HomeMy WebLinkAbout18-20583 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 20583
BUILDING PERMIT
PERMIT INFORMATION LOCATION INFORMATION
Permit Number: 20583 Address: 6907 OAKCREST WAY
Permit Type: ADDITION/ALTERATION ZEPHYRHILLS, FL.
Class of Work: 434-ADD/ALT RESIDENTIAL Township: Range: Book:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Square Feet: Subdivision: OAK CREST ESTATES
Est. Value: Parcel Number: 02-26-21-0230-00000-0110
Improv. Cost: 14,100.00 OWNER INFORMATION
Date Issued: 12/18/2018 Name: ZEA-PENA GONZALO &ZEA MARIA
Total Fees: 285.00 Address: 6907 OAKCREST WAY
Amount Paid: 285.00 ZEPHYRHILLS, FL. 33542-1695
Date Paid: 12/19/2018 Phone: (352)424-264
Work Desc: PORCH ADD 506 SQ FT & SHINGLE & GARAGE DOOR ENTRY,@FT X 10 FT & DW
CONTRACTORS APPLICATION FEES
HOMEOWNER BUILDING FEE 172.50
HOMEOWNER ELECTRICAL FEE 67.50
HOMEOWNER DRIVEWAY 45.00
Ins ections a uired
FOOTER 2ND ROUGH PLUMB MISC INSULATION 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: (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 maybe 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.
"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 Must Accompany Application:All work shall be performed in accordance with
City Codes and Ordinances. NO OCCUPANCY BEFORE C.O.
NO OCCUPANCY BEFORE C.O.
mh ca/ Cc
CONTRACTOR SIGNATURE PERMIT OFFI R
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTION
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
01.3-f au-UUZU City of Zephyrhills Permit Application Fax 813-780-0021
Building Department 0
Date Received Phone Contact for Permitting F(
ImROZA= ...........f"rr7TTTTrr1 ..................... ..............
Owner's Name C to 7jea- Pc-tTG Owner Pion Nu or 1362 vt 2-1
q Y)ra
Owner's Address G 019 kk&7— tdd y Owner Phan:Numb
Fee Simple•Titleholder Name Owner Phone Number
Fee Simpli1itleholder Address
JOB ADDRESS 012K&L-5rWIL U P�r A 14 ft 0 FZ,3 36 V 21 LOT#
SUBDIVISION PARCEL ID#
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED. NEW CONSTR ADDIALT SIGN Q 0 DEMOLISH
e INSTALL M REPAIR
PROPOSED USE SFR Q COMM OTHER
TYPE OF CONSTRUCTION s BLOCK Q FRAME 0 STEEL
DESCRIPTION OF WORK—�4 rict;i" PC Ck CU4 t-4 so
-BUILDINGtSIZE SO FOOTAGE I Jc) 6 _J HEIGHT F_
C9 VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL 1$ ie9C)C) I AMP SERVICE Q PROGRESS ENERGY Q W.R.E.C.
=PLUMBING $
7
=MECHANICAL 1$ VALUATION OF MECHANICAL INSTALLATION
=GAS Q ROOFING- 0 SPECIALTY OTHER
FINISHED FLOOR ELEVATIONS rr FLOOD ZONE AREA =YES NO
i i v i v i i i 2 N i i v v i i i 2 s 6 ff
BUILDER! COMPANY
SIGNATUREC� REGISTERED I Y/'N FEE CURREN
Address
License# F—
ELECTRICIAN
COMPANY ezdn&IL-_
"SIGNATuR*E REGISTERED FEE CURREN;
Address License#
PLUMBER! COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address License#
MECHANICAL COMPANY,
SIGNATURE REGISTERED YJ N I FEE CURREN
Address License#
,OTHER_-- -COMPANY
SIGNATURE REGISTERED _Y/ N FEE CURREN. L_yl N_J
.Address F License#
F
............
