �r • ,
""PROPERTY SURVEY required,for all NEW construction.
Directions:
FIII out applicaUon completely.
Owner&Contractor sign back of applicaUon,notarized
If over 52500,a Notice of Commencement is required. (AIC upgrades over a7500)
_ ,
" Agent(for tFie contractor)or"Power of Attomey(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER.PERMITTING - (Front of Application Only)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plof/Survey/Footage)
Driveways-Not over Counter if on public roadways..needs ROW
-- �����u�
� 4
*
RIOTBC�OE IDEE�r RESTRICTICIN�: The und�rslgned u�d���tands°:that t�ls:per•m�t.m�y.be.sub�ect to�de�d".restrtctlons"
wrhich may:be::moce'restr(ctive th�n Giaunty�regulatlons. �The und�rsigned�assur�ies responsibillty for�corropliance witti any
appAcabie;deed r�stricttons. _
UMLIC�WSED �CON'FRA►�TBR� ANCb Ct)NT��T�R �2ES�t�NSt�tLi'1rtE�: �tf the owner fias hfir�d a contractor or
oantract�o�s to undertak�wark, �h�y may be;eequieed.to.be:licens�d In a�cordanc�.with-state.and•locai r�gulations,. If the
cantra�4or_,fs not,tlaensed as requlred'`6y lariv, both the awnet and�cor��actor-may be-cffed�for a�inisdemeanar vlolation
under state law. If the owrner a�r intended,ccantracto� are.wncertaln as to what Iicensing.requlrennents eraay;,appiyh�for�t6roe
intended work, th�y are advised ko contact the Pasco County�uAiiing"inspectdora Dlvlslon-Llc�nsing��c#is�r�at 727-847-
8009. Furthermare, i€ the oinrner has hi�ed a contra�foi- �r cor�tractnrs, he is advised to have the �ontractar(s) slgn
portion� of the "contractor Block" of this application for which they will_be responsible. If you,.as.#he owner'stgn°as tfie
co�ttractor, that may be �rt indic�tion that�he is n��.properly 13cens�d and !s not entitted to permitting pr��ileges In Ras�a
County. ;
TRAN��QRTATIAN�,II4�PA�T/U'�"�LITIES-lMt�AC'g'AND�RESOURCE RECClVE�'�C FEES: 7'he under�igned understands '
th�t Trensport�tian Itv►pac#Fees and.Rec�urse Reca�ve.ry.F�es may apply ta tfie c�onstPuation af new bulldings,_change of t
use in �xisting buildings,4or-�expari�ion:�f�e�Osti�g,`�ulidings� as specifled.in Pasco Counf� Ordinance number 89-07 and
90-�7, as amended. .The'undersigned �Iso�u�derstands, that�such feesf;as�may��e�_due;.,�nrill��be Id��tified at the fime of
perr�itting. It Is fu�tfier understaad that Tran�po�tation Impact Fees and Resource Recovery'Fees.must �e paid prlor ta �
receiving�"aerfificate��f occtapancy" or finai power release. :I�the p�s��ect,ciaes.no4 ir�ve►tve��a;certif3ca#e a�mccu�ao�ay or-
finai p�wer reiease, #he.fees must be paid prlor ts� permit I§suance. Furtherrraore;-i�Pasco County�Vllater/Sewer-Impact ,
fees are due,.Qhey�.must_be�pald prior Qo permit�lssuance-tn accordance w(tfi appllcable Pasco G�unty o�dinances. �
GON�'�'#�UCTION CIEN'L:JaiN"(Gha�Q��7�i3, Flor�d��tatut��,�ame�nd��): fff valuati�r�mf work is$2,5�0.�0 or more, t
certify that 0, #h� .applicant, ha�v�-been prov(ded with. a copy of #he "Florida Constru�tion Lien. l;aw:.Homeawner's
Protectian Guide" prepared by the Flarlda Depa�ent af Agrl�uEture and Cons�amer Affalrs. �f the appltcant Is s�meone
other than th��owner", I certify#hat 1 h�ve.obtained a.copy,of.the abov�.described docurnent and.promise in,good faith to
del9ver It ta the nowner"�prle�r�to•ccamer�en�emen4: '
CON'TRACTOit'S/QWNEt�'�AFFt�A'�IT: i ce�ify fhat aN the informatic�n in�this appllca#ime�is �ccurat�and that all wrork
will�b� done in compliance with all applicable laws regulating construction, xoning and land d�velopment. Applic�tion (s
hereby made ta obtatn .a per�»it ta do. woi�C and installatlon as tndlceted:�;_ 1 certlfjr"th�t no woik or i�stslla#ian has
camrroenced prior to I§suance of a permit and #hat all work wil) be pertormed to meet standards of ail laws regulating�
constructian, CounQy and City codes, xonEng cegulaQEons, and land development r.�gtalations�in the �ur�sdiction. i al'so
certify that i uz�derstand Qhat th� regula#I�ns of other government agencles may apply�ta th� intended work, and that it is �
my respo�sibility to Qd�nti�y�what,actlons i must t�ke to be,ln:.cgmpllance. Such agencles Include but-ar�.nc►t Iimfted to:
- Depa�tmen# �f Envirs�nrr»t�ta1�Pratec#ion-C:ypr�s"s.Ba�heatls, Vll�tiand Areas and Errvirr�nrrtientatiy Ser�sitive
L�nds, W�t�rMlastewater Treatment. ,
- Soe��hwes# �lorida V�later M�nagerv�ent Dfstrict Vilells, Cypress. 8ay_heads; ldVetland Are�s, A#terinc�
iNaterc�urses. �
- Army Corps of Engineers-Seawallsf Docks, Naul�able 1MaQe�virays. ,
- Department of Health � Rehabilitativ� Seniices/Ertvitonmenfat Heaf#h Unit Weiis, Wastewater �'reatmen�,
Septtc'fi'anks. ,
- �1S Environrn�entai Ptotection Aget�cy-Asbestos�batem�nt.
