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Home My WebLink About06-5510 '. CITY OF ZEPHYRHILLS 5335 - 8TH STREET (813)780-0020 BUILDING PERMIT 5510 Permit Number: Permit Type: Class of Work: Proposed Use: Square Feet: Est. Value: Improv. Cost: Date Issued: Total Fees: Amount Paid: Date Paid: Work Desc: 5510 MULTI-FAMILY RESIDENCE 103-NEW CONST DUPLEX 2-UNIT DUPLEX Address: 5840 8TH STREET ZEPHYRHILLS, FL. Township: Range: Book: Lot(s): Block: Section: Subdivision: CITY OF ZEPHYRHILLS Parcel Number: 11-26-21-0010-01400-0190 42,900.00 3/30/2006 3,389.06 3,389.06 3/30/2006 NEW DUPLEX - 820 S Name: RYMAN, KEVIN Address: 5840 8TH STREET ZEPHYRHILLS, FL. 33542 Phone: 813782-0825 A MARTIN ELECTRIC WILLIAMS DENNIS (INDIVIDUAL) BAHR'S PROPANE GAS & AlC, INC. RYMAN CONSTRUCTION OF FLORIDA IN PLUMBING FEE RADON WATER CONNECTION RESIDENTI FIRE PLAN REVIEW FEES POLICE IMPACT FEE PUBLIC SAFETY 5% 98.00 8.20 398.05 33.56 254.00 26.35 MECHANICAL FEE SEWER CONNECTION RESIDENTI WATER METER RES 3/4" FIRE INSPECTION FEES FIRE IMPACT FEE 8 .70 82.00 1,535.20 180.00 7.50 273.00 {fJJ., I ()f~" j HI' c-X / ~J ~:/ I Ye~ / U H L DUCTS INSTALLED CONSTRUCTION POLE 2ND ROUGH PLUMB DUCTS INSULATED PRE-METER WATER SHEATHING MISC SEWER MISC MISC MISC. MISC. MISC. MISC. MISC. DRIVEWAY MISC. MISC. REINSPECTION FEES: Reinspection fees will comply with Florida Statute 553.80 (2)( c) when extra inspection trips are necessary due to anyone of the following reasons: a) wrong address b) condemned work resulting from faulty construction c) repairs or corrections not made when inspections called d) work not ready for inspection when called e) permit not posted on job site f) plans not at job site g) work not accessible. 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." NO OCCUPANCY BEFORE C.O. t?,- ~-~ SIGNATURE PERMIT OFFI CALL FOR INSPECTION - 8 HOUR NOTICE REQUIRED PROTECT CARD FROM WEATHER o MOVE 0 DEMOLISH '~~FAMILY ~ OF UNITS .::J.../ o INDUSTRIAL WORK PROPSED: ~CONSTRUCTION o SIGN o ADDITION PROPOSED USE: 0 SGL FAMILY DWELLING o COMMERCIAL o ALTERATION o REPAIR o INSTALL o MOBILE HOME o OTHER o SWIMMING POOL j)VfJ Jey DESCRIPTION OF WORK 1\ e.. -cu BUILDING SIZE ~Xl, c.fJ l? ~ c=J RESTAURANT & HEALTH DEPARTMENT APPROVAL ~/'€fKJ - ~~ . ~cL SQUARE FOOTAGE J (p 7 d::; t;, -R~ HEIGHT €/ RESIDENTIAL: ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. COMMERCIAL: ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS. IF SIGN PERMIT ONLY (2) SETS OF ENGINEERED PLANS REQUIRED. PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.. MI ~~ A ~ . \?~~~~~ ~UILDING IiYELECTRICAL ~LUMBING ~ECHANICAL o GAS ~OOFING AMP SERVICE VALUATION OF TOTAL CONSTRUCTION Er-Progress Energy o j $ ~<0.<DD W.R.E.C. o OTHER VALUATION OF MECHANCIAL INSTALLATION o SPECIALTY TYPE OF CONSTRUCTION: ~OCK o FRAME FINISHED FLOOR ELEVATIONS BUILDER SIGNATUR o STEEL o OTHER IS PROJECT IN FLOOD ZONE AREAD YES E(NO STATE CERT OR REGIST . c.-Ri!.- - {)35"J3Y~ ~********************************************* COMPANY ma..-r-..J-t ~ 8J~f-r ;.~€ STATE CERT OR REGIST # CC - /3CO 1,?~-3 SIGNATURE ***************************************************** PLUMBER SIGNATUR COM PAN ili 8-h.. V'\..L -S. W: L t l ~. "'" ~ STATE CERT OR REGIST =It c..~ - /c.{...2S'fo ([):L MECHANICAL *****************~*************tt>**** ~ "' COMPANY llJ.