HomeMy WebLinkAbout19-21313 CITY OF ZEPHYRHILLS
5335-8TH STREET
(813)780-0020 21313
BUILDING PERMIT SINGLE FAMILY RESIDENTIAL
PERMIT INFORMATION LOCATION INFORMATION
Permit#:21313 Issued: 6/17/2019 Address: 5644 CYPRESS 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: 253,349.85 Total Fees: 2,438.78 Subdivision: YINGLING ADDITION
Amount Paid: 2,438.78 Date Paid: 6/17/2019 Parcel Number: 12-26-21-006B-00000-0220
CONTRACTOR INFORMATION OWNER INFORMATION
Name: CUSTOM HOMES LLC Name: PREMIER HOUSING INVESTMENTS LLC
Addr: 6084 IDLE AWHILE CIRCLE Address: PO BOX 566
RIDGE MANOR, FL. 33523 ZEPHYRHILLS FL 33539-0566
Phone: (813)713-2800 Lic: Phone: 813-778-1840
Work Desc: CONSTRUCT SINGLE FAMILY 2,249 SQ FT
APPLICATION FEES "
PLUMBING FEE 196.50 ELECTRICAL FEE 294.75 MECHANICAL FEE 137.55
BUILDING FEE 1,336.20 WATER METER RES 3/4" 473.78
� - 31- Zv
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.
CONTRACTORS SIGNATURE PERMIT OFFI
PERMIT EXPIRES IN 6 MONTHS WITHOUT APPROVED INSPECTIO
CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED
PROTECT CARD FROM WEATHER
Jacqueline Boges
From: City of Zephyrhills Support <support@zephyrhillsfl.zendesk.com>
Sent: Monday,June 17, 2019 2:51 PM
To: Jacqueline Boges
Subject: [Request received] 5644 Cypress St by#21313
EXTERNAL EMAIL
##- Please type your reply above this line -##
Hello Jacqueline Boges,
We are working to resolve your request promptly and will keep you updated. One of our Support Analysts will keep
you updated on the progress of your request.
Best Regards,
FATHOM Support Team
TO ADD ADDITIONAL COMMENTS, reply to this email or click the link below:
https://zephyrhilisfl.zendesk.com/hc/requests/279645
...................................................................................................................................................................................................................................................................................................................................................................................
Jacqueline Boges
--�-' Jun 17, 1 1 :50 AM MST
by#2131 3 5644 cypress st service
This email is a service from City of Zephyrhills Support .
1
INSTR#2019091222 OR BK 9914 Pt;316 Page 1 of 1
05/30/2019 01:52 PM Rcpt:2059071 Rec: 10.00 DS:0.00 IT:0.00
PauCa S. O'NeiC Ph.D., Pasco County CCerk&ComptroMer
Pemuit No. Parcel ID No /1—.9 100 —,�9000c,`C)220
NOTICE OF COMMENCEMENT �
state of �C/rl�f Q CauNy of �Q'S( '115)
THE UNDERSIGNED hereby gives nolica that improvement will be made to certain reel property,and in eorwrdanw with Chspwr713,FWWa Statutes,
the fotovdng Intomwton ta provided in this Notice of
1. Dosaiptlon of Property: Parcel Identification N 0%% �6--2/—ODO/> tJGY�c7—0220
Sh t Address: Z C SS
2. General Description of lmarouamant its CW / �/!7
3. Owrer Infom+aticm or Lessee 4dormalion It the Lesseo contracted forthe improvement
N� - ,s /dam
®9
Address dy slate ®�
Interest in Property: av✓..r✓Pf'
Name of Fee Simple Titleholder: @ %)
(ff different from Owner listed above)Addrm
a. Contractor.C r LG cityr, '`
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CaU daps Tewptulm No.: o
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Address City State ® rn LU E U
Amount of Bond: Teiapta a No.: Z LL-
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Address Chy stal0 Q Of 2 z J
Lender's Tobplame No.: I}— O U U
7. Persons wdlliln die-State of Florida designated by the owwer upon whom notices or otter documents maybe served as Wundded by Z 2 O OU 05
Section 713A3(1xa)(7),Fbnida Statutes. =DLL
H IL W O Y
Name C.) = U z UJ
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Addrass Cory. slate iR r"-- � a z O
Telephone Number of Designated Person: 0 0C Of _, ¢ W
6. In addition to h4nseff,the owner designates of^� V OU O
to receive a copy of the Lienor's Notice as provided in Section 713.13(1)(b),Florida Statutes.LL O0 Z O � U
r Telephone Number of Person or Enfty Designated by Owner; W rn w Lu'wQ g
9. Expiration date of Notice of conata,tcernent(ilia eV gaft date may not be befma the cDMP abort of CmWt"m and imal payment to the F 2 R Z j Q }
contractor,but will be am year Nam the data of recording tmtass a different data is spwAad): U3 1— F-- O � i� m
WARNING TO OWNER: ANY PAYmr-NTs MADE BY THE OWNER AFTER THE EXPIRATION OF THE NOTICE OF COMMENCEMENT
ARE CONSIDERED.IMPROPER PAYMENTS UNDER CHAFTER 713, RTY
PART 1 BECTICIN 713.13 FLORIDA STATUTES AND CAN
RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPt . A NOTICE OF COMMENCEMEN)' MUST III-
RECORDED AND POSTED ON THE JOB SITE BEFORE THE FIRST INSPECTION. IF YOU INTEND TD OBTAIN FINANCING,CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE COMMENCING WORK OR RECORD YOUR NOTICE OF COMMENCEMENT.
