HomeMy WebLinkAbout19-21913 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21913
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
PERMIT INFORMATION LOCATION INFORMATION'
Permit#:21913 Issued: 10/16/2019 Address: 5920 12TH ST
Permit Type: NEW SINGLE FAMILY DWELLING ZEPHYRHILLS, FL.
Class of Work: 101-NEW CONST/SFR Township: Range:
Proposed Use: NOT APPLICABLE Lot(s): Block: Section:
Sq. Feet: Est. Value: Book: Page:
Cost: 211,100.00 Total Fees: 2,198.78 Subdivision: CITY OF ZEPHYRHILLS
Amount Paid: 2,198.78 Date Paid: 10/16/2019 Parcel Number: 11-26-21-0010-02100-0170
CONTRACTOR INFORMATION OWNER INFORMATION
Name: BUTTERFIELD INVESTMENTS INC Name: . BUTTERFIELD INVESTMENTS INC
Addr: 31325 AMBER LEA RD Address: 31325 AMBERLEA RD
DADE CITY, FL 33523 DADE CITY, FL 33525-6225
Phone: (813)973-5250 Lic: Phone: 813-973-5250
Work Desc: CONSTRUCT SINGLE FAMILY 2,535 SQ FT
APPLICATION FEES
PLUMBING FEE 165.00 ELECTRICAL FEE 247.50 MECHANICAL FEE 115.50
BUILDING FEE 1,197.00 WATER METER RES 3/4" 473.78
n C/
�i ko
ow
Inspections Required
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.REINSPECTION FEES:
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.
"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 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.
CONTICACThRS KNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Butterfields Investments-5920 12th St.-2,535 sqft
lColumn Es
SQ. FEET PRICE
MAIN OR LIVING: 2,535 $ 112.65
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 211,100.00 Contract Price
FEE SHEET $ 1,100.00
ADDRESS $ 30.00
DRIVEWAY $ 45.00
BUILDING: $ 1,197.00
ELECTRICAL: $ 247.50
PLUMBING: $ 165.00
MECHANICAL: $ 115.50
SUB-TOTAL $ 1,725.00
TOTAL $ 1,725.00
SEWER: $ 09 1.00 c•
WATER: $ 1,0 '00
IRRIGATION: $ -
TOTAL: $ 3,100.00
WATER METER:1 $ 473.78
IRRIGATION METER $ -
FIRE DEPARTMENT FEES
PLANS TOTAL:
INSPECTION TOTAL:
PERMIT TOTAL
TOTAL: $ -
PUBLIC SAFETY IMPACT FEES
POLICE $ 00
FIRE $ R3.005% $TOTAL: $
SUB-TOTAL $ 5,852.13
PARK IMPACT FEES $ 70P,56
SIF'S: $ 7,7a00
100.0% $ 7, 8. 0
1.0% $
TOTAL: $ 7,80528
TIF'S: $ 3, 3 .00
99% $ 3,59 6
1% $ 36.
TOTAL: $ 18,058.97
I
1 _ _
City of Zephyrhills
BUILDING PLAN REVIEW COMMENTS
I
Contractor/Homeowner:
Date Received: �r
{ Site: f off® IA�A 14
Permit Type: o y4Nc fN-A k
r
Approved w/no comments:❑ Approved w/the below comments: Denied w/the below co ents: ❑
1
This comment sheet shall be kept with-the-permit and/or plans.
