HomeMy WebLinkAbout17-18883 CITY OF ZEPHYRHILLS
_ _-,= 5335-8TH STREET
(813)780-0020 18883
DRIVEWAY PERMIT
� PERMIT INFORMATION � � -_ �� � LOCATION INFORMATION
Permit Number: 18883/18845 Address: 5627 20TH 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: 11-26-21-0010-11000-0080
Improv. Cost: OWNER INFORMATION
Date Issued: 10/26/2017 Name: LANTMAN EDWARD & BONNIE
Total Fees: 40.00 Address: 911 N HILLTOP RD
Amount Paid: 40.00 PEORIA, IL. 61604-4743
Date Paid: 10/26/2017 Phone: (309)696-8601
Work Desc: CONSTRUCT NEW DRIVEWAY 36 X 19 FOR ADDITION
CONTRACTOR S APPLICATION FEES
BACK CONSTRUCTION 813)355-1195 DRIVEWAY 40.00
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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 erformed in accordance with Ci Codes and Ordinances
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CONTRACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
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PGRII•�ZT�I►�LL\rn�i01'e '��'��,
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D�tIVE�lAY PERN�IT APPLYCATIOA!
CO�ISTRUC7"IQt�! �IIITNILa! PUBLIC RIGhIT-OF��/�Y
All informatlon�be filled-in campletely ,
City of Zephyrhills
5335 8'"Street,Zephyrhflls, FL 33542 �
Telephone 813.780.0000 Fax 813.780.00U5 '
Date ofapPlkatlon:�-7��(7 Proc�sed Byd - -- Pe'mit#: � ��
(crar r c� «ry? �
- _ __ []Copy to Buflding'Department _ - - _ ����b��W�
PRO7ECT.�pB SITE; I� _ PROPERTY OWNER
Address:56�.7 2oT7! sT, - /GG5 FG Name:l.El. MH G.EeS Kd ' Ban/nJ/E_�', '
Unit�: � Address:9// . N1�Gy-aiP ,¢d Unit: �
Parcel Identiflcation Num6er: _ � CI State ZI . .6aR��q 2G . (�/6oy�5f7�3 � '
!
/1�.Zla=1/.-Do/0-/(000�0080 Phone•3oq-�gG�86o1 Faz:,}/.q.
CONTRACTOR: - _ ,
Com an :.��7CK .Co .S�RUCTio / �, - - -
Name:W/GGI�s►? �. g - - _ . _
Contractor`s Ucertse#:.C�C �/FDl - - _ - E-Mall:. ABAeq� _.-a[J'7GOC' � .
-_Phone: � 1;_ �/ -355/f 9 5- Fax: .,4. -
ARCHITECT/ENGINEER: -
Name: � �✓a� V��e� Firm Name• ,
naaress: C' : S�tet . - ;'
Stafe license#: � - - Z� �
_ _ - Phone: _ Cell: _ Fax•
- - �e cr( tion of P 'e - - - - '
T'P -0F bRNEW 3rotaA�GfH OF DRNEWAY �A. �_
RESIDENI7Al.DRNEWqY �" � ULVERTS NEEDED -
COMMERQAL DRNEWAY �—�DTFi OF DRIVEWAY ( EINFORCED � - .
PUBLiC ACCE55 DRNEWAY � EXCAVA'fION
DEPTH LWEA— R FpET" � ) ;. ED MA'fERIA�
( ` CULV
CUF2B CUT RE UI '0��(IXPLAIN) i
SPHALT � -� . � -
CONCAETE - -
Q��ADWALL REQUIRED? YES V MO ,
NOTI�E YO lnPPtICANT: If ac�tual�nrork exoeeds scope of this descript6on,additional pesmit�or cirawings
wP�P be rec�a�6red.
UTILITY LOCAYLOIVS REQUIRED• CALL BEFQRE YOU DIG; 1.800.432.4770
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PERMIi'A€�PLI�ATIOPi
UtILYTIES LOCATE CC1NF�tiMA'!'I4N NUMSER. . pt+Dfl Y 2�i Q J ! -� .8?t.?
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PRO!/ItAf SKETCH IN THIS AREAr I�AD02TIONAL SPA�E IS REQUZR�D,ATTACH TO THYS
APPLICATION.
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AFFIDAVi3�: Applicatl�n is heret�y made to obtaln a perrnit ku do wtrrk and instaliallons as indicated. I ceriify that all forego[ng ,
inforrnadon Is accurdbe and that aR wark wi[I camp{y with all applkaate codes. I understand tttese c�des shat!take precedence aver al!
approved construc8on dacurnents,and issuance of this permtt is ve'�f'ication that I will noflfy the propetty owner of FlOrlda L�en Law
rec�.,F.S.7i3.
The iSSU�nce oF fhis permit does not ensure complianoe with deed restrlctions and I understand khat addidonal cteed '
restrtctians may apply to thls praperty.