Under penalty of I declare Ural I have read the foregoing notice of arW that the facts staled therein are true to the best
r.
of my knowledge Deiiat ••`�•' I
STATE OF FLORIDA 1F r9-
COUNTY OF PASCO
Irue Owner or Lessee,or Owner's or Lessea's AWw dM
of
Of ml0iroctodPadnedMenager
signatory s Tile( 1 1 Q Ji C� a
The foregoing imstrun"vas acknowledged before me this 20 by A C t( r-r rn ru%r Z
/I�LY1�Y�/L7 (bps ofcrily.e.g.,at=,trustee,allorney In fad)for
c O
Personally Know0 La Produced IdantiLcal� Notary signature � Q �a
Type of Identification Produced L Name(Print)
a
Ij
/ 813-780-0020 City of Zephyrhills Permit Application Fax-813-780-0021
Building Department ¢/
Date Received Phone Contact for Permitting U/ �+— o
Owner's Name & r L v ,r/S Owner Phone Number O 2/ ?M 0
Owner's Address �. /✓G'�S Zr r J 3� Owner Phone Number
Fee Simple Titleholder Name Owner Phone Number
Fee Simple Titleholder Address
JOB ADDRESS /V f ASS -s� LOT#
SUBDIVISION F PARCEL I D# ODa -OU�C Z) 022-0
(OBTAINED FROM PROPERTY TAX NOTICE)
WORK PROPOSED NEW CONSTR e ADD/ALT = SIGN = = DEMOLISH
INSTALL REPAIR
PROPOSED USE SFR Q COMM 0 OTHER
TYPE OF CONSTRUCTION — BLOCKS 0 FRAME = STEEL
DESCRIPTION OF WORK ��Gf/ �f�� d✓►i 1 1 5
BUILDING SIZE 7 y7� SQ FOOTAGE HEIGHT
=BUILDING $ /�� VALUATION OF TOTAL CONSTRUCTION
=ELECTRICAL $ 6 15- AMP SERVICE PROGRESS ENERGY 0 W.R.E.C.
=PLUMBING va
=MECHANICAL Is
i VALUATION OF MECHANICAL INSTALLATION O /
=GAS = ROOFING 0 SPECIALTY = OTHER
FINISHED FLOOR ELEVATIONS FLOOD ZONE AREA =YES NO
BUILDER / COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN Y/N
Address �/2,d C C/L�� �t? /!?Gvf License# I r
335�3 / s�
ELECTRICIAN �r� �Cy COMPANY J/v L//l/e L 1 G �/
SIGNATURE �/ (/ REGISTERED Y/ N FEE CURREN
Address ll�VA 5oST�a rC icense
Z L
PLUMBER GA�� COMPANY
SIGNATURE --� REGISTERED Y/ N FEE CURREN Y/JN
Address ) W e T Je ✓SONS r L License# C�1 FC
MECHANICAL COMPANY Soy— C+^r1 Cdr4, �/► L�G
SIGNATURE q REGISTERED Y/ N FEE CURREN Y/N
Address Yt'O( tr Z 6SG cdebJ 4,_ License#
OTHER COMPANY
SIGNATURE REGISTERED Y/ N FEE CURREN
Address I License#
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 w/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.
Directions:
Fill out application completely.
Owner&Contractor sign back of application,notarized
If over$2500,a Notice of Commencement is required. (AIC 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)
Reroofs if shingles Sewers Service Upgrades A/C Fences(Plot/Survey/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"de4d" restrictions"
which may be more restrictive than County'regulations. The undersigned assumes responsibility for compliance with any
applicable deed restrictions. i
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 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: 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 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 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 areeleVated 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
nditions set forth in
i 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, after, 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'i§suanciail 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
PAYINa-TWICE-FOR-IMPRO-VEMENTS-TO-YOUR-PROPERT--Y--IF—Y-OU-INTEND TO-OBTAIN FINANCING,CONSULT--
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT.
