HomeMy WebLinkAbout20-112 :PERMI1rAPP13CA170N �
I RrVEWAYPIERMIT.AP PLICA'�ON
CONSTRUCU. ON WITHIN.PUBLIC RIGHT OF-WAY .
fail lnfarmatioh must-be=filled-1n completely
City.ofZephyrhiNs
a335:8�`Street,�ephy�lils,'F133542
Telephone B13.780.0000 Fax 813 780.0005
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:PRf3�E:CF 9CB;ylC 'PROPERTY OVDIER
Address: Name: -rhiS-T(e-dc.-A-jju MriJ7s !,C
-Unit*: Address: =Q Goa c,&J ,-,v-f }}LtUirit
Parcel Identifiration*Number: Ci Stbte Ta• zc F�rs'�'�lu
o l'�a Phone:?6;.-.L;sg- f r,r'ci Fax
-CONMC.TOR:
Company: 'C.bby _inn: --t-toC.
Name: f ;=1:> ;
Contractor's License#: .r>cG 4 772-�5 E-Mail;
-Phone: r?J�ri,-o525 Cell:' Fax:
ARCMEc&JENGINEE1R:
Name' Firm Marne•
Address: City State` Zip:
State Ucense#: Phone:. Cell: Fax: '
De_scri[Lbon of Project
TYPE OF®MEWAY y� LENG H Or DRIVEWAY CULVERI`S'HEEDED
/ RESIDENTIAL DRIVEWAY ' t r WIDTH OF DRN6WAY { )REIMRCED CONDE
COMMERCIAL DRIVEWAY ifT C W, EXCAVATION ( )CORRUGATED MA1'EMAL
PUBLIC ACCESS DRIVEWAY �/ Dff" LINEAR FEET ( )BOX CULVE-P'T
( }OTHER(WLAIN)
COMS8'RUCTION mATERrAL. . CURB CUT REQUIRED ,
,ASPMALT YES NO
�_ CONCRETE
,H-E&D—WALL REOUM YES —L/ NO
NOTICE T•O APPLTC#INT; If actual Work exceeds scope of this description,additional permits or drawings
well be requlired.,
UTTLTrt LOCATjdNS RE40UIRED: CALL BEFORE YOU DIG:1.80DA32.4770
Page I, of 3
PERMIT APPLICATION
UTILITIES LOCATE CONFIRMATION NUMBER:
PROVIDE.SKETCH IN THIS AREA,IF ADDITIONAL SPACE tS REQUIRED, ATTACH.TO THIS
APPLICATION,
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AFFIDAVIT: Application is hereby made to obtain a permit to.do work and.Installations as indicat.ed. -I certify thatall foregoing
Information Is accUrate and that all work will comply:with"all applicable codes. I understand these codes shalt take preoedenod over all"
approved constriction documents,;and Issuance of this permit Is verification 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 deed
restricfions may apply to this property.
All work shall comply with the current Florida Building Code,Public Works Design Manual and FQOT Design
Standards(if applicable). (Public Works Design Manual online link www.cl,zephyrhllls.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 aephyrhills Ts not.hesponsible for'mairrbenance or re
paits of driveways. Driveways shall not alter I
Interfere with existing stormwater treatrnent and I or conveyance.
PROPERTY OWNERS: By signing this application: I oerlify that I have read and understand the owner/builder disclosure
statemerit (please Initial) r
Applicant Print Name Applicant Sign at re Date
Permit Technician Signature (or)Notary Signature Date
Applicant is( )personally known to me or produced as identification.
(type of identification)
Page 2 of 3
-• ���ff��++ppap /� ®fir/+ .p�/�
rGRMIT- APPUCA.TION
OFFICE USE ONLY
t {.. C Y B
Ccincrete. (min:6'� Y N
Asphalt Base(min.6') : Y N.. ,
Asphaft(mina Ilk") Y N
Length(min:19) Y - -N -
Width(10'min.-2W max) Y _. :.N:
Existing sidewalk:. Y
New sidewalk:. Y nN
ADA compliant. Y_ N:
Expansion material required. Y:- 'N
Contlguous parking pad. Y N:
Triangular-flare(3W X,710. Y. fist
Visibility triangle o.k:? Y - N
Side set back(Y min:R.M.) Y N
Ptan Review Fee
_ ddifional c esi c=a to n:aid_t
Permitapplimtion.appmved by: Date:.'
page 3 of 3
!AmiabTOP WORK e tdo
By Order of the Building Official: WirramA. (Burgess � v
All Building, plumbing, electrical and mechanical wor _ .,, 'd
shall cease at the below mentioned property.
Address: 6 9 S i
Y 1 IIwwY-I�w.wYl®-�IIYYY®B
Date: ).0 2—a C.
i Y wY w
Code Enforcement Officer: GA Co l�
Contact the
Zephyrhills wilding Department
5335 - 8th Street
813-780-0020