A�I wark�h�ll campty wi�h the current Ftorida Building Cade,Publlc Works Design Manual and FDOT Design
Standards(if applicabie). {i�sbiit Worlcs Destgn Manual online link:w►vw,cf.zephyrhilis.fl.usjpublic_works.asp)
APPt,ICATlON IS VOID UNLESS SXGNED V�II'TH PROPER IDENTIFICATION AND WTTNESSED BY A PERMIT
TECHi�ICIAN tJR�JOTARY PUBLIC. '
idOTE: The Ctty of Zephyrhills is nat responsibfe for maintenance or repairs df driveways. Driveways shall net�fter j
inkerFere with eacisting�tormwater treatrner�#and f or conveyance.
Pi20PERiY C}���EF�: By signEng this appltcation: I oertify that I have read and undersEand the awnerJbuilder dtsdosure .
statement S ,E�, (please 1n(tiai) f�s�d�� �fj
�,Ar.�.t,nrrta'T, l�J��iJltGt.�+�i �8.r{,�.c� ��� � ,��,�f'•u�.� _-Dr�28—2017 �
Applicarst Print Name Appticant Signahtre � Date � " -
Perrnft Techn3dan SPgnature {or)Natary Sic�nature 13ate - �
Appticant is( )persenatly knawn to me nr produced - as Id�tlBcaklon.
�type af Identificatlon)
Page 2 of 3 .
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PUB�IC WORKS USE t3NLY
�Concrete {r�t(n.5`� Y'� N
r �_
Asphalt Base(min. 6`� Y N
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Asphatt(min. lTlz'� Y N
Lengtfi(min. 19'} Y N
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�Ivt����,dr I1i�C1^Z�r iT�dSl'� 1•
E�cisting sldewalk. � Y N
New sidewalk Y N
ADA comptiant Y N
Expansion materiat requined, Y N T
Contiguaus par3�ng pad. Y N
Trlangular flare(31N x 71) �1( N
V[sibillty irlangle o.k.? "M N
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Side set E�ack(3'min.R.O.W.} � j N
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� P(an Review Fee
Additiaeai descri #ion of wark as defined b Aubilc Warks Dlrector and or desi nee:
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Permft appficatlan approved by: Date:
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5627 .20� Sr. (6►w �A�k� 8�3—355-►19s
Z iN�LS ,FL 33s�2- �
�rida Section it, Township z6, Range 21, 0.7 rniles NE of tephyrhills ,
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Street name information is maintained by the Pasco County BOCC GIS
Department.
a`�saeaoaao City of Zephyrhills F'ermit Application Fax 813-78f1-0021
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� Bu3tding department - "�
nac�R.���,�a " $13 3 � S _ 1I 9 5
�� Phone.Canta�'for Permltf[n
Owner's Name •�bk1�"'� �N'"��'� � 4wner Phone Nurnber
Owner's Address �6 27 � � S� z'��"S�.�L Owner Phane Number � �
I ' . ,
Fee Slmple;Titlefiolder Name /�.A � �� Owner Rhone Number '�� �
Fee Stmple;Titlehalder Addresa N .Q�--
� -
JOBADDRESS �(02 ZaTN S�• Z'lfiuS, FL- 33 S'f� �oT# ��
SUBpIVtStON �� . � � P,ARCEt»ID#
7 - , - . (OBTAINED FROM PROPERTY,TAX NOTICE)
WORK PROPOSELI :NEw CONSTR• . ADDlA�fi �` S1GNy Q � [� • DEMOLtSH ,
� e- INSTALL � . REPAIR •� -
PROPOSEDtUSE Q SFR Q COMNI' t ' � =OTHER ""
TYPE OF CONSTRUCTION � Q =°BLOCK ' Q FRAME L�' `STEEC C]
DESCRIPTION OF WORK ...,, I/�sT�,�'�' �r✓C• Q�V��1�Y S ��� S/'� P�'�1 �
, �/
�[lN.DlNC,SIZE N•J� - � SQ FOfJTAGE��, . . HEIGHT���
y.
�,: .
� �''� .� ' �_=�.� - -� -.
8;���tNC'' I' � VALUATION;OF`TtOTAL CQWSTRI:ICTION
L� ' �J
QEI.ECTRICAL ` �� AMP SEF3VICE Q PROGRESS ENERGY [� W.R.E:C.
�
�
QPl.UMBING� g 1 . - .
�� , ,
QMECHANtGAL $ VAR.UATtON OF.MECHA�IlCAL INSTAlIA'f10N
, � �..
QGAS [� ROOFlNG ;Q SPECIAITY �� OTHER� �
FINISHED FL.00R EI.EVATIONS � � FLOOD ZONE AREA QYES. .NO
BUlkDER . ".i���� Gt�N1PANY� 1'�'9� '�'�S'�:�InJC. '
SIGPIATURE ��— REGISTERED Y/ N fEE CURREA Y'/N .
J4�ldrs�s - L":Irsnse#'� � �
E�ECTRIGt�t+l: - ,CdMPANY
SICiNATURE ' REGISTERED Y/ N FEE CURRE�`' �`Y/N �
Address , • , -. . . LlcenSe#.�` _ �
PLUM�ER' - CC?MPANY.� , • �
SIGNATURE` ` '' , �REf315T.ERED . < 'X./.N.. ;;h,FEECURRE� � " Y�/N
Address " ' ` Licepse.# �r . .. �. •.