FLORIDA JURAT(F.S.117.03)
OWNER OR AGENT CONTRACTGO�
Subscribed and sworn to(or affirmed)before me this Subscribed and sworn✓to or affirm d fo me this
by by -�*101 -
Who Is/are personally known to me or has/have produced Who is/are personally known to me or his/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,printed or stamped
D
s
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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.M. 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).
11. 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.AX units shall be raised at least 3" above finished grade. M1308.1
14. Return_air in all bedrooms. F.B.C. M162.0.4
1.5. 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 RB.C:
17. All means of egress are to be in accordance with R31 I of the F.B.C.
-l8. ``Green gypsum board" shall not be used as a backer in showers or tubs. R702.4.2 F.B.C.
19. Combination-type AM 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.
22. All 2016 M.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 Withh-a minimum thermal resistance (R-value) of R-3 shall be applied to the
following:
Piping 31,inch (19.1 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 cove of the-energy cacls-shall be with wermit at all limes
27. Coou of final insulation report shall-be or6vided with permit-before rnaL
28. No fence,pool or screen enclosure -is issued with:this permit.
F.F.E.-Finished Floor Elevation
F.B.C-Florida Building Code 6 h Edition
R.O.W.-Right of Way
A.D.A.-Americans with Disabilities Act N.E.C.-National Electric Code (2016)
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6 7'sol , 9
Custom Homes-5644 Cypress St-2,249 sq ft
Column Es
SQ. FEET PRICE
MAIN OR LIVING: 2,249 $ 112.65
OTHER AREA UNDER ROOF: - $ 88.00
OTHER: - $ -
VALUATION $ 253,349.85
FEE SHEET $ 1,310.00
ADDRESS
DRIVEWAY
BUILDING: $ 1,336.20
ELECTRICAL: $ 294.75
PLUMBING: $ 196.50
MECHANICAL: $ 137.55
SUB-TOTAL $ 1,965.00
TOTAL $ 1,965.00
SEWER: na
WATER: na
IRRIGATION: $ -
TOTAL: $ -
WATER METER:1 $ 473.78
IRRIGATION METER $ -
FIRE DEPARTMENT FEES
PLANS TOTAL:
INSPECTION TOTAL:
PERMIT TOTAL
TOTAL: $ -
PUBLIC SAFETY IMPACT FEES
POLICE
FIRE
5% $ -
TOTAL: $ - na
SUB-TOTAL. $ 2,438.78
'PARK IMPACT FEESI na
SIF'S:
100.0% $ -
1.0% $ -
TOTAL: $ - na
TIF'S: na
99% $ -
1% $ -
TOTAL: $ 2,438.78
SUB-CONTRACTOR AFFIDAVIT
DATE: r
TO VMOM IT MAY CONCERN:
L Thomas Lachance d/b/a Southern Comfort Eat.Inc.
License Number: CAC1813579 will be the Mechanical
contractor for this permit application.
The job address is:Prem`r SGy�C✓nfeti5 ,5� 1, ��3 �'G 3 33
e of Ljo&m Holder or Authorized Agent
STATE OF: FL RI)A
COUNTY OF: SU MR.
I HEREBY"CERTIFY that the foregog instrument was acknowledged before me this
day of rr i .20 it by .Thomas Lachance who is personally known to
me..
S' o€No &
Print,Type,or Stamp of Notuy
! wi""'•�� DARLENE FORD
# MY COMMISSION#GG094359
� ••;3rq„�' EXPIRES August 07,2021
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?ERMIT APPLICATION " C'
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DRIVEWAY PIERMIT APPLICATION.
CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY
f All information must be filled-in completely
f City of Zephyrhills
5335 8th Street, Zephyrhiils, FL 335,42
Telephone 813.780.0000 Fax 813.780.0005.