-t.-r \.!:. V TO ~ e-~r-i~ STATE CERT OR REGIST =It ~ - oL/S'f9f ~ OTHER ****************~********************* . ~ COM PAN ~~<+r-~~I'\.-\; STATE CERT OR REGIST it ~ J3:LSSas gJ A. NOTICE OF DEED RESTRICTIONS The undersigned understands that this permit may be subject to "deed restrictions" which may be more restrictive than City regulations. The undersigned assumes responsibility for cofnplic.n'ce with any applicable deed restrictions. B. UNL~CENSED 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 City of Zephyrhills Building Department, 813-780-0020. Furthermore, if the owner has hired a contractor or contractors, he is advised to have the contractor(s) sign po~tions of the "Contractor Sections" of this cipplication for which they will be responsible. If you, as the owner signs as the contractor, you are indicating that you, rather than the contractor, are responsible for the work. If the contractor wishes you to sign as contractor that may be an indica~ion that he is not properly licensed and is not entitled to permitting privileges in the City of Zephyrhills. C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED) I certify that I, the applicant, have been provided with a copy of "Florida's Construction lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture and Consumer Affairs. If the applicant is som~one other that the "owner", I cerify 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. E. 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. Appliqation is hereby made to obtain a permit to do work and installation as indicated. I certify t~at 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, City codes, zoning regulations, and land development regulations in the jurisdiction. I also certify that I understand that the regulations of other governmental 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 Regulation-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 *U.S. Environmental Protection Agency-Asbestos abatement I also certify that, if fill material is to be used in Flood Zone "A" or "A, etc.", it is understood that a drainage plan addressing a "compensating volume" will be submitted which is prepared by a professional engineer registered in the State of Florida prior to permit issuance. 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 code. Every permit issued shall become invalid unless the work authorized by such permit is commenced within six months of issuance, or if work authorized by the permit is suspended or abandoned for \a period of six months after the time the work is commenced. One 90 day extension of time may be allowed for the permit with fee charge of $15.00. The extension shall be requested in writing to the Building Official. An approved inspection must be logged during each six month period, or the project will be 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 YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER c;l~~A;UE ;07? VRECORU ANU POST (~~=-?T"~ J J- SIGN~;~R~~ - SIGNA~~r- STATE OF FLORIDA ~ STATE OF FLORIDA--~~~~ . COUNTY OF ~~ COUNTY OF ~ The foregoing inst t w acknowledged The foregoing i~nstr. nt Wa~f}P~Ckn_~OWledged Be 0 m is , 200~ Befo~ ~ehthis y of ~ ' 200~ by by ~_I e... I c. \, loame of person . --lname of person aCKnowledged) rlEtWhO is personally ~o is personally known to me, or of identification) take an oath. o who has produced ______ (type of identification) ~ not take an oath Owho has produced .