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 _____________

State 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). (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 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

PUBLIC WORKS 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 (min. 10' - 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 Fee _________________________

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

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Permit application approved by: __________________________________________ Date: ______________________________