Kalvin r—Plans Examiner Date Contractor and/ar Homeowner
(Required when comments are present)
11-26-21-0010-02100-0170 1 Pasco County Property Appraiser Page 1 of 1
Parcel ID 11-26-21-0010-02100-0170 (Card: 1 of 1)
Classification 00000-Vacant
Mailing Address Property Value
BUTTERFIELD INVESTMENTS INC Ag Land $0
31325 AMBERLEA RD Land $17,535
DADE CITY, FL 33523-6225 Building $0
Extra Features $0
Physical Address
5920 12TH STREET, Just Value $17,535
ZEPHYRHILLS, FL 33542
Assessed (Non-School Amendment 1) $17,535
Legal Description (First 200
characters)
Non-School Taxable Value $17,535
See Plat for this School District Taxable Value $17,535
Subdivision
CITY OF ZEPHYRHILLS PB 1 PG 54
LOTS 17, 18 & NORTH 1/2 OF LOT
16 BLOCK 21
Jurisdiction
CITY OF ZEPHYRHILLS
Land Detail (Card: 1 of 1)
Line Use Code Description Zoning Units Type Price Condition Value _
�1 0100V 1_132-1 SFR 00112 8,400.00 SF $2.00 1.00 00
2 0100V LP2-2 SFR 00112 2,100.00 SF $0.35 1.00 $735
Additional Land Information_
— Acres Tax A_ _rea _ FEM_A Code-- Res Code Com Code Condo Code
0.24 2-OZC ( - ZHLH I ZHLH ZHLH
Building Information (Card: 1 of 1)
Unimproved Parcel
Extra Features (Card: 1 of 1)
Line Code _Description - _Year_nits Value
No Extra Features
Sales History
Previous Owner: SAFEFUTURES INSURANCE LLC
Month/Year _ Book/Page_ ^iType �- DOR Code o_Condition '!Amount
_ 03/2019 _y� 9883 / 1915- _ 1 Warranty Deed - 01 T Vacant $22,000
10/2017 9624 / 3308 I Tax Deed _ _11 Improved $22,500
04/1999 4133 / 0970 _ Warranty Improved $20,000
06/1998 _ 3996 / 1385 Warranty Deed _ Improved $2.7,500-
03/1989 1796 / 0621- Warranty Deed Improved $0
10/1976 ��-1_ 0859 / 1166 --� i � Improved $0
http://search.pascopa.com/parcel.aspx?parcel=2126110010021000170 10/15/2019
813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department
Date Received
rrrrrrrr........ Phone Contact for Permitting ?-)3
.LL rrTrrrrrrrrTTrrrr= .......... ...............
Owner's Name Owner Phone Number
Owner's Address[_91s2,s" ApnigeJea Rd Owner Phone Number
3;512 Owner Phone Number
JOB ADDRESS LOT#
SUBDIVISION PARCEL 0#111-26-21-0,0/0-02100-0170
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR R ADD/ALT SIGN DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR COMM OTHER
TYPE OF CONSTRUCTION BLOCK 0 FRAME STEEL
DESCRIPTION OF WORK _. SO FOOTAGE[Zj�E HEIGHT
BUILDING SIZE F_2'9� x �7]
=BUILDING VALUATION OF TOTAL CONSTRUCTION Lof
VA
F ELECTRICAL IJII
E$ )A SERVICE E21 DUKE ENERGY W.R.E.C.
2,C1 CJ C) I
=PLUMBING
1$
=MECHANICAL VALUATION OF MECHANICAL INSTALLATION
=GAS ROOFING F__1 SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES QN
BUILDER COMPANY (3ct-te, �^ d kVtj7,� C`7*f) ,, OIL-
SIGNATURE V_ REGISTERED I(Y4 N FEE CURREN L)L/N
Address 3i_524
License# Fcqc/v fw_s-
ELECTRICIAN COMPANY
SIGNATURE REGISTERED Y/_N FEE CURREN
Address
IK ��_A License# 1 F-C-L90og
PLUMBER COMPANY
SIGNATURE REGISTERED FEE CURREN /N
Address License#
ZJ
MECHANICAL COMPANY
SIGNATURE REGISTERED Y N FEE CURREN L_y LN_J
Address License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN LYLN_J
Address License# I
!HHHH I I I I I I I a I I I M I I f HHHHHHHH+
RESIDENTIAL Attach(2)Plot Plans;(2)sets of'Building Plans;(1)set of Energy Forms',R-O-W Permit for new construction,
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans w/Silt Fence installed,
Sanitary Facilities&1 dumpster,Site Work Permit for subdivisions/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 new construction.
Minimum ten(10)working days after submittal date. Required onsite,Construction Plans,Stormwater Plans wl Silt Fence installed,
Sanitary Facilities&1 dumpster.Site Work Permit for all new projects.All commercial requirements must meet compliance
SIGN PERMIT Attach(2)sets of Engineered Plans.