-llype -BtfiC:f not ur person taking acknowledgement ~ Ryman ~ "'............00''''... . ty . ~~28~tamped re~~e~~ing acknowledgment . . My CommIIIIon 00121426 ~ !:~ III_!M ?ntIfl Name typed, printed or stamped Name Fire Chief Robert Hartwig ZEPHYRHILLS FIRE DEPARTMENT 6907 Dairy Road, Zephyrhills, FL 33542 Bus (813) 780-0041 Fax (813) 780-0044 *~ Billing Phone No.: Billing Fax No.: Contact: PERMIT FEE Occupancy No.:}\ ;, Plan No.: {.L'-- Of" / BusinessName:~ "/1 BusinessAddress: ~~ ~ Business Phone No.: Business Fax No.: Contact: PLAN REVIEW FEES ~ Site Plan N/C . Building Plans .04 sf Revision .06 sf PLANS TOTAL ttJj 2- INSPECTION TOT~ / ~~RAN~JT..?TAL I gt;Z /7L Comments: r ~5 ~ . ~'~ ~ . Ye~~// '611 STANDPIPE SYSTEM o Per Riser $25 SPRINKLER SYSTEMS o 0 - 25 Heads $30 o 26 plus Heads $60 FIRE PUMP o Per Pump $100 FIRE ALARM SYSTEM o 0 - 25 Devices $30 D 26 plus Devices $60 SUPPRESSION SYSTEMS ~ Wet $35 Dry $35 C02 $35 Other $35 GREASENENTILATION o Hood/Ducts $35 INSPECTION FEES Annual N/C 1 st Re-inspection $25 2nd Re-inspection $50 3rd Re-inspection $125 4th Re-inspection $250 5th Re-Inspection $500 Construction $15 Commercial $25 SPINKLER SYSTEMS Hydro Undergrounds $45 Hydrostatic System $45 Wet Acceptance $30 Dry Acceptance $45 Hydrant Flow $25 Hood / Booth $30 Grease Duct $15 FIRE ALARM SYSTEM o System Acceptance $50 D Recall Acceptance $50 I OTHER . " Fire Wall/Smoke W~ LPGas ~. Natural Gas $25 Fuel Tanks $25 Tent $15 SPINKLER SYSTEMS o Automatic $15 FALSE ALARM FEE 1 st Alarm N/C 2nd Alarm N/C 3rd Alarm N/C 4th Alarm $25 5th Alarm $50 6th Alarm $75 7th Alarm $100 8th Alarm $150 9th Alarm $200 10th Alarm $250 FIRE PUMP o Fire Pump $15 FIRE ALARM SYSTEM o Detection $15 OTHER ~ LP Gas Natural Gas Fire Works Fuel Tanks $45 $45 $25 $45 GREASENENTILATION o Hood/Ducts $15 D Kitchen Suppression $15 PERMIT TOTALI FALSE ALARM I TOTAL Date: Inspector: -~ 33,!5Gc ,.50 ~l. \ 'Z Ryman Construction 5842 - 8th Street SQ. FEET PRICE MAIN OR LIVING: 820 $ 50.00 OTHER AREA UNDER ROOF: $ 50.00 OTHER: $ - VALUATION $ 41,000.00 FEE SHEET $ 235.00 ADDRESS $ 30.00 DRIVEWAY $ 30.00 BUILDING: $ 412.50 CREDIT: $ - BUILDING LESS CREDIT: $ 412.50 ELECTRICAL: $ 80.70 PLUMBING: $ 98.00 MECHANICAL: $ 82.00 SUB-TOTAL $ 673.20 RADON: $ 8.20 TOTAL $ 681.40 SEWER: $ 1,535.20 WATER: $ 398.05 IRRIGATION: $ - TOTAL: $ 1,933.25 WATER METER:I $ IRRIGATION METER $ 180~00 I FIRE DEPARTMENT FEES PLANS TOATL: $ 33.56 INSPECTION TOTAL: $ 7.50 PERMIT TOTAL TOTAL: $ 41.06 PUBLIC SAFETY IMPACT FEES POLICE $ 254.00 FIRE $ 273.00 5% $ 26.35 TOTAL: $ 553.35 SUB-TOTAL $ 3,389.06 I . 769.561 PARK IMPACT FEESI $ SIF'S: $ 1,659.00 100.0% $ 1,659.00 1.0% $ 16.59 TOTAL: $ 1,675.59 T1F'S: $ 1,588.00 99% $ 1,572.12 1% $ 15.88 TOTAL: $ 7,422.21 I () o If=L o o o n (') {') n () o PERFORMANGE BUSINESS PRODUCTS, INC. 813-719-8008 FAX 813-719-7tl1G lo..- 05 ~l CITY OF ZEPHYRHILLS ZEPHYRHILLS, FLORIDA WATER ACCT. NO, DATE 3/ ~/of.o , . OWNER/ 0 1/- RENTER ~ ~-("\ , kEv I v\ / 5<642.. t~S+ I bv..p\~x. MAILING SERVICE ADDRESS :5 <is 4 2- ~'h S-\--re..e- -t ?E.t.M.