............ III mi'H!H H!!I I! HHH HHHH I I I!!!HHHH I-H HHHHH+H'-.iHIIIHNl I
_*66ENTIAL Building Plans;.(I).set-of Energy,Fqrms;R-O-W.Permit foe'new-construcUon,,
Minimum'ten'(1 0)+workl+fi6 Aays after s dbmittaild6te. Required onsite,Construction Plans,Stormwater�Plans.w(,Sllt Fence installed,
Sanitary Facilities&1 dumpster,Site Work Permit for subdivisi6ns/large projects
COMMERCIAL Attach(2)complete sets of Building Plans plus a Life-Safety Page;(1)set of Energy Forms.R-O-W Permit for now construction,
Minimum*ten(10)working days after submittal'date..Required onsite,Construction Plans,$tormwater Plans wl Slit Fence installed,
. . 9
Sanitary-Facilities&I dumpster.Site Work Permit for all new projects.All commercial requirements must meet oompliance
SIGN PERMIT Attach(2)-Sets of,Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
W!'Will 111114444;R111 sIIIIIII ............
Fill out application completely.
Owner.&Contractor signback of application,notarized
If-over$2500,a Notice of Commencement Is required. (A/C upgrades over$7500)
Agentffor the contractor)or Power of Attorney-(for the owner)would be someone with notarized letter from owner authorizing same
OVEkTHECOUNTER PERMITTING . (copy.of contract required)
-.R4661sff-shingles Sewers Service yoori&s A/C, Fences(PlottSurVey/Footage)
.Driveways-Not over Counter if on public roadways..needs ROW
NOTICE OF DEED RESTRICTIONS:. The undersigned understands that this permit may be subject to"deed" restrictions"
which may be more restrictive than County.regulations. The undersigned.assumes responsibility for cgrnpliance�with-.any
appllcable•deed:restrictions. '
'UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES: If the owner has hired a contractor or
contractors'to undertake work, they may be required to be licensed in accordance with state-and local:.regulations:= 1'the
contractor is not licensed at`required by law, both the owner and contractor may be cited for.a'misde' meanor violation
under,state law. if the owner or intended contractor are.uncertain as_-to what licensing requirements may apply for the
intended work,they are advised.to contact the Pasco County Building inspection Division—Licensing Section at 727-847-
8009: Furthermore, if the owner has hired a contractor or contractors,. he is advised to have the contractbf(s)'sign
portions of the "contractor Block" of this-application.for-which they will be responsible. If you, as the owner sign as the
contractor, that may be an indication that he is not properly licensed and is not entitled to permitting,privileges in Pasco
County: ,
TRANSPORTATION IMPACT/UTILiTIES.IMPACT AND RESOURCE RECOVERY FEES: The undersigned understands .
that Transportation Impact Fees and.Recourse Recovery Fees may apply to the construction of new buildings, change of
use in existing buildings, or expansion of existing buildings,as specified in Pasco County Ordinance number 89.=0:7 and:.
90-07, as amended. The undersigned also understands, that such fees, as maybe due, will be identified at the-time-of
permitting. It is.further understood that Transportation Impact Fees and Resource Recovery Fees must be paid priorto
receiving a "certificate of occupancy" or final power release. if the project does not involve a certificate of occupancy or
final,power release, the fees must be paid prior to permit issuance. Furthermore, if Pasco County Water/Sewer Impact,
fees are due,they must:be paid prior to permit issuance in accordance with applicable Pasco County ordinances.
CONSTRUCTION LiEN LAW(Chapter.713, Florida Statutes, as amended): if valuation of work is$2;500DO or-rnore, i
certify that 1, the applicant,"have been provided with a copy of the "Florida Construction Lien Law—Homeowner's
Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is someone
other than the"owner", I certify that I have obtained a copy of the above described document and promise in good faith to
deliver it to the"owner"prior to commencement
CONTRACTOR'S/OWNER'S AFFIDAVIT:,decertify thatall-the information in this-application is accurate and that all work
will be done in compliance with all applicable,Laws.regulating construction, zoning and'and development. Application is
hereby made to obtain a permit to do work• and installation as"indicated. I certify that'no work or installation has
commenced prior to issuance of•a permit and-'that all work will,be,performed to meet standards of all laws regulating
construction, County and City codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other government agencies may apply to the intended work, and that it is
my responsibility to identify what actions 1 must take to be in compliance. Such agencies include but are not limited to:
Department of Environmentai Protection-Cypress Bayheads, Wetland.Areas and Environmentally Sensitive
Lands,WaterMastewater Treatment: -
Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetiand Areas, Altering
Watercourses.
- Army Corps of Engineers-Seawalls, Docks;Navigable Waterways.