****PROPERTY SURVEY required for all NEW construction.
Ill 1;ml
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (A/C upgrades over$7500)
Agent(for the contractor)or Power of Attorney(for the owner)would be someone with notarized letter from owner authorizing same
OVER THE COUNTER PERMITTING (copy of contract required)
Reroofsifshingleg'- Sewors-- Upgrades A/C., Fences(Plot/Survey/Footage)
Driveways-Not over Co6hterif6n,,pubIi6 roadways.".neieds 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 compliance with any
applicable 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. If the
contractor is not licensed as required by law, both the owner and contractor may be cited for a misdemeanor 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 contractor(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 89-07 and
90-07, as amended. The undersigned also understands, that such fees, as may be due, will be identified at the time of
permitting. It is further understood that Transportation Impact Fees and Resource Recovery Fees must be paid prior to
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 $2,500.00 or more, I
certify that I, the applicant, have beer":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: I certify that all the information in this application is accurate and that all work
will be done in compliance with all applicable laws regulating construction, zoning and land development. Application is
hereby made to obtain a permit to do work.and installation as indicated. I certify than 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 I must take to be in compliance. Such agencies include but are not limited to:
- Department of Environmental Protection-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands,Water/Wastewater Treatment.
- Southwest Florida Water Management District-Wells, Cypress Bayheads; .Wetland 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 Agency-Asbestos abatement.
- Federal Aviation Authority-Runways.
I understand-that the following 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 are elevated by fill, an 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
set aside any provisions of 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 FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH-Y-OUR_LENDER_OR_AN_ATTORNEY_BEFORE-RECORDING YOUR-NOTICE-OF COMMENCEMENT—
FLORIDA JURAT(F.S. 117.03)
OWNER OR AGENT CONTRACTO
Subscribed and sworn to(or affirmed)before me this Sub crib and sworn t or affl Q�e efore is
by 12,4e
Who is/are personally known-to me or has/have produced VVh I / re personally kn ^to me or has/have produced
as identification. as identification.
Notary Public Notary Public
Commission No. Commission No.
Name of Notary typed,printed or stamped Name of Notary typed RnLPOdS_M_A L_D_O N_A_D O
mmission#GG 346 27
_5
Expires June 18,2023
Bonded
Thru Tray Fain insurance 800-385-7019
D
Q
i
Single Family Dwelling
Plan Review Comments
1. F.F.E. shall be a minimum of 8" above the road elevation and an engineered site plan.
2. Lots shall be graded to comply with R401.3 of the F.B.C.
3. Compaction test required if 24" or more of fill dirt is brought in at any one place.
4. Tie in survey required before pouring concrete.
5. Driveways require a R.O.W. use permit. All 4 sides of driveway thru the sidewalk shall have
expansion material.
6. All setbacks shall be met.
7. All property markers shall be uncovered and marked at time of first inspection.
8. All A.D.A. requirements shall be met.
9. No electric,plumbing,mechanical, or framing shall be covered without an inspection and
approval first.
10. All Garages shall comply with section R302.6 of the F.B.C. (Fire Separation).
I L Appliances shall not be installed in a location where subject to mechanical damage unless
protected by approved barriers. M303.4 of the F.B.0
12. Water heaters shall comply with section P607.3 of the F.B.C.
13. Foundation supports for A/C units shall be raised_ at least 3" above finished grade. M1308.1
14. Return air in all bedrooms. F.B.C. M1620.4
15. Smoke detectors are to be installed in accordance with R313.1 of the F.B.C.
16. All glazing requirements are to be in accordance with R308.4 of the F.B.C.
17. All means of egress are to be in accordance with R311 of the F.B.C.
18. "Green gypsum board" shall not be used as a backer in showers or tubs. R702.4.2 F.B.C.
19. Combination-type AFCI breakers are required at all locations requiring an AFCI type breaker.
20. Carbon monoxide alarms will be required in new construction that uses fossil-burning heating
or appliances or an attached garage. They shall be installed in accordance with the F.B.C:
21. All plumbing,mechanical, and electrical shall be separate from unit to unit. This includes all
underground plumbing and electric.
21 All 2016 N.E.C. Codes will be enforced.
23.•Tamper- Resistant Receptacles in accordance with 406.11 of the 2016 N.E.0
24. In accordance with the Land Development Code, lots shall be sodded before final at least 10
feet around the structure.
25. R403.5.3Hot water pipe insulation
_Insulation for hot water pipe with a minimum thermal resistance (R-value) of R-3 shall be applied to the
following:
Piping V. inch (1.9.1 mm) and larger in nominal diameter.
Piping serving more than one dwelling unit.
Piping located outside the conditioned space:
Piping from the water heater to a distribution manifold.
Piping located under a floor slab.
Buried in piping,
Supply and return piping in recirculation systems other than demand recirculation systems.