MECHRNICAl: ''� - •, ,. CCiMPANY, - .
SIGNATURE •� " � REGIS,TERED • Y./ N. . ; , FEECURRED - Y./r.N
�.. .
' b.-, , � -
l0.dd(8s8 , t c; . � . r . ' ` UGer,IS6# ���. �
'� .. . • - .
QTHER - � _ , ' � , . , t.: ,.COMPANY '- , . .., � , :
SIGNATURE -�. � " T • ` ` REGISTERED` Y/ N., FEE CURRE� Y/N .. s
Address � . . . ' _ L'icsnse# ��,. �
RES4DENTiAL';. Atkach(2}nPtot�Plans;.(2}§ets�af�Bullding�Plari`s�(1 j�set'oF=Eneigy�Foiins;.R=O=W'Peiirii#for new consttuction, - � ' � � ,
- .. =MlnimumUten,_(:1.0),puaricinA�days:afier,'submiftal date.�`:Requlred onslte;:Consfruictlon=Rlans;�Stotmwater Plans w/'Silt°Fence installed, '
� `� Santtary Facllfyes;8�1,,dumpster_Slte�;WprlczPerrnit forsubdivisions/larg"e;project`s;_,:., ..::�4:� -' �' ' "` ' �- ` �
COiVtM�RCiAt. Attach{3)=cbrriplete'se#s'of�Buliiiing Piaiis plus a'Life S�fefy Page;{1}set af Energy Forms.R•4MU Permit fcr nernt construc#an.
Minimum ten(10)working days after submittal date. Required onsite,ConstrucUon Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilides&1 dumpster.Site Work Permit for all new:projectsi.All commerctal requf[ements,must meet comppanca
S1�N PERMFT Attach{2}sefs of Engl�eer_ed.Plans.� �: �-, , . " -
""""PROPERTY SURVEY reguired for_all.NEW,constructlon.. ,
D€rections: �t �,:_` r .
Fill out applicaUan wmpletely.
Ctwner 8�Contractor sign back af appi(caHon,ttotarized
If over�2500,a Nottce of Camme�ecement is required. {AtC apgrades over�7�00)
.. ,:„�;c=�:?t.,;-;
Agent(fq�tFie co�tractor)or`Powe�'of-Attoriie`y(for tfie"ovmer)would be someone with�notarized letter from owner authorizing same
4VER. 'ft{E COtlNTER.PERMITTING - �-- �(Frant-af-Appflcation Only}- ' `
Reroofs if shingles Sewers Servlce Upgrades A/C Fences(PlodSurvey/Footage)
D�ivewaya-Not aver Counter tf on publfc roaduvays..naeds F20W" � `
�
�
. �
• ' �:" - .._:-
., _
NOTICE OF DEED RESTRiCTIONS: The undersigned und;ergtands�;th�#�thls;���r:mif�,may:be,subJect to."deed",re5trlctions",.,.:- ` ''
which may��tie,more.�rest�Ictive>th��Counfy��regulatlons:�`�'TFie.underslgned`assumes-resp�insibility'.for'"compliance inritii"any� �' ��
appilcabie deed resMctions. - �y � , - ` - -. ,.. - .-
UNLICENSED•'CONTRACTORS AND CON�'RACTOR RE�PONSIBILITIE�: °alf°the�owner;has��htred��a"contractor or
contractors to undertake work, they may;be;reiqutcedzto.-�be;licensed ln�accordance.with state.andslocal._tegul_ations:��.if�the°-�-' ���� �
contractor is-not Itcensed'as requlred;tiy lew, botlr the owner and'conUacto�=may�be�clted for�a�misdemeanor violation
under state law. If the owner or Intended,;contractor;are,,uncertaln as to what Ilcenaing.requlrements.;may�::appty�.�,for~the����- r����"`
intended"work,they are advlsed to contact the�Fasco County.:Building'Inspection�DIvlslon-Licenstng Section at 727-847-
8009. Furthermore, If the oviiner has�hired�a`cont�actor'or contractors. he Is advised to hade -the contracto,r(s),.sign _
portlons of the:."conttactor Block" of.thls._application_.for.wrhich.they will:.be;:resp.onslble.-.•li:you;=as-the owner"'sign'�a��tlie' ' � �
contractor,�that tnay be an indication that fie~Is'not.properiy=Ilcen�ed�anif`�is not entitled to permifting:Privileges In Pasco
County. � ' . .. - - -_- '� � � - ---
TRAN§PORTATIONsIMPACTIUTILITIE$�IMPAC'��ANb ItE30UitCE RECOVERY�FEE3:� The untlersigned understands
that Transportation Impact Fees and.Recourse-Recove.ry,Fees may�.apply:to�tf�e:constructlon,of new.buildtngs��change•'of"` `��= ��-
use in ezisting buiidings,�or�expansl�n�Y of�ezlstin�<buildings, as specffied.in Pasco County Ordinance number 89-07 and_
90-07, as amended,,.,The undersigned also;�un:derstat�ds, that:�such fees,�;as,ma�r�e•due;��n►ili:tie identified at the�time�of� �� �
permitttng. It Is further understood that Transportatlon Impacf'Fees and;Resource_;Recovery=Fees..must be pald prlor to
rece4ving�a 'cert�icate.of�occupancy"-or flroal'.power,�elease.� :ifthe proj�ct..does.not,involve=�-.certfficate of occupancy�o"r���"��s
,_ ..