Department of Health & Rehabilitative Services/Environmental Health Unit-Wells, Wastewater Treatment,
Septic Tanks.
US Environmental Protection-Agericy-Asbestos abatement.
Federal Aviation Authority-Runways.
I understand that the fallowing restrictions apply:to the use of fill:
Use of fill is not allowed in Flood Zone W"unless expressly permitted.
If the fill material is to be used in Flood Zone "A", it is understood that a drainage plan addressing a
"compensating volume"will be submitted at time of permitting which is prepared by a professional engineer
licensed by the State of Florida.
if the fill material is-to•be used in Flood Zone "A" in connection with a permitted building using stem wall
construction, I certify that fill will-be used only to fill the area within the stem wall.
If fill material Is to be used in any area, I certify that use of such fill will not adversely affect adjacent
properties. If use of fill is found to adversely affect adjacent properties, the owner may be cited for violating
the conditions of the building permit issued under.the attached permit application, for lots less than one (1)
acre which.rare elevated by'fill,.ail engineered drainage.plan is required.
If i am the AGENT FOR THE OWNER, I promise-in good faith to inform the owner of the permitting conditions set forth in
this affidavit prior.to commencing construction. I understand that a separate permit may be required for electrical work,
plumbing, signs, wells, pools,,air conditioning, gas, or.other installations not specifically included in the application. A
permit issued shall be construed to be a license to proceed with the work and not as authority to violate, cancel, alter, or
of set aside any provisions the technical codes, nor shall issuance of a permit prevent the Building Official from thereafter
requiring a correction of errors in plans, construction or violations of any codes. Every permit issued shall become invalid
unless the,work authorized by.such permit is commenced within six months of permit issuance, or if work authorized by
the permit is suspended or abandoned for a period of six(6)months after the time the work is�commenced. An extension
may be requested, in writing, from the.Building Official for a period not to exceed ninety(90) days and will demonstrate
justifiable cause for the extension. If-Work ceases for ninety(90)consecutive days,the job is considered abandoned::
WARNING TO OWNER: YOUR FAILURE.TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT•iN YOUR
PAYING TWICE FIDW IMPROVEMENTS70 YOUR PROPERTY. IF YOU INTENDTO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING`YOUR.NOTICE OF COMMENCEMENT.-
FLORIDA JURAT_(F`S. 117_03)_
OWNER OR AGENT � G CONTRACT r , 7-c'.4,
Subscribed and swom to or rmed) efore a this syy4qs be an wor�nn to or;affinmed) efore me this
by t D L t l � by r,o �[1 d Z,eCa-
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personally own to me or has/have produced Wh War erso ly kpa Ti to me or has/have produced
r5 ' as identification. as identification.
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Notary PublicDlalle_ kf- Notary Public
mm sion o „�t•_. Commissi
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DISCLOSURE STATEMENT FOR OWNER
CITY OF ZEPHYRHILLS BUILDING DEPARTMENT
I, have read and fully understand and
agree to the provisions of this instrument.
The undersigned states and affirms that he or she is desirous of constructing,
renovating, adding to or reroofing his or her own domicile, that he or she
actually occupies, or will occupy by said domicile, and same is not for
rent, lease or sale. That he or she shall comply with the following conditions:
1. That the owner and he or she alone shall act as the builder for all phases of
construction.
2. That the owner will comply with all provisions of the City of Zephyrhills
ordinances and codes pertinent to the building.
3. That in the event various phases of construction are subcontracted, he will
engage only properly licensed subcontractors and will personally supervise
such work.
4. That in the event the Building Inspector shall require corrections to be made,
the owner will assume full responsibility to insure they are made, and upon
completion will call for a reinspection before proceeding with the building.
S. That the owner shall assume full responsibility for the construction and will
not expect supervision of his work from the City of Zephyrhills Building
Department.
6. That prior to final inspection any additional fees, including reinspection
fees, must be paid in full. A written request from this office shall
constitute an official notice to pay additional fees.
7. That the owner shall comply with all City, State and Federal laws in regard to
social security, workman's compensation, lien laws, etc. , where applicable.
8. That the owner shall comply with all the safety codes issued by the Florida
Industrial Commission.