25. Blower door test shall be provided before C.O.
26. A copy of the enerzy cacls shall be with permit at all times
27. Copy oflinal insulation report shall be provided with permit before LinaL
28. No fence, pool or screen enclosure is issued with.this permit
F.F.E.-Finished Floor Elevation
F.B.C- Florida Building Code 6d Edition
R.O.W.-Right of Way
A.D.A.-Americans with Disabilities Act N.E.C.-National Electric Code (2016)
Permit No. Parcel ID No ll��(D-Z� D6I()-p216o 170
_ 1 NOTICE OF COMMENCEMENT
State of `/CI County of f�lQS G d
THE UNDERSIGNED hereby gives notice that improvement will be made to certain real property,and in accordance with Chapter 713,Florida Statutes,
the following information is provided in this Notice of Commencement:
1. Description of Property: Parcel Identification No. -2(O-2�) -Cy-)/O -02/00- D 1-7 U
Street Address: S9 2 6 /2 fh Z e P Pil l /b,/)r,/- L 9 3 5 y 2-
2. General Description of Improvement cSJ' �Ltfv)/��/ h %tee hcW Con j fiu e-f,b,j
3. O,wwnner Information or essee information if the Lessee contracted for the Improvement:
3J�ZS /IMebc//�� 9 G! Dade- t� 33S2-3 PL
Address City State
Interest in Property:03 vn e.--
Name of Fee Simple Titleholder:
(If different from Owner listed above)
Cam(
Address
4. Contractor: 0,4-t G-7C/ �� 1'M C o .J /il J -1� ity
J ��C n $tat
L• /e✓� /���fc�%/ 7
/32S Nam!'ll�be�/Cc2 �G IDock G .33523
ICL-
Tddress 2/ /G/9 S City State
Contractor's Telephone No.: 7 J
5. Surety:
Name
Address City State
Amount of Bond: $ Telephone No.:
6. Lender:
Name
Address City State
Lender's Telephone No.:
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:
Name
Address City State
Telephone Number of Designated Person:
8. In addition to himself,the owner designates of
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.
Telephone Number of Person or Entity Designated by Owner:
9. Expiration date of Notice of Commencement(the expiration date may not be before the completion of construction and final payment to the
contractor,but will be one year from the date of recording unless a different date is specified):
WARNING TO OWNER: ANY PAYMENTS MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED IMPROPER PAYMENTS UNDER CHAPTER 713, PART 1, SECTION 713.13, FLORIDA STATUTES, AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. A NOTICE OF COMMENCEMENT MUST BE
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TO OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR`A�QTWORX5X),3E'ORE COMMENCING WORK OR RECORDING YOUR NOTICE OF COMMENCEMENT.
Under penalty of pequr ?1 rA thM.Q.*1 �&)the foregoing notice of commencement and that the facts stated therein are true to the best
of my knowledge and ...
q� '
STATE OF FLORIDA �' y
COUNTY OF PASCO ' v' My Cornm.Expires
June 10,2022 Signature of OwnergXessee,or Owner's or Lessee's Authorized
No.GG 226691 - Officer/Director/Partner/Manager
ch''• A i' Q%--cG f ✓
%,�,9' VBL�G �O�. SignatorysTitle/Office _�_�. .....n..........0 /� -��� \n` �J+
The foregoing instrument was acknoGfl@ c��efbr Q 26'day of I i�� 206 by \ ti 1—e�C- �� 1 ��I v"
as r ��\' (type of authority,e.g.,officer,trustee,attorney in fact)for
h (name of party on behalf f whom instrument was executed).
Personally Kno�n�/�OR Produced Identifrcetion(� Notary Signature
Type of Identification Produced �� i Name(Print) `n v
INSTR## 201 144118 BK PG d ��
08/26/2019 10:51am Page 1 Of11
Rept: 2084498 0.00
0.00
DS: 0.00 IT:
wpdata/bcs/noticecommencement_pc053048 Nikki A 1 varez-SOw 1 eS, ESC�-
PaSCO County Clerk & Comptroller
r ERMIT APPLICATION
DRIVEI WAY PERMIT APPLICATION
CONSTRUCTION WITHIN PUBLIC.RIGHT-OF-WAY
All information 1ga be filled-in Completely
City of Zephyrhills
5335 a Street,Zephyrhills, FL 33542-
f Telephone 813.780.0000 Fax 813.780.0005
.:r.,
Date of application ,' �, *P�aress�ed��.ty„�• � .x Perrnit# � ,�=-. ��. �°,:�:"��c��a
'�1Co�y,to ilclmgDep (#meet' 1; CIGQP 14 Publ► Y}torlss ,a
PRO3ECT/3013 SITE: P OPERTY OWNER
Addressi -517 Z h S '= e. Name: �f . n tre n-►�.�{� .