- Federal AvBat(a�n_Authori4y-Runways.
I under�tarad that the following rest�lctio�rs apply tv the use of flA;�
- Use of fili i§nat aliowed in Flood Zone"V"un{ess expressl�permikted.
- 9f the fill materfal is to be used. ln Flvod �one "A", It. (s understood that�a drainage plan address[ng �
"compensating volume"will be �ubmttted at ti�ne of per:mltttr�g wh�c� is prep�red by a professlonal engineer
liaensed by the State-of Fl�rida.
- If the fiil materlak_is:#o be used In Flood Zone �,4" in�cannec$ion �rl#h.a��ermit#�d bu14d1ng �sing ste�t �nral!
� construcfion, I certify that fill�.wilt::b.e�used only.�o fil�the area within the stem wall.
- If flll rnaterlal is�to be used in any area, I aertffy that .use. of'such fil9 wii# not adverssly a��'ect adJacenQ
properties. 1�use of f311 is#ound to adver�ely.�f�ect ad��eent prdpe�ties,,the awner may b���ted fvr violatir�g
the conditions of tlae building,permit issued•ur�der the attached pecmit application, for I�ts less than one (1)
a�cre vvhlch ar�+�leva#ed by#l11,an englne+�red dralnag�plar�Is requlred�
If I am the�►G�NI'FUR'g'HE OWNER, I;promise In good faith to inform the awner af�the permitting.conditlons set forth (n
this a�idavi6 prior k� oommecncing cons�ruction: 1 �anderst�t�d that aYseparate �ermlt may be requtred for electrical work, ';
plurnbing, signs, weils, paots, air cond6tioNng, .gas, ar other anstallatlons naE.�pec�3calty inclusied�in.th� appticatian. .A
permi4lssued shall be construed to be a'Itcense to proceed with the vi►ark and not as �uthortty to.violate,cancel, alter, ar
set astd�any pro�islons of the technlcal.cod�s;�nor�hall lss��nce��a.perml#.prevenf#he Bultdirig O#flclal fram the�ea#ter �
requUing a correction af errors in plans, constiruction or vialatlons of any codes. Every piermlt Issued shall become invalid
unless the wrork authorized.by such perrv�ik�is-coErimen�ed�wEthln �i�c�trtonths of permit issu�t�ce, or if wor�authorized by �
the perrnit is suspended or.abandoned fo�a:petiod ofsix�8)montfl�.after the tit�ne the�uvatk ts commenced.,�n extension
may be requested, tn writing, from th� �uilding.Officlal for a p�riod not to exceed ninety(90) days and will demanstraQ� �
�us#�iabl�cause for.the extensi�t�. �f w¢rek ceases for nlnety��0��o�s.ecutive days,..the�ob is.ca�ns{deted�bandoned.4 :
;
I�tARNiN� TO OWNER: YQUI� Ea�QLURE�T!'�=REC.QRD�A..NCb7iGE �F•G�1U!lM�NC�ME1sl3' MAY°�tESULT 1N'1rQUR
paYtNG°NViCE�oR tMPROVEMENT�T�YOUit:PROP�RTY:�:1�°YC�.u�iNTEND�TO OBTAIN•�PI�t�►NCING;�CONsuL7 ;
UV17'�1 YAUR I�,ENDER:ORl,AN�A�TO�NEY B�FOR��RECOR��(�V��YOUR'N�lTSC�;�F�`CI�MMENCEMEN'T.� ____ _ -
Fi.�'iRIf�A JtfF'cA e(F.a�9 9?:t�3) �--- - ---- -- �
DWNEIi OR AGENT COIdTRA�CTOR
3ubscribed and swom to(or af�mted)be#ore me thts Subscribed and'svuom#o{at af�rrsied)�betor�`me thi�
by �by
IVho Is/are personally kno�m to.me or hasfiave produced Who Is/are personelly knawn ko me or hasfiave�produced •
as identlflc��on, as Iden�flcat�on.
..,.
Natary Pubiic tJotary Public
;orttmisston tdo. -- � Commisslon 9Vo,
Vame a►IVofar�r typed,prfnted or statt�pec3 Name of I�atary typad,pdnted or stamped