final power,release;;the.fees mu�t tie paid,prior to permft Issuance. Fu�thermore;(f Pa�co,County�lNater/Sewer•�Impact �-� ���
fees are due,..they�must be:pald_prior to permit_;Issuanee°'.in accordance.wltFi appilcatite_Pasco�-County�o�dinances. -
CONSTRUCTION'LIEM�L:AVII'(Chap4er 713� F10r�da�tatutes�a��mendee!): «valuatlon of work is$2,500.00:or more� I� .
certify that I, the apppcant;-have=:been. provided wlth-a copy�.of�the:�'Florida� ConstnicNon:_�Lien :Lavu�Homeowner's
Protection Guide" prepared by.the Flo"rlda Departmenf of Agriculture and Consumer;Affairs. If the applicant Is someone•. � .
other than the"owner", I.certify.that,I�have.ob.tained-a'copy.of..�h�.atiove:.descrlbed;�docuii�ent;and;p.r.omise,in,good_falth-to .
deliver It to:the�`owne�"�'piio��to�cornmericement:,', ' . - . �' � :. = . . �
CONTRIACTOR'S/OWNER'S AFFIDAVIT: I.ceitify;;:tti;at;all�.theb;inf.ormetibn:;ln�thi� applicatlon i� accurate.and that all work
will'be done in compliance w(th all applicable�laws regulating constructlon, zontng and�,land�development. Applicatlon is
hereby made to obtain..a permit;:�to,,do_,work;,,and�;installation as indi�ated:�:.��1� cettify"that no work`:or installation fies
commenced prio� to Issuance of a permtt�"and that':all work will be pertormed�to meet.standards,-of all laws regulaXing-
construction, County and City codes, zoning regulations, and land development regulatlons�tn tFie Jurisdtction.• I:al's'o-
certify that I understand that the regulations of othe�government agencies may�apply�to the..intended v�rork, and that it is
my responsibilliy to identify.what.actions I must;take_;to be,in:.campllance;..S.uch.agencies-include but-are.not limited to: ;
- Department of Environmental�Protection=Cypress`Bayh'ead�; WeHand Areas and Environmentally Sensitive
Lands,WateNlMastewater Treatment. ,
- Southvvest FloHda Water Management :DisUict-Wells, Cypress.��Bay�eads; Wetland Areas, Altering
Watercourses. � .
- Army Corps of Engineers-Seawalis,Docks,Navigable Watervvays.
- Department of ,Health:;& RehablNtative.S,eniiceslEnv(ronmen#al Health Unit Weils, Wastewater Treatment,
Septic Tanks:_ ' ' � - � - .
- US Environmental Protection Agency-Asbestos abatement.., _ _ ' .
Federal Avlation_Authority-Runways:�� „ , '
I understand that the.following:.�estri'ctions apply to the use of flli:•
- Use offlll is not allowed in'Flood;Zone"V"unless expressly permitted.
- If the-.flll�rnaterial`-is to"b.e used_'`In-�Flood-Zone. "A", I�is understood that a drainage plan address(ng a
"compeFlsating volume" will be submitted at time of permifting vuhich ts prepared by a profess(onai engineer -
Iicensed by'the State of;F�orida: �" � � _ �
- If ih�-flll•materlal�is to�:be�used In Flood Zone 'A° in�connection�with�a�permitted b�ilding using stem waii
-� constrvct(on, l cert(fy,.that fUl:wlll=be used only.to.flll the area within�the�stem�wall: '
- If fill m�terlal (s to be used °In any area, I �cenify that .use. of'such flll will not adversely affect adjacent
properties. If use of.fill is found to adversely:�ffect adJaeent�prdperties,.the owner may be cited for violating
the conditions_of_the buildtng:perrriit-Issued_under the�attactied�ermit application;�for:lots.less:.than.one (1)
acre virhich are elevatecl�tiy flll,a�r engineer�ed drainage plan ts required. •
If I am the AGENT FOR THE OIMNER, I;promise In good faith to laform the��owner of•the permitting conditions set torth in
this aifidavit�p�ior to commenaing constructlon. I understand tha#a�separete permlt may be requtred for elecMcal work,
,..,,.a .�, .