9. State law requires construction to be done by licensed contractors. You have
applied for a permit under an exemption to that law. The exemption allows
you, as the owner of your property, to act as your own contractor with certain
restrictions even though you do not have a license. You must provide direct
onsite supervision of the construction yourself. You may build or improve a
one-family or two-family residence or a farm outbuilding. You may also build
or improve a commercial building, provided your costs do not exceed $75,000.
The building or residence must be for your own use or occupancy. It may not
be built or substantially improved for sale or lease. If you sell or lease a
building you have built or substantially improved yourself within 1 year after
the construction is complete, the law will presume that you built or
substantially improved if for sale or lease, which is a violation of this
exemption. You may not hire an unlicensed person to act as your contractor or
to supervise people working on your building. It is your responsibility to
make sure that people employed by you have licenses required by state law and
by county or municipal licensing ordinances. You may not delegate the
responsibility for supervising work to a licensed contractor who is not
licensed to perform the work being done. Any person working on your building
who is not licensed must work under your direct supervision and must be
employed by you, which means that you must deduct F.I.C.A. and withholding tax
and provide workers' compensation for that employee, all as prescribed by law.
Your construction must comply with all applicable laws, ordinances, building
codes, and zoning regulations. p
OWNER'S SIGNATURE' —'tiOIL� DATE.
ADDRESS CYO Ze ] } 5yZ J
PHONE A-2 y'2 Y y8 2
WITNESS PERMIT #
From: Michael Poston
To: Oakcrest Estates HOA Architectural Committee
(Michael Poston, Richard Forrest,Joel Roman)
Date: September 27,2018
Subj: HOA clearance for proposed building project at 6907 Oakcrest Way
On September 27, 2018, Mr.Zea submitted a request to me for HOA clearance to submit building plans
to the Pasco County building authority. This is to comply with the HOA Covenants Conditions and
Restrictions,Article II Section 2. His original request is attached on the back of photo 1.
Mr.Zea desires to construct a back porch of no more than 500 square feet on the west side of his home.
His design will be similar one of the attached photos 1 and 2.
He also wants to construct a covered entry at the garage entry door on the south side of his home,
approximately 6' by 10',similar to attached photo 3.This doorway is behind his fence.
Mr.Zea will perform the work himself with all necessary permits and inspections required by the county.
If approved by the Architectural Committee on this letter, I will draft a clearance letter for Pasco County
for your review and signatures.
nicha72��ton
6903 Oakcrest Way
Michael Poston approve disapprove
Richard Forrest approvedisapprove
Joel Roman i-/_approve disapprove
I
rim
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
Contractor/Homeowner: (! 6 ' [ Alt`"'
G �?
Date Received: I f' `�'t 6.D
Site: &9 0 7-
Permit Type:
Az
Approved w/no comments:Cl Approved w/the below comments: r
Denied w/the below con
I) & �ed:&A
This comment sheet shall be kept with the permit and/or plans.
/& DEC i.A 2010
Kalvin Swi r—Plans Examiner Date Contractor and/or Homeowner
(Required when comments are present)
From: Michael Poston
To: Oakcrest Estates HOA Architectural Committee
Date: November 1,2018
Subj: HOA clearance for proposed driveway extension at 6907 Oakcrest Way
Mr. Zea has submitted a request to me for HOA clearance to extend his driveway width. This request is
to comply with the HOA Covenants Conditions and Restrictions, Article II Section 2. His original request
and simplified drawing is attached on the back.
Mr.Zea desires to extend the width of his driveway 7'on the south side of the existing driveway. He will
obtain all necessary permits and inspections required by the city and county.
The addition is in compliance with driveway conditions stated in Article II, Section 6 of the HOA
Covenants Conditions and Restrictions. If approved by the Architectural Committee on this letter, the
project will commence immediately.
