HomeMy WebLinkAbout16-17138 CITY OF ZEPHYRHILLS
5335-8TH STREET ,
(ssa)�so-oozo 17138/'
DRIVEWAY PERMIT �'`
� . PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 17138 Address: 39042 7TH AVE
Permit Type: DRIVEWAY ZEPHYRHILLS, FL. 1�
Class of Work: DRIVEWAY/REPLACEMENT Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est.Value: Parcel Number: 12-26-21-0020-01100-0441
Improv. Cost: 1,500.00 OWNER INFORMATION
Date Issued: 3/08/2016 Name: MORRIS ROBERT & LOLA
Total Fees: 40.00 Address: 39042 7TH AVE
Amount Paid: 40.00 ZEPHYRHILLS FL 33542-4537
Date Paid: 3/08/2016 Phone: 813-782-0048
Work Desc: DRIVEWAY 12 X 24
CONTRACTOR S APPLICATION FEES
PAUL D. SCHAPER CONSTRUCTION (813)782-092 DRIVEWAY 40.00
.�
` � L
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 City Codes and Ordinances
RACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
.
�
Driveway Plan For:
Mr. Robert Morris
�� -"` 39042 7th Street
Residence
Zephyrhills , FI 33542
g � Plan "A" Driveway
Existing 4' Asphalt
- Apron to Remain �
Plan "B" Apron
Existin9 - Remove and Replace Apro
Stoop
I /g
� tz
�
Proposed
New Proposed
Walkway New
Drive
Plan��A�� � �i���4+41Y A$$mN -m 6E ,
P��D �Y �o�4cT°r�- �I
t�c�G�� �ae�s '
� 3,x� � � B� s���
�—.
Possible A ron n"B
P
— s4�✓CvT �7 �� O�' �—
�
��v��� �r�� ��� _
�r��c�z�� �-?�� a� ��r���r
/�/I/ :�z�:.�
� '��;�:;__�::�
_ • :r�� � \ .*n�.,�t`#`�
� .:�' �';^1..; �
�1\�d �� .. ' 3n • � ,S�♦ r����.�;•:1�,.
' .'• M t�^�� �.�,....,,_"'�'"''� �: p�t",��''
.. -.� �.�1.+ ♦� '.i,l, '1. ►� •• . "� . . ' � • � _,y �� , �e!`r �
• e• ,.� ��.:.���
,, ' '� �s 'k.��•�y' � -` _� \..�---` 7'' r rF¢e. �, ��.
� � � �'+ � ' � � rit 1� -i:'V` t�i� y��a ' � - e.�!M ) ,{�i•':�1 �• i
, y Y � F s' �1 ' \ 'G���.�:• ��a'i . . fry"f� � � 4.{:" �.. . r
. ;r. �'�..r � .f� , . ` ��� a'.''� 1��, a�, ___. a 'rr Ij � «i`` •�����,
`•�!`I.�''�M;• " ii" •r tii ..� � ��4`� '�'� ,�+^•+ �,K�.+ ;r*" a
•-'4`' Y`�: tiii ,• ,,� , .� , t '.' .�. e a .'!,y � , � ., .�' • .
'i.,:';. `.'7,'�t � . , �, �;F: `' ;' - �3�" 1 � ` ' �f. �' ,�'+J� ���1����.
� ,� . t' ' ~ y�1' •�"� ��`� � .h L� '! ��'� 'i�`'� �"i"
" � � � ' '.,�. � �.,7 `.'" �r ' • - 'MF � . • ."'„ tti �:.,�� �:�:
' * � �„ , . ,�. �, � . ; "'t
�..�: � �}�k"�''
. . .` i .'-' „� �. •iy �, t ., .. :�', ,""s.: t..t4„" "' ti �,» g
-"i' ' ' ' `� _-� � _' a s.�� ' i ` . : .'�i,.,y+%� i� 7
�;��.�, w:. yt � � � 'f�.i_. y ` '�. . . , r , K*�y� �..a .1Nt, � ;��
',• � .� .*,�' .4'fi'_ S(.i j ''\ ��A!,�'�w:+V�� 4�:!�7r
"t' . , '-' � ' ♦ '� "` �o-. . + R: .�' �,. �S' 4. �' '�,h��, �
' ' '�. , .?� , i`�+ ``� �t .��!�a: '� 4' ''�, ,i.j••`2.,.�' �a M''f,.. 4
' i> � ' . �• •' ?-;y_�<„t'� '�r ,tyt4'+ 1.,
�'��` ' # � . " . ' .. 1 ° '�, �J'.j�,��� 'u�* '�2.:�'"� � 'R� �.s�,:C
� � 4.. + ' +� ,.c.'[ � �-":••',r'.�';t � •�
�� � t.. iI� .�. i t�
.y�4L ;���.?+`-�,'-� �;, .r '` ra.�, � A ' ` ` ,'•.k�F��:yl ,�.,�';�•tw:' r�� _�" f �r
� ?` f . L - ' „ti' +� '.L�r� '
:• !��� • '}�'=!. }.f�� � ..t�a-.