plumbtng, signs� wells,.pools;.air�conditioning�:gas, or:other instal(�tions nol�spec�leally Inclu�Jed�in.the application. .A
permit Issued shall be construed to"be�a'Itcense�to'�proceed wtth'ttie.work and:not as:authoNty.to:violate;::cancel, alter, or
set aside any�proviston§of the.teahnical codes;�nor shall issuance�of a.permit.prevent the Bulldtrig Offictal from thereafter �
requtring a correction af eRors;in�.pians; constivction or violations of any codes. .Every�permit=lssued sfialFbecome invalid
unless th� work authortzed.by such permlt:�is.commenced�withfn sUc�.months of�permlt Issuance, or If work authorized by
the permit is suspended or:abandoned-for a=period.of six:(�)�mon�s.after;the:time the�woMk is commenced. An extenslon
may be requested, tn writing;.from.the:;Bufiding,Official for a peNod:not=to exceed'�niriety`(90)'days a�d-will'demonstrate
Justifiabl�_cause tor.�the extension�: If work ceases:for ninety.(90)cons.ecutive day.s�..th�)ob:is considered aba�doned. ±
.-_--�--_�.. .. _ , . _ �
WARNING TO OWNER: YOUR..F,AILIJRE-;TO,,R�ECORD A��10TIGE:O�;C0lIAlNEMCEIIAENT.MAY�RESULT IN YOUR
PAYING TVYICE;FOR.IMPROVEMEN�'S�.TO.YOUt��PRQPER7Y:Y�IF°.YO.UtIiVTEIi�D��T�"�OBTAIN��F1PhA1�1-EFNG;'CO�ISULT
WITH YQUR LENDER OR AN°�►TTORNEI��B�FOR�tRECOR�DIMG'YOIJi�'MOTICE'OF`COM ENrEfIl1ENT' '
..,: . _ ..., . .. _.. _. .. _ .. .
OR J RA�r(F.3:1.17.03} _ ' . . - . � _ �
OWNER OR AOENT CONTRACTOR �
Subscribed and swom to(or aRirmed)betore me thls Subscribed and'swom�to(ot atflrmedpbefcre me ttil�
by .by...,
Who Is/are personally knovm to.me.or:haslhave produced Who.ls/are p.eraonally.�mown•tu me or lias/have•produced • . �
, ae IdenBfl�tlon. as IdenBflcaOon.
Notery Public . Notary Publlc �
Commisslon No: Commisslon�No. ,
Name ot Notary typed,p►Inted or stamped Name of Notary typed,pdnted or atamped
:
CITY OF ZEPHYRHILLS
5335!8TH STREET
(80)780-0020 1888'3.
DRIVEWAY PERMIT
PERMIT INFORMATION LOCATION INFORMATION- "
Permit Number: 18883/18845 Address: 5627 20TH ST
Permit Type: DRIVEWAY ZEPHYRHILLS, FL.
Class of Work: DRIVEWAY/NEW Township: Range: Bo k:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: CITY OF ZEPHYRHILLS
Est. Value: Parcel Number: 1 1-26-21-001 0-1 1 000-0080
Improv. Cost: OWNER INFORMATION
Date Issued: 10/26/2017 Name: LANTMAN EDWARD & BONNIE
. Total Fees: 60.00 Address: 911 N HILLTOP RD
Amount Paid: 60.00 PEORIA, IL. 61604-4743
Date Paid: 9/18/2018 Phone: (309)696-8601
Work Desc: CONSTRUCT NEW DRIVEWAY 36 X 19 FOR ADDITION 1x reinstate
CONTRACTORS APPLICATION FEES
BACK CONSTRUCTION 813)355-1195 DRIVEWAY 40.00
DRIVEWAY 20.00
� n
DRIVEWAY Ins ection Required
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 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 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
CONTRACTOR PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIOlt
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
PERMIT ARPLICATION
DRIVEWAY PERMIT APPLICATION
CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY
Ali information M_ug be filled-tn completely
City of Zepityrhills
5335 a Street,Zephyrhlils,FL 33542
Telephone 813.780.0000 Fax 813.780.0005
oata of applicaition —7, :(7 Oracemed 8i/i _ Permit#:
(gray tita!! arr)
CICoFY to Augdiri'g'Depdttmert[ - _ ElCopy to F'.ubitc Works _
PRO7EC1' 3015 SITE: PROPERTY OWNER
Address:562,1 20^rN :s7' — 144-S F'G Name:LR, MR L.eA _.l +Cb godA37s Y.
Unit : Address:10 . PmmaP Rd Unit:
Parcel Identilication NumbdP _ I city,State,Zip.ACORM :S`G . 01610 -�4'7.i3
Phone: Fax:AA.
r
CONTRACTOR: `
Name:W/4444M A.' 4
Contractor`iUoense#:GGC • 5F,10 E-Mail:. ' AQWK. - _o GOLti' .
