Driveway Permit Application

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:                                                    Permit #:

                          ____ Copy to Building Department               ____ Copy to Public Works

PROJECT/JOB SITE:

PROPERTY OWNER

Address:

Name:

Unit #:

Address:                                                    Unit:

Parcel Identification Number:

City, State, Zip


Phone:                                            Fax:


CONTRACTOR:

Company: _____________________________________________________________________________________________

Name: ________________________________________________________________________________________________

Contractor's License #: ___________________________  E-Mail: _________________________________________________

Phone: _______________________  Cell ____________________________  Fax: ___________________________________


ARCHITECT/ENGINEER:

Name: __________________________________________ Firm Name: ___________________________________________

Address: ________________________________________ City: _______________ State: _____  Zip: ___________________

Sate License # ______________________ Phone: _______________  Cell: _______________  Fax: ____________________


Description of Project

 

TYPE OF DRIVEWAY                             _____ LENGTH OF DRIVEWAY                                         CULVERTS NEEDED
_____ RESIDENTIAL DRIVEWAY          _____WIDTH OF DRIVEWAY                                           ( ) REINFORCED CONCRETE
          COMMERCIAL DRIVEWAY          R.O.W.                 EXCAVATION                                       ( ) CORRUGATED MATERIAL
_____ PUBLIC ACCESS DRIVEWAY    _____ DEPTH       _____ LINEAR FEET                           ( ) BOX CULVERT
                                                                                                                                                           ( ) OTHER (EXPLAIN)_______
                                                                                                                                                           _________________________

 

CONSTRUCTION MATERIAL                         CURB CUT REQUIRED                       
_____  ASPHALT                                             _____YES  _____NO
_____CONCRETE

HEADWALL REQUIRED?    _____  YES   _____ 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

 

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). 

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)



____________________________________    _____________________________________   _________________________
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)

 


OFFICE USE ONLY

Concrete (min. 6")                      Y     N

Asphalt Base (min. 6")                Y     N

Asphalt (min. 1 1/2")                   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 7'L)          Y     N

Visibility triangle o.k.?                  Y     N

Side set back (3' min. R.O.W.)    Y     N

Plan Review                                Y     N


Additional description of work as defined by Public Works Director and or designee:

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Permit application approved by: ____________________________________________ Date: _________________________