Michael Poston
6903 Oakcrest Way
C
hae:Forre:st
n approve disapprove
ard � approve disapprove
Ro - approve disapprove
yh}
a-'b
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2 201820
Peril No. �o 3 Parcel lD No
NOTICE OF COMMENCEMENT
State of G.`�_ County of
THE UNDERSIGNED hereby gives notice that Improvement will be made to certain real property,and in accordance with Chapter 713,Florida Lutes,
tlie following Information Is provided in this Notice of Commencement: a 64 n �O�
1. Description of Property: Parcel Identification No. V10
Street Address: W_Q L� P 19
2. General Description of Improvement
.S IC ?oyc /0 x
3. Owner Information or Lessee information if the Lesse 'contracted for the improvement: �'/•� _�
ame a.S ea�-I�c<<-�c�Y Rcpt:201�2810.00
Name IDS: 0.0000
12/13/20ty Clerk
Address City State
Interest in Property:
Name of Foe Simple Titleholder:
(If different from Owner listed above)
Address State
4. Contractor. 4 t`70)� [�
Address _ 7� i y State
Contractor's Telephone No.: 35
5. Surety: I IIIII)IIIIIIIII IIIII IIIII IIIII IIIII IIIII IIIII IIII IIII IIII
Name 2018213592 ]�
Address City State ��� 'e
Amount of,Bond: $ Telephone No.:
6. Lander:
Name
Address City State " a ® U
Lender's Telephone No.: Iv
/*
7. Persons within the State of Florida designated by the owner upon whom notices or other documents may be served as provided by
Section 713.13(1)(a)(7),Florida Statutes: a?
Name Rept:2015112 Rec: 10.00
: DS: 0.00 IT: 0.00 �� a
12/20/2018 E. M., Dpty Clerk $�
Address City State Q t— W Y
Telephone Number of Designated Person: CO W W
W
_ J
0 (r�
8. In addition to himself,the owner designates L
of_ U :5 7) O = J
to receive a copy of the Llenor's Notice as provided In Section 713.13(1)(b),Florida Statutes. Q UO C J�0
Telephone Number of Person or Entity Designated by Owner: Ur p W d
Lie � W Z tl 0
9. Expiration date of Notice of Commencement(the expiration date may not be before the Completion of construction and final payment to the O O 2 — J
contractor, Y' LLf— pQactor,but will be one year from the date of recording unless a different date is specified): I— W LL x U U
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT Z = O O
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDATY. A NOTICE OF ,STATUTES, AND CAN }— >- U LL
RESULT IN YOUR PAY IL W
RECORDED AND PO TEID NG ON THE JOB SITE BEFORE T ETWICE FORSFI FIRST INSPECTION.
TO YOUR IF YOU INTEND TO OBTOAIN FNANC NG,CONSULT MUST BE ® Q Q � O
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT. _= U U
Under penalty of perjury,I declare that I have read the foregoing notice of Commencement and that the facts stated therein are true to the best ® } U Co U
of my knowledge and belief. r0 LL
W = Z O J \
STATE OF FLORIDA 0 ag LL S Q W U
CO G 6�7 `•' 6�1 —J W O O Z
KIMBERLY E.HOWELL Signature�o ner or Lessee,or Owner's or Lessee's Authorized �- U U W }_
NoMYCOMMISSION8GG21GM178 Officer/Director/Partner/Manager L- Q C3 U \
, EXPIRES:May 10,2022 ® F— Z O
LIIU7QJ J
Signatory's Title/Offs /0 Q L
The foregoing instrument was acknowledged before ni�,J�r _day ,2 by f 7i'f1 /��bJ � F O 0 m
as r".Lj' .'. (type of authority,e.g..officer,trustee,attorney in fact)for
`►`r{,t' (name of nrtv on b half of whom Ingtnighent was ex
Personally Known❑OR Produced Identification { "1vOtary Signalu
Type of Identification Produced L �'� ' Name(Print) ��
PRULA S.O'NEIL,Ph.D.PRSCO CLERK S. COMPTROLLER
PgULR S.0'NEIL,Ph�Q ,CO CLERK 8 COMPTROLLER. '" 12/20/2018 02:41 m 1 of�y1
12/13%2018 m1 f 1 KIMBERLyE,HOWELLOR BK .83 PG14
OR BK PG �5�� MYCOMMISs10NIGG211478
�� exPlRas;Ma
Y 10,2022
wpdata/bcs/no8cecomm en cem ent_pcO53048
..........
... ........
-PERMIT-APKICATION
DRIVEUVA":Y' PERMIT.APPLICA'IION
�CONSTRUC7I0N .W.1THIN 1PUBLIC=RIGHT OF-WAY
All information-must-be-filled-in completely
iCity.ofZephyrhills
'5335 Sth 5treet,Zephyrhilis,"FL 33542
Telephone.813.780.0000 Fax 813.780.0005
G +a^n:�•Y'.e =:".!. -.:r++sa3xs�x,;.s,4ii'°='�:. _ �::4.,rd`.::..y;�:.;sA!.a �u '4, .i"'.:_ `7;6tw,,. 'r;7r::+,'s:�^ a=1::.;-"di`'.s�'�: _ .,. ".