Phone: Fax .A• _
ARCHITECTjENdINEER:
Name: firf..? ,t,>y: Finn Name: l�
-Address- city: State: _ Zip;
-State license#: y Phone: Cell: ft:
beuscstation of Pnoiect,
WO - F D 3_t LENGM OF ORNEWAY tULVERTS NEEDED _
_Y—J2ESMENTIAL DRNEWAY /Q_WIl7TH OF DRIVEWAY ( 'NF_ORCED
COMMER=D WEWAY W EXCdVATION ( } - D MATERIAL
_-_RWC AaZSS DRNEWAY af-PMH — _,Li M FEET ( CUL
ER(EXPLAIN) '
GTIQIY MATERIAL CURET CUT REOUI -
PHALT 'YES iy- '
CONCRETE
},LAR&LL REOUIRED7 YES V NO
NOTICE TO'APPLICANT: If at#taat work exceeds scope of this description,additional permits or drawings
will be requiT+ed:-
IMLM LOCATIONS REQ IU REQ: CALL BEFORE YOU DIG:IMO. 32.4770
Page 1 of 3
i
. .ti
PERMIT APPLICATION
OFFICE USE ONLY
PUBLIC WORKS USE ONLY
Concrete (min.6`1 Y N
Asphalt Base(min.6') Y N
Asphalt(min.1T/a') Y N
Length(m1n.19-) Y N
Width(10'min—20'max) N
I3dsting sidewalk. Y pei
New sidewalk Y IV
ADA compliant Y N
Expanslon material mqulred. Y N
Contiguous parking pad. Y iV
Triangular flare(3'W x TL) 1f N
VislbElty triangle o.k.? N
9de set back(3'min.R.O.W.) N
Plan Review Fee
AddlUonal description of work as defined by Public Woft Olrector and or desi nee:
Se o of -ON S '"o
c
Permit applic0on approved by: Date:
Page 3 of 3 `
eta-7e0-0020 City of Zephyrhills Permit Application Fax-813-700021
• BuRding Department '}
Date Received } ehone.Confaat-for Pe S/k3
Ownsr'a Name QPJ G,4^>7/h04� Owner Phone Number
Owner's Address 56 2-720 7w sr Z-►}9 BLS r F�- Owner Phone Number
Fes SNnplr•Tilleliolder Name Owner Rhone Number '
Fee SlmplaTltieholderAddress �•LA
JOB ADDRESS 5foi2 Zo7W S7. 7--MM:s,I-4— 33 S*•- LOT
SUBDMS19N PARCEL ID#
• - (OBTAINED FROM PROPERTY.4AX NOTICE]
WORK PROPOSED 'NEW-CONSTR• . ADDIALT Q' SIGN' 'Q Q DEMOLISH,
e• INSTALL ; REPAIR
PROPOSE�XSE SFR• 0 Cow. • ] 10THM
TYPE OF CONSTRUCTION Q' "ELOCK Q FRAME :��: 'STEEL 'Q _
DESCRIPTION OF WORK Y IAIsT�w AFC'• QR,I✓FIJf9y :S 0A4- Sl';• 00tdq�j
r
BUILDING f..IZE Al A• SQ FOOTAGE=; , •J=61T
=BUILDING $ VALUATION OF TOTAL CONSTRUCTION h
=E}EC1 RICAL $ AMP SERVICE Q PROGRESS ENERGY WA MC.
=PLUMBING. $
l
[:3MECHANICAL $ VALUATION'OF.MECHANICALINSTALL•ATION
=GAS ROOFING ;Q SPECIALTY[= OTHER-
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES. .NO
BUILDER COMPANY A4c-x (bw07--,/-AJC!,
SIGNATURE REGISTERED I Y/ N +EE CURRM •Y/N
Address - Clcensa#'
ELECTRICI W F -COMPANY
SIGNATURE ' REGISTERED I Y/N FEE-CURRW I •''YIN. .
Address
PLUMBER) v
COMPANY
SIGNATURE' ti REGISTERED l Y.I.N.. ;.•yl:E-CURRIR: '''Y-I N
Address !.l�iae,#
MECHANICAL:' _ COdAPANY
SIGNATURE
REGISTERED. _Y,/N.':.., FEEGI•tRREt. Y.IrN
Addaft' .3 :'> LICQ9so�F
OTHER „GOI�IIpA(dY- _
SIGNAT `
URE •C'. t:. ' : It�'cISTEReb' Y FEE cU
__
' .-
Address
-. •e.• .....j. r•..-...
RESIDEI'ITIA4,'•• Atlach(?)�?IotP.lens:t2)s�fs,bUBu(Idteg'f?laii"s'Ei)set'oflEnergyForin�R�-'VII�Perg'Ilicrnewcoirahpelrori. -'•' -
-,,.+_;Mhlimumtep<1?0}ayorkUlg days agar s¢bmfHel datgx Requfietl ohslteaCaiietitiLtlon Raehe<Stormwataz'Pna w)_BIItIFenee Installed,
tanilaryleQtleg ,r}tdump8tel:SiteIf�rkd?@rmltto
e
rsubirnii6lbtlURatgb'grlu] ;. :` 'v
COMMERCIAL Attach(3)bbmplate'safe`ot`9utitlthg°Plans plus Lfe SatelyrPaga;(1)set of'tcnergy Fomrs Rr0 YV Permttfor nerV oonsWerion.