''� �.* • ` ,�� H 1' .���+i�., .: .�1:�'�. � . +
• "!`r+� •",;�s=���^r:.
•�2,' .t;�' _ . .? ' ' _N. ` � ` t•', `,.�a;i .�,y �� S�;�,i.
��-��t�i-`�~ 1�Vt•�k1 • ' • ' " . ' •.+•�`•4� ~K�.,+t���e��± ����+�'�''����*�
•_���..�" ��.. �i�.'
'+K��e : . .'t 4 " ;r�,�; ?,'•`tr• , �sc,�y�,k�.M1,,; -
� y�` .2�:r $i,:::t r`'�i:va °',i+71` .
`� . .�.+. � . . �< '' '�1 ..���?}�'�3+�.,r'i:N.
• " • a r� �t V� .�{1 �:
�,�1'y, i ��^::j.�ry �TA
._ �.r y.`,�
� ..+.r., , � Y�;y�?�'''"Mr:.
�� ' � ', _ ' ,.. :.F`. •��t.� 'a3`:
y *i•;;°i'[ tiv���r�v��.` �
'.c i M �'��`j,yY.�L S„�,yi;2 ,o��rw
. . ,, � �J.+. ttt ��' ,}
Jr�;�`� �
• `� 1 ''�:''t ,'?'� �k S'Y�,!�-,;r;.: .�,. ;
� �.s-.,, • _o•,},'�,� �+`
'�j ��`n""t,„� �, ��}�,.�•,
i •;t�e,��, .0 �''+'�,�'"R�."�,�+, +�.
I� n,y. R.•. �,�'°_�.,yjy� J' !
i :5��}i•�ryrr''.� .��
i �� .r,
� 4fi,t ,- � ��,.�`; ��
a , .r. �o`�*""�7�;.. , �s
�,.: i, �.^�t�,� .
�'���� ' � . . _��i'�'t � ',t�'�.� �G
'4�,a - � `•i .�. I nY� ' ��x.Y'�µ:
' . , . � � r` '.i '".`,• .
. . , � . .i �,'►�`. i 't,
- . . . x;4' '* i c'•at�r .:'at
. , , ' .��:.•. �e i�'!�"'-y��
. . .i�i:::fi' qf-.
, T���
. :(�� � '�i,
.- ` a s
, . '.:.'."�..%r. :^r'�-.r.
� t'syti�•�'?`. �.� t•-.i.
� � " r��'� • ` � . .•t�+«;>. ::j;.
' . '�� ' . `•': ` I+� Jx'nn�:cx.+?Y`, `'t1`.'�,.
( ;�t y. �.,:s�, �C�•;,. ('
. .+ ' � � j 7. ` �r h . �:f;. ���;�N .4. � f l
'i} � { t r A.y Y!� V S�.{��
�+ � ` � }� 1 '�I�� .�Mt�.� tr� } '�
• r T�t t~�i �( , •. ��. � { �I ' a��r T`�R ;Y vl �\n.:. f1�,, �,'i�'�y�
\ ��� '� ,��• � a • ����,� • � � � �t1��� �� �
r�../.�'1. * . ` '1� �
�... �� • �� ',, L. aa} u � a�'i.w�
_ '�.'„?,y w 4�� :e. , ' �: ;�,���, ;;tis'! .� ��•�' ,�
- �,� a'�� . TylJ�� y. ;� ;,� .c .�'�' �.