~+.3!: SSlD [iJI" WATER SHUT OFF SERVICE o INSTAll.. METER [jJ/" ~ o SEWER ,',,, .. TURN ON SERVICE o GARBAGE "'----- READ METER o [d'" IN CITY CHECK METER o o OUT CITY ~ No. OF UNITS OTHER o _ DEPOSIT AMOUNT sf ,"- W f\-+E(t. Nek~ _ AMOUNT lAST Bill _ DATE _ MISC. CHARGE WORK COMPLETED BY & DATE COMPLETED ORDER TAKEN BY s. ORDER GIVEN BY Retain white form in office at all times. Send pink & yellow forms to Water Service Depl. Water Service Dept. to sign yellow form & return to office. 'Dr ! .~. ../01- I I I I' i~ I- I I I I I .I ~~ ' j 5"2' / 8 &l s:+-r e ek- --0) ~Lo/)- I' '%.- ~D.' FORM 600A-2001' . . ~LORIDA ENERGY EFFICIENCY CODE '7~ FOR BUILDING CONSTRUCTION Florida Department of Community Affairs Residential Whole Building Performance Method A Project Name: Address: City, State: Owner: Climate Zone: Model 1678 Duplex 5~ 4 2. /S"i?'-lO %-1-1'\ '5+ I?:~~ ~L- ~ yn Z).IY\, t<sz.-u'l ~ Central Builder: Ryman Permitting Office: 'z:..e.p~"=> Permit-Number: 5'50<1 (5516 Jurisdiction Number: to i I <060 1. New construction or existing 2. Single family or multi-family 3. Number of units, if multi-family 4. Number of Bedrooms 5. Is this a worst case? 6. Conditioned floor area (ft2) 7. Glass area & type a. Clear glass, defauh U-factor b. Default tint c. Labeled U or SHGe 8. Floor types a. Slab-On-Grade Edge Insulation b. N/A c. N/A 9. Wall types a. Concrete, Int Insul, Exterior b. N/A c. N/A d. N/A e. N/A 10. Ceiling types a. Under Attic b. N/A c. N/A 1 L Ducts a. Sup: Unc. Ret: linc. AH: Attic b. Sup: Unc. Ret: Unc. AH: Attic Single Pane 0.0 ft2 0.0 ff' 0.0 ff' New Single family 1 2 No 1616 ft2 Double Pane 152.1 ft2 0.0 ff' 0.0 ff' 12. Cooling systems a. Central Unit Cap: 30.0 kBtulhr SEER: 11.00 Cap: 30.0 kBtuIhr SEER: 11.00 b. Central Unit c. N/A 13. Heating systems a. Electric Heat Pump Cap: 30.0 kBtuIhr HSPF:7.50 Cap: 30.0 kBtuIhr HSPF: 7.50 R=O.O, 182.0(p) ft R=5.5, 1456.0 ff' R=30.0, 1678.0 ff' Sup. R=6.0, 200.0 ft Sup. R=6.0, 200.0 ft b. Electric Heat Pump c. N/A 14. Hot water systems a. Electric Resistance Cap: 30.0 gallons EF: 0.97 Cap: 30.0 gallons EF: 0.97 b. Electric Resistance c. Conservation credits (HR.-Heat recovery, Solar DHP-Dedicated heat pump) 15. HVAC credits (CF-Ceiling fan, CV-Cross ventilation, HF-Whole house fan, PT -Programmable Thermostat, MZ-C-Multizone cooling, MZ-H-Multizone heating) MAR 1 1 2004 Glass/Floor Area: 0.09 Total as-built points: 21117 Total base points: 21637 PASS I hereby certify that the plans and specifications covered by this calculation are in compliance with the Flori Energy Code. .., ,/ PREPARED BY: '.-/. DATE: :J/I; /0 Lj , I hereby certify that this building, as designed, is . compliance with the Flo' Eye. OWNERlAG DATE: BUILDING DATE: Review of the plans and specifications covered by this calculation indicates compliance with the Florida Energy Code. Before construction is completed this building will be inspected for compliance with Section 553.908 Florida Statutes. I=ncrn\lr.:"'"n<>liil {\Icrc::inn' 1=1 RI""PR \I~ ~n\ NOTICE OF COMMENCEMENT STATE OF FLORIDA COUNTY OF PASCO THE UNOERSIGNED her~y gives notice that improvement will be made to certain real property, and in accordance with Chapter 713, Florida Statues, the following information is provided in this Notice of Commencement: 1. Description of Property: Parcel No. 11-26-21-0010-01400-0190 5840 8th