pafe of.application:! r , %` Processed B:ye: i., D Permit,;#: ;
(graya(044Gstafr�us' n(y)-
' >Copy,toBuiltlfng�Departmenfi'',.'.-, ,'_..:=..`.:'_• - ' �opyao;PublicVlfoiks . '
PROJECT 70B SITE: PROPERTY OWNER
Address:.-- : `/Y l . ss' )T Name: -
Unit#: Address: ,?.4i;x Unit:
Parcel Identification Number:/ - 4-Zf-o0 6 e-- City, State, fc
moo 00 -cy za Phone:`r,-�. Fax:
CONTRACTOR:
Company: yrcs 4 C
Name:
Contractor's License-#: 6"/9C 0 E-Mail:
Phone: Cell,J1' 3 i/77 GYM Fax:
ARCHITECT/ENGINEER:
Name:/-n/c/Od �'►'� �w .�G" Firm Name: -r;q-,,C
Address:3%y �7 S State: Zip:
State License Phone:3Jz- Cell- Fax:
Description of Project
TYPE OF DRIVEWAY `��� LENGTH OF DRIVEWAY CULVERTS NEEDED
PRESIDENTIAL DRIVEWAY ZIL'WIDTH OF DRIVEWAY ( )REINFORCED.CONCRETE
COMMERCIAL DRIVEWAY R:O.W. -EXCAVATION ( )CORRUGATED MATERIAL
PUBLIC ACCESS DRIVEWAY l" DEPTH -0/ LINEAR FEET ( )BOX.CULVERT
( )OTHER(EXPLAIN)
CONSTRUCTION MATERIAL CURB CUT REQUIRE e
- ASPHALT YES NO
_CONCRETE
HEADWALL REQUIRED? YES -NO
NOTICE TO APPLICANT: If actual woric exceeds scope of this description,additional permits or drawings
Will be required.
UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
,f
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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 applkable cosies. I understand these codes shall take precedence over all
approved construction documents,and issuance of this permit Is verlficatlon that I will notify the property owner of Florida Uen Law
req.,F.S.713.
The Issuance of this permit does not ensure compliance with deed restrictions and I understand that additional need
restrictions may apply to this property.
All work shall comply with the currant Florida Building Code,Public Works Design Manual and FDOT Design
Standards(ff applicable). (Public Works Design Manual online link:www.ci.zephyrhills fl.us/public_works.asp)
APPLICATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WIf MESSED BY A PERMIT
TECHNICIAN OR NOTARY PUBLIC,
NOTE: The City of Zephyrhilis Is not responsible for maintenance or repairs of driveways. Driveways shall not alter)
Interfere with existing stormuntlw treatment and I or conveyance.
PROPERTY OWNERS: i3y signing this application: I certify that I have read and understand the owner/builder disdosure
statement._ x ,11��(please initial)
Applicant Print Name Appiicant Signature Date
Permit Technician Signature (or)Notary Signature Data
Appiicant is( )personally known to me or produusat! of( as Identification.
Identification)
Page 2 of 3
P,ERMIY APPLICATION
OFFICE USE ONLY
_ PUBLIC.:WORKS.:USE
Concrete. (min. 6D- Y, _ . N. 46a,;{ is K, w.CTu �u RiGHT o� W.
Asphalt Base(min. 6") Y N
.Asphalt(min. 11/2'1 Y N . . .
Length (min. AD 1' N
Width(10'min-20'max) Y N lC5 ` .
Existing sidewalk.. Y
New.sidewalk.. Y. >:
ADA compliant. Y N ►�
Expansion material required. Y N Z of Viky ;O
Contiguous arkin
P 9 Pad. Y
Triangular flare(3'W x 71) N -1&6'TL( StDE:S
Visibility triangle o.V. Y) N.
u
Side set back(3'min..R:O.W.) Y N
Plan Review Fee
Additional..descri tion of-irvork as defined b' Publie WorKs Directoe,and;or desi nee:
Permit application approved by: . --� . . Date: _.�Li
Page 3 of 3
CITY OF " NOTICE / / BUILDING
ZEPHYRHILL3 DEPARTMENT
OF ADDITION OR CORRECTION
D • OT REMOVE
ADDRESS DATE PERMIT#
THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before the job
will be accepted.
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It is unlawful for any Carpenter,Contractor,Builder,or other persons,to AFTER CORRECTIONS ARE MADE CALL
cover or cause to be covered,any part of the work with flooring,lath,earth 780_�Q FOR RE-INSPECTION
or other material,until the proper inspector has had ample time to approve
the installation.
OFFICE HOURS 7:30AM-4:30 PM MON.-FRI. INSPECTOR
CITY OF / / / / BUILDING
ZEPHYRHILLSNOTICE
DEPARTMENT
OF ADDITION OR CORRECTION
DO ,-'NOT REMOVE
ADDRESS DATE PERMIT
TH (es t — Zf31
THIS JOB HAS NOT BEEN COMPLETED. The following additions or corrections shall be made before the job
will be accepted.
16h&d±( Las
It is unlawful for any Carpenter,Contractor,Builder,or other persons,to AFTER CORRECTIONS ARE MADE CALL
cover or cause to be covered,any part of the work with flooring,lath,earth n20 FO R -I E?CTION
or other material,until the proper inspector has had ample time to approve 780-0
the installation.
OFFICE HOURS 7:30AM-4:30 PM MON.-FRI. INSPECTOR