. " �y.. ,�► r� ��t}(' jy �' .�d"`" 1,�+.�,�i +.. ` t4
;" �S�, •}�C+1 -fi� '� .r��1. ': �. �; '
�� , eF' '- ��.� �{`� �f ��. � ..x t �
� . ,1„''�� ' '•�,-•y�', ;. 1.. .� . G }. ' 4
:, s � • • . ;•� .r,;� �� �� `�i'.'-» � 4 � ��
s.�l;f. ,�►y,�;' �'""`r1E.�•�''� ��s� . �:
.
t+� ;s, „:,t�i. �f+�. , .�`4 ;. ,, r
" �r�s 1.. �/f ��,• •�,y%r
'`� . � i . �i .'�.
� ' . y.r � ���. l,
� ' ', • „ /� � r� f{ �' .
��' �! ' �b7'r J 'L"y� '►' y
'� "'�� ����,�� r� � i�
+ � 1 �'ts{f��f ��1� / ' I '
. h 1 � t�.
)i �� l: r �_ �� I
. : 'j . s'� ;:�•.
, � � „M,Pri t i
���' " .;_ �'S/' ��'t.r� , .�. ..t� i
r
. ♦` 57 4 1�~
, r', �r �;3 i �7 "���y�F��'��� a �� ;.� �t ,
+�+ � ;��1�'��'s 4�'�..���,, r�• y �
. � � s d�7 � ,r��.�, �, .,
r M� � �p t�,., .
�� ��' ti ��lt%��','�. �
' 1 }
•i�M/ ' „ ;:',�`� ,�� ��.,, '�
, . { 4�p y
� � �Mv , r'���
�w.� �
.�' �1��'�,:� �����
,i , '�*,,. i. !,w `i
' ,,y� ' 'L
y dF'r�.
�
l "�
�
` .
. � � ;%j
PERMIT=APR.I.�CA't�ON � �7�
,:,
�DRIVEWA�f'=P.ERMIT.AP.PLTCAT:ION
=Ci3NSTR1lCTtt3N�tNITM�N}P.UBLIC=RIGNT.Q.F�INAY
All information„Lr�ust�befilled-in completely
• +City.af�Zephyr6ills �
"5335�8�'Street,ZephyrhiNs,'F!33542
Teiephone.813.780A000 Fax 813:780.0005�
�,---.�..a
' a<. a� 'G- i.Yy ;tJ+? " ^T# ` ' .:r:,� �.-'•:�r�,�t'n^ s n, .Y, s•,5"'-'�
f' 3
'C. n°'.^1'«Y:. 4" -'S_,..';". - ';j.:^iF
' �_�[Q�i02I��` ;'�'�". .�.i��,�,"��,'.. .., ;�r- + "�:�) t�2�`��r7'�i{-�.. .a£;'�r$+rl�: S�nai�:r�' �.s�%,`,
Y'^�� w»..'�-�Z;�;f �' �+> '�rX���e��'',�, «�.'�•- �P�::�: ����{�;'i����:s'M1���p���.Z"�;.1 ��"s..' .7•t,Y'�z'f 7'�',z�rY"•��;i"€':FG'=
,��1�s�1�� .�r"�t '� *`u;�.�r.� �',w,�,?,�w.�.�,�".`2„�.�.� :,r�"".�.�,Y:�'c�r`='� ;��`�`�'r "� „�" �" �/g ,,^;z"
;Y ,�3 p�k�p -�_�. #' � � r�,.� ,:�{,,','��.:�:,„:. *: .:�j�y�:�� "a'��;.