Street, Zephyrhills, FL 5842 8th Street, Zephyrhills, FL 2. General Description oflmprovement: New Duplex 3. Owner Information: Name: K@vin L; and Tammy L; Rymm Address: 5612 Beech Street Zephyrhills, FL 33540 111111111111 1111I11111111I11111111111 1111I11111111111111 I11I 2006070068 Rcpt: 9862!50 DS: 0.00 04/06/06 Rec: 10.00 IT: 0.00 Dpty Clerk Interest in Property: Name of Fee Simple Titleholder: If other than owner: Address: City State 4. Contractor: Address: Ryman Construction, Inc. 36413 S.R. 54 West Zephyrhills, FL 33541 ~~90;~~~"AN~,P1ASCO COUNTY CLERK 11.3 am 1 of 1 OR BK 6924 PG 902 5. . Surety: Name Address City Amount of Bond: $ Zip Code State 6. Lender: Name Address City nla State Zip Code 7. Persons within the State of Florida designated by 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 Zip Code 8. In addition to himself, Owner designates: of to receive a copy of the Lienor's Notice as provided in section 713.13(1) (b), Florida Statutes. - 9. Expiration date of Notice of Commencement (the expiration date is one (l) year from the date of recordjng unless a different date is specified.) Signature:Of~ - Printed Name: KevinL.Ryman ::~:li:~b:iS~~Pr My GpIDmission Expires: .... .. d ~y PI\, R~... . . ~- 'I "> Oft'O Notary Public State of "'fonda Bobbie J Knight My Commission D0416222 Expires 03/31/2008 CITY OF ZEPHYRHILLS "NOTICE" OF ADD.ITION OR CORRECTION BUILDING DEPARTMENT DO NOT REMOVE s;.~iD ro~~. :~(cn" PE",,"TS5/D I THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the jab will be accepted. , * ~V""l - A\\ ~\L"'~~ J€ve.,I~~-\- 1.",,-),\\ ~e.cv..\re.. CL ~ 1-4 .r~ce ~c (- .~~ (O{L'D. 'XI "j( - tiLl) \..J OFFICE HOURS 7:30 AM - 5 PM MON.-FRI. AFTER CORRECTIONS ARE MADE CALL 780-0020 FOR RE-INSPECTION INSPECTOR ~ It is unlawful for any Carpenter, Contractor, Builder, or other persons, to cover or cause to be covered, any part of the wor1< with flooring, lath, earth or other material, until the proper inspector has had ample time to approve the installation. ,,' "'--- Jj .,',.,,< l': ("'\ (":'\ (-") o o PERFORMANCE BUSINESS PROQUCTS. INC. 813-719-8008 FAX 813-719-7919 ("') (" ~ o CITY OF ZEPHYRHILLS ZEPHYRHIUS, FLORIDA WATER ACCT. NO. OWNER/ \) 1/ - / 5011 ~~ RENTER ~ t-J\C..<'. ( J.....EV1y\ I 0' 2. (s' s+ MAILING o a o k- uS ~I 4-iP DATE ..jO{g bU.f>\~K SERVICE ADDRESS SHUT OFF SERVICE o :5 ~ 4 2- W\.. S-\-i"e..e- i YE.t.f...\ ~.\--J:!: S S l D TURN ON SERVICE [iJI" ~ INSTAll. METER READ METER o CHECK METER o OTHER o sf ,"- W p..\.E~ Nek9- WORK COMPLETED BY & DATE COMPLETED ORDER TAKEN BY ORDER GIVEN BY Retain white form in office at all times. Send pink & yellow forms to Water Service Dept. Water Service Dept. to sign yellow form & return to office. o;r"" WATER o SEWER o GARBAGE u::r IN CITY o OUT CITY -L No. OF UNITS _ DEPOSIT AMOUNT _ AMOUNT LAST Bill _ DATE _ MISC. CHARGE _I PERMIT APPLICATION ~~~ /;; ~Ldl r -,;11) -D4. ($5J I ;/f01/v./ '-Pe\)'Yl'~ _ DRIVEWAY PERMIT APPLICATION CONSTRUCTION WITHIN PUBLIC RIGHT-Of-WAY All information must be filled-in completely City of Zephyrhills 5335 8th Street, Zephyrhills, FL 33542 Telephone 813.780.0000 Fax 813.780.0005 Date of application: Processed By: (gfllY area for staff use only) OCopy to Building Department Permit #: OCopy to Public Works Address: ';fJ;.j Unit #: Parcel