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, <br /> y���^,F <br /> �w��i r`f5-�:. <br /> .uvmbn\ti-y <br /> PERMIT APPLICATION ;`'h'"`"`���� � <br /> ��:;�.< i <br /> ( <br /> I DRIVEWAY PERMIT APPLICATI4N <br /> � CQNSTRUCTICIN INITHIN PUBLTC RIGMT-CiF-WAY <br /> Ali information must be filled-in completely <br /> Cit�r af Zephyrhills <br /> 5335 8"'Street, Zephyrhills, FL 33542 <br /> ( Telephane 813.780.00Q0 Fax 813J80.04Q5 <br /> Date.of appiicatian: � � � � Pracessed By:,;,;1: � ' - ., ,.Permit�#:` `� " •� . •�. ` • <br /> - . �'�''��5:. , , .. , - <br /> ` ,:, .. ' , , (g�yaseafof'staffu n!y) � �,`' , .:��-`. � ., _:, . .. . <br /> ; � � K[,(Gopy;to'Buifding,Departmerit.� . ..�`'- � ���Gopy�to=Fu6lic�.uVork's � � � <br /> PRQ�ECT/3 B SITE: PROP RTY O ER <br /> Address: Name: <br /> � Address: D! Unit: � <br /> ParcelIdentification Umber: Ci State i � �- 5 <br /> •t - �. Phone I Fax: � � <br /> ��� <br /> CONTRACTOR: <br /> Com an : N <br /> Name: l . 0.V � l'� <br /> Cantractor's License #: /ac� E-Mail; �(lGV- • p � ( . <br /> Phone: i 2,. - �4 Ce11: 3 9 7-2a� Fax: <br /> ARCHITECTJENGINEER: ��� <br /> Name: Firm Name: <br /> Address: City: State: Zip: <br /> State�icense #: Phone: Ce31: Fax: <br /> Description of Proieck <br /> r <br /> 't'XPE QF DRIVEWAY �� LENGTFi OF DRNEWAY CULVERTS NEEDED <br /> �RESIDENIIAL DRNEWAY 2_�WIdTH OF DRNEWAY ( )REINFORCED CONCRE?E <br /> COMMERCIAL DRIYEWAY R.O.W. EXCAYATIO(�i ( )CORRUGATED MATEF2IAL <br /> PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEET ( )BOX CULVERT <br /> ( )OTHER(IXPLAIN) <br /> CO[dSTRUCi`ION MATEitIA� CURB CUT REOtJIRED <br /> A�,$PHALT YE$ ,�NO <br /> _�CONCREfE <br /> HEADWALL REOUIRED? YES _�NO <br />� NOTICE TO APP�.ICANT: If actua!wark exceeds scope of this description,additianal permits ar drawings , <br />; ; witl be required. ` ' <br />' 4 UTILI'i'Y LOCATIONS REQUIRED: CALl.BEFORE YOU DIG: 1.80Q.432.4770 <br /> � <br /> 1 <br /> � .< <br /> s <br /> � <br /> ; Page 1 of 3 <br /> t <br /> � . <br />