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.t{74������. N1•!!r. r*� &�'.F �.Y1 s.5�._t_la �-Gl.'�GY ti.� D•+.t.,£•���"�gf',N�Na4J�NCkrt✓.'FX',^•�h�.� ^l t"il.'S=''�f"..`L,���.,.iS�;J.�.;
,.�t'�.y� t ���'r '?'F�.s:"'��yo�.�:����t � �s �.r a. 1:,{ x'""° S.y"..3{:�'rnv `x. }s�"`E` �•• �.5'.ca� +=3.+f.....
i;-� ""`�.S:�rg�st� _ 7' •`;tj�yyy����€�'.•*�,'�(,,��t�t :��{,� ,riw3`+� .._ .i,,; r. 4.s-f ?��,�[.. �.?y��..,.y�. �.i., Y�•-,, -
{.r-•t:��:£�Y-fin,T.!'�5��:;^.'P.'.'t #. �Y!i�/".+D�� Ca!�'��.w�i': x�)^,;:.}c�,:�1Hi��/.:rTd���.'4`:ti'`'.r�,i:i.tt}:.•i'`J'';��is.n::Lw °.f+411r/��ly Y.VLf1:?��.t `�.t'.:; i' ;.'i`�Y;,XY.{:i
PROJ T .SOB{SITE: ��PROPERWOWNER
Address: a Name: C o 'r-a to 'i'ec, ^cf
Unit#: Address: 6&&crels Unit:
Parcel Identification Number: ( city,State zip e V b Y 1' S -L y
'Phone:3 2 Fax:
-,CONTRACTOR:
Company:
Name:
Contractor's License#: E-Mail:
Phone: "Cell: Fax:
ARCHITECT/ENGINEER:
Name: Firm Name:
Address: City: State: Zip:
State License#: Phone: Cell: Fax:
Aescri0on of Project
TYPE QF DRIV AY LENGTH OF DRIVEWAY CULVE'M'NEEDED
ti tESIDENTIAL DRIVEWAY ,WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE•
COMMERCIAL DRIVEWAY R.O.W. EXCAVATION t )CORRUGATED MATERIAL
PUBLIC ACCESS DRIVEWAY —DEPTH, LINEAR FEET ( )BOX CULVERT
COW STRUCTION MATERIAL CURB CUT REQUIRED ( )OTHER(EXPLAIN)
ASPHALT YES --NO
_J,,CCONCREIE
HEADWALL REOUIRED? YES J NO
NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings
will be required.
UTILITY LOCATIONS REQUIRED: CALL BEFORE YOU DIG: 1.800.432.4770, 1
Page I of 3
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1.
Concrete (min. 6'1 Y N
Asphalt Base(min. 6') Y N
Asphalt(min. 11/2,1 Y N
Length(min. 19) Y N
Width(10'min-20'max) Y N
Existing sidewalk. Y N
New sidewalk. Y N
ADA compliant. Y N
Expansion material required. Y N
Contiguous parking pad. Y N
Triangular flare(3W x 71) Y N
Visibility triangle ok? Y N
Side set back(3'min. R.O.W.) y N
Plan Review Fee
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Permit application approved by: Date: T
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PERMIT APPLICATION
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. I certify that all foregoing
information is accurate and that all work will comply with all applicable codes. I understand these codes shall take precedence over all
approved construction documents,and issuance of this permit is verification 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
restrictions may apply to this property.
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/publiiq._works.asp)
APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT
TECHNICIAN OR NOTARY PUBLIC.
NOTE: The City of Zephyrhills is not responsible for maintenance or repairs of driveways. Driveways shall not alter
Interfere with existing stormwater treatment and/or conveyance.
PROPERTY OWNERS: By signing this application: I certify that I have read and understand the owner/builder disclosure
statement. (please initial)
A 1AV1.1A
Applicant Print Name Applicant Signature Date
Permit Technician Signature (or)Notary Signature Date
Applicant is personally known to me or produced as identification.
(type of identification)
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