Identification Number: CONTRACTOR: 5510 55 OCt 5~\3 55\5 551<0 56\i-\ E-Mail: Fax: ARCHITECT /ENGINEER: ,rJA Firm Name: City: Phone: State: Cell: Zip: Fax: Name: Address: State License #: TYP OF DRIVEWAY RESIDENTIAL DRIVEWAY _COMMEROAL DRIVEWAY _PUBLIC ACCESS DRIVEWAY DescriDtion of Proiect ~ LENGTli OF DRIVEWAY ~WIDTH OF DRIVEWAY R.Q.W; EXCAVATION ~DEPTH _LINEAR FEET CONSTRUCTION MATERIAL _ASPHALT -::X-CONCRETE HEADWALL REQUIRED? _YES -t-NO CURB CUT REQUIRED _YES -+-NO CULVERTS NEEDED ( ) REINFORCED CONCRETE ( ) CORRUGATED MATERIAL ( ) BOX CULVERT ( ) OTHER (EXPLAIN) NOTICE TO APPLICANT: If actual work exceeds scope of this description, additional permits, or drawings will be required. UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 Page 1. of 3 - P'ERMIT APPLICATION UTILmES LOCATE CONFIRMATION NUMBER: PROVIDE SKETCH IN THIS AREA, IF ADDITIONAL SPACE IS REQUIRED, ATTACH TO THIS APPLICATION. s~~ A+t~ LleJ AFFIDAVIT: Application is hereby made to obtain a permit to do work and installations as indicated. r certify that all foregoing information is accurate and that all work will comply with all applicable codes. r understand these codes shall take precedence over all approved construction documents, and issuance of this permit is verification that'! 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 restrictions may apply to this property. All work shall comply with the current Florida Building Code, Public Works Designc Manual and FOOT Design Standards (if applicable). (Public Works Design Manual online link: www.ci.zephyrhills.f1.us/public;..works.asp) APPUCATION IS VOID UNLESS SIGNED WITH PROPER IDENTIFICATION AND WITNESSED BY A PERMIT TECHNICIAN OR NOTARY PUBUC. NOTE: The City of Zephyrhills. is not responsible for maintenance or repairs of driveways. Driveways shall not alter / interfere with existing stannwater treatment and I or conveyance. By signing this application: I certify that I have read and understand the owner/builder disclosure (p~.;n~:a~ ~ ~ cr/W(P" lOs ,. \ t..f.. A Icant Signature Date L 9 - ...2 tr ot(7 (or) Notary Signature Date Applicant is ( ) personally known to me or produced as identification. (type of identification) Page- 2. of 3; VJ ~' ,,' ~ ~ 0 I c;-~ Av<. 1'-10 I "'l r -..; ~Ol " [ -i,- I\' [ '" w i l..J 0 i .." I O_ J 3 3 i ~ I :2. ! '\ t '+ ~ { \ i f\~ ; I I -..: I -.J 1 [ I ~ l "l<. 10 I i ...1 i ~ - ! t I .t i"- I ... ! V>- I ~ ~ , :.J.. ~ ( r~ r f -..' \ ~ ~, , f "I ,. n:. I, 3- f ~ I, ~ I --V V\ 1 ... ~ ~ I ~... ~ r . C , ( t",< " ~ I - I - ( i , r "" :;)0 / I ~ \t:-~ i '" , I /tI.. V\I ~ <:3 , ~ , ... i s .-- I S' s ! ""' 9 ..J, ~ t J, 1 ~ I\~ \ \ 1 (' ~ .j i I ! "V ,; t f ..... f f , Eyptlf' S.; D r'\ ~ S~dewa..\ \<. t-DI','v'( Vo.J~Y- .;J, ~Oa() PS-r )0;,,1 5 b€~we..e..... SiJe Wet( k ~""J '-/" -+k:<.k eKc.~ft +(.,",:)1.(5 ~ DI'.\/(' wc..y : '" (l.. Ow to" 1'""; (.. k (n".-~-,,).Q IJ'..lt ';"vL.v40 W,,,, U\ t2.oc.J D/','v (' IVy w; k.t, 1'<; ""/ T"o' d< "'?E'KMIT APPLICATION OFFICE USE ONLY PUBUC WORKS USE ONLY Concrete (min. 6") y N Asphalt Base (min. 6") y N Asphalt (min. 1 V:z") 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 7'L) y N Visibility triangle o.k.? y N Side setback (3' min. R.O.W.) Y N Plan Review Fee Public Works Director- and or desi nee: 'J'tt Date: r?~ 2 O-{J~ ,'" &~