'?r„5�4��.� ���iy'.l, s��HJI +� Ji. 3�.r�.'. <f�,'�"`,�h,v~ 5 F`t�� F R..� �t3.,g. l.,...7..„>i��lt t,fi`,.:Fr,;.� �
' rn�r�s.i-�..e`?�:v,ttr,.r.r„: Y.W�* � '_�� � �'.��r%Mki;.:£4-�;�J�Na��.x3'- <:4.:t�.:7.,`� ''^, »,ri;,a.�.e�'.`•'��
�.3'r�. �i`?•'^�.?r`` x.7 ���^..�� F:.''"-,; !Yr,xa�`
; ':PRQ�ECT .30B:SITE: -PROPERTY'flWNER
Address: 3 " �'� � c.c,� IVame: -t rs^i1�
Unft#: Acfdr�ss: Untt: -
Farcel Identification Number: Ci .State Zi �
!e� - -,� - �- 11�D- � Phone; Fax:
�CONTRACTQR:
Cam n � �y
Name•
contractar�s ucense#. �s. � E-Malf: ud � 3,;�t�.c ' . r--
Phone: � -7 Csll• / Fax• --7 S -.5��
ARCHITECTjENGZNEER: _
�, Name• Frm Name:
Address: City: State: Zip:
i St�te License#: Phone: Cell: �a�c:
D cri 'on Pro' ct
TYPE O D,�tIV ,N,I�Y . „�I.EN6TH OP�DFtNEWAY � CtJLVER'ES�NEEDED
v/'����RESIDEM7AL pRNEWAY _,�'WID7}i OF DRNEWAY ( )REINFORCED CONCREfE.
COMMERQAL DRIVEWAY R.O.W, �JCCAVATION ( }CQRRUGATED MA`t'ERIAC.
PUBLTC ACCESS DRIVEWAY DEPTH LINEAR FEET ( )BOX CULVERT
( )O'fHER(IXPLAIN)
COIHSFRUCTIOI+�MATERIA� CURB CUT REOUIR�D i
�PHAL7 YES NO
NCREfE I
HEADWALL REOUIRED? YES NO I
NOTICE TQ APPLICANT. If actual work exceeds scope of this description,additiona!permits ar drawings
will be required.
UTILITY LOCATICINS REQUIRED: CAl1.BEFORE YOU DIGc 1.8Q0.432.4770
Page 1 of 3
8�saao-oozo City of Zephyrhi!!s Permit Application Fax 813-780-Q021
Building Department
pate Received p�yQ�$.�,�n��ffor Permitttng - � � — ��d�' �
Owner's Name � 1'/ C!/'!`1 S dwner Phone Number �
Owner's Addrass Q�p^ ��` bwnerPhone Number � �
Fee Simple T4tleholcler Name � r�✓[ � � Owner Phane Number � �
�
Fe�Sfmple Tttleholdar Addrsss '
JOB ADDRESS CJ� 7�` LOT# C_�.�
SUBDIVISION � � PARCEL ID#
(OSTAINED FROM PRdPERTY TA7(NOTIQE)
WdRK PROFOSED ' NEW CONS7R ADD/ALT � S1GN Q Q DEMOLISH
e INSTAL� 8 REPAfR
PROPQSED USE [� SFR Q GOMM Q {?THER
TYPE OF CONSTRUCTfON Q BLOClC ' � FRA{UIE � STEE� �
pESCRIPTION OF WORK j�"'' Y r Gf'c'�{�.A.
BUILDING SiZE ��� SQ FOOTAGE[� MEIGHT �.,��
QBUILDING $ �� D� VALUA710N OF�TOTAL CONSTRUCTION
.
�]El,ECTRIGAI. $ AMP SERVICE Q PROGRESS ENERGY [� W.R.E.C.
OPLUMBING -(— ^ , j'_ ����j .
��_ ���l
Q MECHANlCAL $ VALUATlON QF fVIEGHANICAI.lNSTAILATiON
QGAS Q RQOFlNG Q SPECIALTY � QTNER
FWlSliED FLQQR ELEVATlONS � � FLOQD ZC?NE AREA QYES. NO
BUI�DER COMPANY � /
SIGNA7URE RE�Est�a Y/ N FEE GURRER )�!
Address �i U � License# (,'I ,�'�•� 5} �'/�
���cr�c�� con�PAratr
SlGNATURE �' REGISTEREd Y 1 N FEE CUI2RER Y 1 N
Addresa License# � �
PLUMBER Ct}MPANY
SIGNATURE REGlSTERED Y/ N FEE GURREh Y t N
Address License# � ��
MECHAN3CAL C{,}MPANY
SIGNATURE REGISTEREd . Y:/ N FEE CURRER Y t'N
Address� Lloense# I �
O'iHER COMPAt�tY
SIGNATURE REGISTERED Y/ N FEECURREt� , Y.t.N.