Minimum ten(10)worklrlg days after submittal date.Required onsite,Construction Plane,Stortnwater Plans w!Sllt Fence Ursfallad,
8anitary F. Use&1 dumpater.Site Work Permit for
al
SIGN PERMIT Atfal naxrprojeam:All kAmmero[al requlkemants mkrst meet comp0ence
df(2)seed OfEegitlegrad )arle ^'' i
•"'PROPERTY SURVEY required fob ap NEt(V,poitsburilton..
FIB out application completely.
Owner&Contractor sign back of appllkation,notarized
If over nso0•a Notice of Corrmrencement Is required. (AFC upgrades over$7500)
Agent(for ttie oo�raotor}or'Pb14ai''drAt1offii(for the owner)would be someone vilth rkotadzed letter from owner authorizing same
OVER THE COUNTER•PERMITTINM- •--{Frontaf•ApplicaOon Only)-
Remofs if shingles Sewers Sarvice Upgrades AIC Fences(Plot/Survey/Footage)
Driveways-Not over Counter if on pub9e madA;s..needs ROW'
l
NOTICE OF DEED RES ICTIONS: The underslpned Uredecptar� s4tt�A—pprrnIt-may;be,suWectj ',deed!MsIrI b
which
maytie.niois=tssttictiva>lhan Gut�t�risllttiie§retie:dndafainetkassUiie's+iespan<3thlitt 'for"dtinptlan +ilFi atjy
UNLICENSED CONTRACTORS iRF1D CONTR�iC7OR RESPONSIBILITIES:' ^If^the owner has^hires'a'"corifrabtar or
contractors to undertake walk,they mety be;te�ulyddtai�astltmnsed In:accorilonca.wHh c)ata rind tacl;egutacri
contractor b-not•Irc6fidd'as-tequ r violation
under state law. If the owner or Intendstl�coe aofior alse4tfncertaln es bo.whet Iioenetrig raquiremenb may�pply'fiariho•• >'
fntendeftork,they we advised lb contactthe-Patna County�f3uQithig ti>p c n btvTslgir- ti ena)ng Section st 727-847
6008. Furthermore, if the o"ar ffa's''fi1?ed'i(t:rvntsactor dr contractors, hs fie advised to have the can6(gdor(s-•sign ,k,
portions of the'oontrectar Block°otthta.elppli.,*Von_for whidh.theY wHi..bte.msponslble:.•16 you,as xhe oti hdir'.'srgie'"'s'the
conkaotnr,'thattnaybe an thdkmHon that` =is'trot}properly'ficerllisd`aritl°:is'tact eritHtsst�o peifiilEpng.p'rluliegea In Pasco
County. _; xr=._. . .::�
TRANSpORTATION•IMPACTIUTILFTIES`-MPACr'I�AN6 RSSOUaCE RECOVERY—FEES-The uridt�rslgnd'd-Understands
that Transportation Impact Fees•and.Recauma-Rdtxmvery:Paea!nlay;epplyitaethe_consfiroHon of It..bpRdings,,change'of
use In anitetttng bdildings,`or,expadb rrii i S%Milt tugs,$s spedHed.ln Pasco County Ordinance number 89dt7 and.
9M7,as amended.,Tlja undomIgned elso,undsrstands.IMUsuch fees,,os maje0(yiduaj,1NJWbe lddrt_ at therttineVof'
permitting. it Is turttiet undsratbo8 that Traris'portaflon Irnpaot Fees artit R+asourae Racoiktf%y Fess..must be paid prior to
rec:elving-s'cei lcata of aocupancy'or tirmf flaws[Eetease:9-the projedLdoes hot trnatva a r rtf(ti a of oacupanoy=aa✓
final Fu.Mgrmoro;•IEPosco,•Qounty*Witer/Sewevjmpact
fees are dpe,.they must,be:pald prior to perrifit issma 64n a gortl%Ilnc a wltlt:appHcabla.Pasco, aunty o lrnances.
CONSTRudnbfh EN•t.A'tllf( *13,Etor#de Statutes,as amended): if valuation of work Is$450D.QRmr more l- .
certify that 1, the•eppticant,-heve,•,been.provided—with—to—copyof' h9.•-'Florlda°Corisbu-dUbn..-•Leh'.Lew—Homeowner's
Protection Guide'prepared by.'tlfa Fldfida Department'of Agriculture and Consuroeriffalrs. If the applicant Is someone..