Unit.#: Address'312 r,�",/ea.J Unit:
Parcel Identification Number: - CiN,State Zip D7 de Gi FL 2 -
Z fe_=2-1- d p'l d =P 21 O o 0 V7 0 Phone2/_?�,9�7g�2:,S o FcW-
CONTRACTOK:
Company: Add
.Namur' ei
Contractor's License #: C 'L E-Mail: J, oj,7
Phone: Cell: 13 72.4o.S- Fax:
ARCHITECT/ENGINEER:
Name: Firm Name:
Address: City: Stater Zip:
State License #: Phone: Cell:- Fax:
Description of ProiecE
TTY-PE&F DRIVEWAY LENGTH OF DRIVEWAY CULVERTg NEEDED
je! RESIDENTIAL DRIVEWAY 7 _WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE
COMMERCIAL DRIVEWAY. 1t.04 f'. EXCAVATION ( )CORRUGATED MATERIAL
PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEEL ( }BOX CULVERT
CONSTRUCTION MATERIAL CURB CUT RE_�c U11 ECG ( )OTHER(EXPLAIN) -
SPHALT YES ti� NO
CONCRETE /^
HEADWALL REQUIRED? YES y NO
I•
NOTICE TO APPLICANT: If actual work exceeds scope of this descrip#i�n,additional permits or drawing's
h will1 be required.
UTILITY LOCATIONS REQUIRED CALL BEFORE YOU DIG: 16800.432.4770
Page 1 of S
t
750. (C)
S. WOW" . - 74.89 (q)
15.3220
312
14
Ch
19.3
cr-
17
�► � �1�4-rCK �ctST1NC
� � S�►�cWrt�F2
� N
o •�
s
�� � �` � ��• 0 ►tee
Yy
Ci.2C�ce 'D2i11 �SrPp.2o-\(�_ DuE Tb
�.
LoC'Art LofJ Oki lZ__ _.S.77?4�ET .Koz',tiio2wtAkL(--( hPPRn �,
Lot 19
FIR. 5/8" with S.I.R.—\( w
!p Cap -B6945" .z
:w•` ,,, Col
OD
\ w Set Stake
MakeC \ na
F ..
18
~ • ` 3#.8' 47.3' 2e.0' " Cn
8`0 SO Stake t
proposed t Story Mosonry sa►.7°
�Y •a
y T 17 Residence -b,
. oa10.01 bo
#5920 Twelfth Street o co,
" N 31 88:3 20.0 S
N �✓
� -N—Set
Set Stake `•c N. II O T 1 '1 Stake
w ..
-- 140.a (R) . �. S. 7z o2 4 W 139.83 (M)
S 112 Lot 16
z Ga
x rz F.I.R. 5/8" with F.I.R. 5/8" with
- c ; to Cop ' ti945" rp Cop U059"
Wd.F. 1.4" W, 1.2- S . MY. 0.3= S & W
Lot 15
t. CA
.� Q (� 5
PERMIT APPLICATION
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVI.DE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS
APPLICATION.
-715
1Z-> SLR( G aAL V,J& G�iAe
C,,� 12�t� an �Y}�L.
ac0.-ted oil (o,r^et--
2 S- fe e+
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/public—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
1statement. please initial)
2-Ca
Applicht Print Name Appficant—Signat qV Date f
i Permit Technician Signature (or)Notary Signature Date
Applicant is( )personally known to me or produced as identification.
(type of identification)
Page 2 of 3
l
PERMIT APPLICATION
OFFICE USE ONLY
'PUBLIC:WORKS,USE.ONLY
Concrete (min. 6') Y N
Asphalt Base(min. 6'� Y N
Asphalt(min. 11/2') 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(3'W x 71) Y N
Visibility triangle o.k.? Y N
Side set back(3'min. R.O.W.) Y N
Plan Review Fee
Additional'descri tion.of work-as defneelb" :Public Works:Director and;or deli nee:
Permit application approved by: Date:
Page 3 of 3