Address " � � Llcense# i I
RESIDENTIAL ~Attaoti"{2).Flcit Plans;.(2)sets.oF Buitding Fians;{1)'set of Energy°Faims;R-O-W Pern%It for new constructian,
Mlnimum,ten(10)working'days:after.submittal date.�Requlied onsite,Constiuction-Plans;�Stam+water`Plans w!S(It Fence instaUed,
� Sanitary FacitiUes&��1.;dumpster_Site Work.Permit for subdivisions/large projects :_ � �
COMMERCtAL Attach(8}cbmplete sets of Bullitirig Pians ptus a l.ife Safety Page;{1)set of Energy Forms.R-O-W PeRnit for nsw c�nstru�on.
Minimum ten{10)working days'after submtttal date. Required onsita,ConstrucUon Plans,Stomswater.Plans w/5ilt Fenae lnstafled,
Sanitary Facili8es&1 dumpster._Site,Work,P_ermit for all_new projects:All t;ommercial requlrements must�meef compliance
SIGN PERNIIT Attacti"(2}sets of'EngfneeredzPians.; , � - �
""PROPERTY SURVEY reguired for al!NEW,construcUon._
Dltectlans:
FlII out appltcallon complstely.
Owner&Contractor sign back of applfcaUo�,notarized
if over 52500,a Notice of Commencoment is requtred. (A!C upgrades over�7500)
'* Agent(for the cantracto�r}or.Povrier of Attomey(for the awnerj would be someone with notarized letter from owner authorizing same
DVER tHE COUNTER.PERMITTING (Front of Application Oniy)
Reraofs If shingtes Sewers Seroice Upgrades AtG Fences{PtaUSurveylFootage)
� Driveweys-Not over Gaunter if on public roadways..needs RQW
�
NOTICE OF DEED RESTRICTIONS: The undersigned under.stands��th�t:this:p�rmlt may.be,subJect to,"deed"restrictions"� `
which may be<more��r.est�ictive�th�n Gounty�fegulat(ons: �The-�underslgned'assurties respon§(biltty for compltance�witFi any� �
appllcable deed restrictions. . - � < . � - • • , .
UNLICENSED CONTRACTORS .AND -CONTRACTOR RESPONSIBILITIES: - If the owner.has �ht�ed�:a .conhactor or
contractors to undertake work, they may.be:requlred,.to�,-be:iicensed In accordance.with-state.and•local��egulations. :If the
contractor_'.is not.licensed as requlced�tiy law, both�the owner and:confraator�rriay be�cited�fora=misdemeanor violation
under state law. If the owner or intendedscont,r,actor:.are.uncertain as to what Iicensing.requlrements may�apply��or the - '
intended work, they are advised to contact tFie Pasco County Bullding lnspection`Divislon--Llcensing�Section at 727-847-
8009. Furthermore, If the owner has'hl�ed a conhacfo� �or aontractors, he Is advised to have the contractor(s), stgn
portions of the "contractor Block° of this_application for which.they will.be responslble. ,If you, as..the owner'sign as the
contractor, that may be an indicatiomthat he�is�not�.properiy licensed andiis not entitled �o pemiitting pr,ivileges in Pasco
County. � � � <� �
TRANSPORTATION IMPACTIUTILITIES=IMPAC7'�AND RESOURCE RECOVERY FEES:�The undersigned�understands
that Transportation Impact Fees and.Reco.ucse Recove.ry.Fees may,:apply�to�tF�e construction of new buildings,�change of -� "
use in existing buildings,}or:expansion�,of:�existing��6uildings, as specifled.in Pasco County Ordinance number 89-07 and
90-07, as amended,.The undersigned also understands, that such fees��,as�may�be�..due;:wflL.:be ideMifled at the=time of- �
permitting. It is furtlie�understood that Transportation Impact Fees and=Resource Reco�ery'Fees must be pald prior to
receiving a "certificate�of-occupancy" or flnal.powec�release. :Ifthe project does.not Involve:a certificate of occupancy,or '
final power release,_the;.fees must,�be paid pcior to permit Issuance. Ft��thermor`e;�i�Pasco,County-Water/Sewer-Impact
fees are due, they�must be-pald.prior to permit•Issuance�ln accordance witfi:appllcable�Pasco County ordinances.