other than the`owner',b.caft that 1•have.db#elnedea%oply of.t atiRvadegcft ;diicti rtt�nt Arid-pforti a In gDod'(altt>to
deliver It to:the"auvrier`i�llot�to-coiriinerir�merift•°• � - - • '-
CONTRACTOR'S/OWNER'S AFFIDAWT: I.ceftity.:il�at+aihthe�{nfar+nedon In this aRpi(cet(on is aocurate.and that ail worts
will be done In compliance with all applicable lawn regnitating conetrucUon,fining and°tand5develpplrldnx. Application Is
hereby made to cbtain.a parmitJo•-do.eroftf;and;If~etalletfon as (ndt�fed�:1.ceftffy'8iat rto worklor instdilatton Kas
commenced prld)to IssWnce of a periiilt"end thnt:eil'iivork will 6e performed to meet standards-of all laws regulalirig-
construcHon,County and City oodes,Zoning regttiatlorrs, and tend development tegttiatl6fn3=tn tits jurtsdtctton.• t'.18160•
certify that I understand that the regutafione of other goverment agencies may•apply,to the iMeftded fivotk,and that It is
my responsibility to iden tl(ya hat.ecilons 1 ntust;tske jo be.tri ccrrlptlattce...$,t!ch•oparicles-Include-buVare.rwt itmited to: i
Depnittrteent of Envlronmea1ab^0totdatlefi' rpfsss'Sdyheadi4 Wetland Areas and Envircrimentally Sensitive
Lands,WaterlWastowaterTreatmenL
Southwest Florida Water Management:010ict.Welis, Cypress.`Bayheads; Wetland Areas, Altering
Watercourses.
Array Corps of Enginsers-Saawails,Docks,MWIgabie Waterways.
Department.of.Heallh:8r RehsbOfjppve.-Ap vices/Environmental Health•UMI-Walls, WastewaterTreatmerr),
Septic Te'nks:. - .
US EnvlronmehW Prolectlori Agt}ncy-Asbestos abatement..: _
FederalAv,iatlon.Auther3q►;RumNaysr „
I understand that the.followfigte'atr(dfltins apply td the use of fill:
- •Use of it Is not allowed In:M0d:ZgrnG OW urdess expressty.psmittmd.
- If the.fill'matefiat-te'tdfba usWln-Flood-Zone."A', It is underetbod that a drainage plan addressing a
'compensating volume"will be submitted at time of•permlHing which is prepared by a professional engineer-
licensed by'the Staiifi 91FIdr1da.
- if the-fill-ma-teriat-ls to~.be•used in Flood Zone'A'Ins connection*Rh,.a-permitted building using stem wall
construction,I certify.that fi11M. 1pbe-used only•to.flll the area within—he—stem—wall,
if di material Is to be used`lh any afee, i•6ei0fy that use.of-such flit will not adversely affect adjacent ;
properties. 9 use cf,fill is found to adveraidy.affect adjacent properties,.the owner may be cited for violating
the condMons_df-the b(illdlog;pamilt issued=under the attached permit applicallon;-fordots-.less:'than.one('I)
adre onc`h are erevatad1y fill,on engineered draiage plan is required.
If 1 am the AGENT FOR THE OWNER igiroinitie to goad faith to Inform the^atn+ner of the psnnitting candH{ons set forth in
this aHidovlt'prfor'to commen'rlhg coiistructlon. 'I urideref"and that-aiseparate•permlt may be required for elecbical•worl
plumbing,signs,wells,pools,.alr,condilloning,:gets,or:othsr.ine. 1MORd not.speclficalty Included.In.the•application. -.A
permit issued shall be constniedtolu'W fibeiisEFII'praacesd witb;(Ke ti oik amd:npt•as:authority.totvfolaW;toncet.alter,or
sat aside any-proVisldns of the.teciiirlcal codes;-nor shall issuance of a.permit.prevent the BuMdg Official from thereafter
requiring a correoflon of orrors irrplens;•coast botloa or violations ofanycodes. .Every-permit Issued"shatl become Invalid
unless thawork outhorked.by such permlift commenced-within six months bf permit[esuartce,or U work authorised by
the permit issuspended,or• :fro,ebandoned-foria-.periodefdix{8)•months.afiei'theVmethe•work•lecommenced. Anextonsion
maybe requested,In wd0 g,: m.ihe;BuVding Of dai-fbr a perlod not•to•excaed-niNty{g0)'4ilys ahtl-WHt deinanstrate
justHfable crusehi-the ex�tensian. If work csa�ss.far ninety.(90)consecutive-days,thkjob;is considered abandoned. j
WARNING TO OWNER., YOUR.FAILURt,-T�O.RUQRD A.NOY96E 0FrCGMMMCEMEW•.MAY"RESULT IN:'YOUR
PAYING TWICEM9ROMPROW EFI�S10—VOW P130PERTa6'AF YOtJ+IN>EstDD?TQ=dfi3'TAtll•�1r1 NovaciNSULT
t�,1tQ.�R�.,�.NDER�ftAt+tATTORNIsX�F�L+REt�'pRiat G•YAU�i�CLs't3F�O'MNFENG�i>rNT: '
FLORIDAJURATi(R.S t1703}
OWNER OR AGENT CONTRA rC
Subsa@ed and swam tc(oraMm" m me tits subsedbed arurammta ot;Mnedybdtcfne me ces
by, by_
wM Islam personally.known to.me.crihawl aee pMdyaed Who.Wam petspnally.8nom to me or rtaslhave =dtl¢ed a
utdanNifesBan ' -as Id9nmicagom
Notary Public Noffiry Public '
Commission Ne Commisslon No. ,
Name of Notary typed,printed crsnamped Name&Notary typed,printed or stamped