CONSTRUCTION�L"IEN'LAW(Ciiapter 713� Florlda Statutes,as amend�d): If valuation of work�is,$2,500.00.or more, I
certify that I, the applicant,_.have-been provided with.a -copy of the�"Florida�-Construction� Lien Law-1-lomeowner's
Protectfon Guide" prepared by the'Florida Depa�tment�of Agric.ulture and Consumer Affairs. If the applicant is someone
other than the°owner", I certify that,I have.obtained>a copy of.the.above..des.cribed docurrient�and:promise in,good�faithto �
deliver tt to.the"owne�"pdor�to�commencement: ' ' ' " •
CANTRACTOR'SIOWNER'3 AFFIDAVIT: I.ce�tify,that all the Informatlon in�thi.s application is accurate and that all work
will�be done in compliance with all applicable'laws regulating construction, zoning and land development. Appllcation is
hereby made to obtain..a permit to.do.work:and installatlon as indtcated:�:; '1 certify that no work:or installation has
commenced prior to Issuance of'a permif�and that.all work will be pertormed to meet standards of ali laws regulating-
construction, County and City codes, zoning regulations, and land development regulatlons-in the jurisdtctton. ( also
certify that I u�derstand 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 t�ke:to be,in.corr�pllance. Such agencles include but are.not Ilm(ted to:
- Department of E�lvironmental:�Protection'-Cypress.Bayhead�; Vlletland Areas and E�vironmentally Sensitive
Lands,WaterNVastewater Treatment.
- Southwest Florida Water Management- :District-Wells, Cypress.r�Bayheads�, Wetland Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawails,�Docks, tdavtgable Waterways.
- Department of Health 8 ReF�abilltative Services/Environmenfal Flealth Unit Well.s, Wastewater�Treatment,
Septic Tanks. . � - ,
- US Environmental Protectfon Agency-Asbestos abatement.
- Federal AvlaQon=Authority-Runways. ��"- � ,� ;>.
I understand that the following,restrictions apply to the use of flll:• .
- Use�of fill.is not allowed in Flood Zone"V"unless expressly permitted. , �i�� i;..e :t , -`�� . r :'
- If�the filF'materfal Is to'�be used''in �Flood Zone. "A", It. ts understood that a drainage plan addressing a
°compensating volume" will be submitted at ttme of permitting which is prepared by a professional engineer
Iicensed by�he,State-of Florida.
- If ihe fill materfa).is-to be used In Flood Zone "A" in�connec�ion�with:a permltted building using stem wall
construction, I certiy that fill�:w111=b.e used only.to.fill the area w(thin the stem wall.
- If flll materiai Is to be used in any area, i certify that .use. of such flll will not adversely afiect ad)acent
properties., If use of fill is found to adversely.affect adJaeent��pr�pertles� the owner may be cited for violating
the conditions of the�buiiding=:permit issued under the_attached�permit application, for.lots less than one (1)
acre which are elevated by flil,an engineered drainage plan is required. .
If I am the AGENT FOR THE O.WNER, I;�promise In good fatth to Inform the owner of�the permttting condfttons set forth tn
this affidavit prior to commencing construction. 1"understand that.a-separate permtt may be requtred for electrical work,
plumbtng, signs, wells, pools; alr.conditioning,.gas��or othec insfallat'tons not.spec�fically included in tMe application. .A
permft Issued shall be construed to be a°Iicense to�p�oceed wfth tFie work and not as:authority to,violate..cancel, alter, or
set aside any provistons of the technical codes; nor shall issuance�of a.permit.pcevent the Bulld(rig Oi�ictal from thereafter
requlring a correctton af er�ors In.plans, constFuction or violations of any codes. Every permit issued shall become invalid
unless the work authorized.by such permit��s.commenced�within sGc months of pertnit issuance, or if work authorized by
the permit is suspended or.abandoned.fo�a:period-,of�six(8)montF�s after the time the�work is commenced. An extension
may be requested, in writing, from the Building,Official for a perlod�not to exceed ninety(90) days and will'demonstrate
justlfiable cause for.the extension. If work ceases,for ninety(90)cons.ecutive:day.s,..th�Job is consldered aba�doned.
WARNING TO OWNER: YOUR.FAILURE.TO,RECORD.A:NOTIGE OF•COMMENCEMEMT;MAY�RESULT IN YOUR
PAYING TWICE FOR:IMPROVEMENTS�TO YOUR;P1tOPERTY.��I�°YO.U�INTEND�'T��OBTAIN�=FINANCING;'CONSULT
-�fiflYYi YOUI�" - PiDE API A'�TOitivE��$ �'r�r'Yc� i'et��R� t'a:�YOa� ' d0 ���:0�'�- . . E lCF� � 'T� - = - ---
FLORIDA JURA'�(F.S.1.17. 3) � �
OWNER OR AOENT CONTRACTO
Subscrtbed and swom M(or aRi d)before me this Su crl ed and'swom to(o ffirmedpbefore me thi�
bY �'�// •by
Who is/are personally knovm to. e or has/have produced Who is/are p.ers aliy k wn•to me or haslhave produced •
as Identlflcatlon. as IdendBcatlon.
7 �
Notary Public _ � i� Notary Publtc
Commisslon No. Comm�s,s an No.
Name oT Notary lyped,printed or stamped Name of Nolary typed,printed or stamped
' PER�NIT APPLICATION
,s
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVIDE SKETCH II1! THIS AREA, IF ADDYTIONAL SPACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
AFFIDAVII': Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing I
information is accurate and that all work will comply with all applicable codes. 1 understand these codes shall take precedence over all
approved construction documents,.and issuance of this permit is verifiption that I will notify the property owner of Florida Lien Law
req.,F.S.713.
The issuance of this permit does not ensure compliance with deed restrictions and I understand that additional deed
restricdons may apply to this properly.
All work shall comply with the current Florida Building Code, Public Works Design Manual and FDOT Design
Standards(if appliCable). (Public Works Design Manual online link:www.ci.zephyrhills.fl.us/public works.asp)
APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT
TECHNICL4N OR NOTARY PUBLIC.
NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of drivewa�s. Driveways shall not alt�er/
interFere with existing stormwater treatment and/or conveyance.
PROPERTY OWNERS: By signing this appiication: I certify that I have read and understand the owner/builder disclosure
statement. (please initial)
c�li,�4 � -�!i �t/a��/�o
Applicant Print ame Applicant Si ature Date
Permit Technician Signature (or)Notary Signature Date
Applicant is( )personally known to me or produced as identification.
(type of identification)
Page 2 of 3
:
', PER�+IIT APPLYCATION
. :
oF�zc� usE aN�.Y
.. . _, .... _ .. _ - . - - - -
- � . - - - �!UBC:�C.11{F�RKS;U�E=;`�?N�Y._�, � : = � � .. : _ ..,
Concrete {mir►. 6 Y N
Asphalt Bas�{min. 6�} Y N
�
Asphalt(min. 1�1z`� Y N
E.ength (m�n. 19'} Y N
Width(SO`mfn—20'max} N
F�cisting sidewalk. Y N
IYew sidewalk, Y N
ADA compliant. Y N
Expansion material required. Y N 7" � �+ � �^'
�
Cgntiguous paricing pad. Y
Triangular flare(3'W x 7`L} N �T�f ,�'/p}C�"',�'
I� Visibility triangle o.k.? iV
Side set back(3'min. R.O.W.} Y N
' P(an Review Fee
� �.6W __ r.t:3 �,'�:4��P=:r,•i`'?:�.�`�"r.^ �s`;&.' u:�:-J,aVm3< <�y... *'1«£".«�=-z ' 'ti,"z.0 ^.ffYxiP'.it.. _..�� - .,y: -
A';,-%i onat:i#`escx� �o '�` 'r '��' � ,, _ :..�;�,�•...r:�;s��;� ..a;:.�_._: <.;::,;;..,._:- -
.d i#�.. S 1� n�s�f.wo�tc as:d n�d. ��Pu6lic�iN �ks;�irec`to�r�:andfaf�des�"n�e t:��- :�`
o .r���t.�:. ,.
SE' 7Z'
.
Y
Permit application approved by: Date:
Page 3 of 3