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P <br /> Q d ' ' <br /> o . . <br /> PERMIT APPLICATION � �"��� . <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION VISITHIIV PUBLIC RICHT-OF-WAY <br /> All information must be filled-in completely <br /> City of Zephyrhills <br /> 5335 8"'Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> ;4ate of applica`�ion: r : 7—:�� � Processed'By:' . ._. . - • Periiait#; . . . _ . . __ <br /> f (gray�a�ea for staff use only) <br /> t, - -OCopy to,Building Departrnent, - ,�oPy E,o,Public Works_ �� � - - <br /> PRO]ECT/ OB SITE: PROPERTY OWNER <br /> Address: ,' � - ` Name: - <br /> Unit#: --- Address: ' ((,t��`� � it: �(;� <br /> Parcel Identification Number: " -�Ci -��I-(�Ci.G-C 'Uc.� Ci State Zi � l �j`'. "3 <br /> �- C� Phone: � '- IU Fax: - - �}Q 5 <br /> CONTRACTOR: <br /> Com an : � ',j� � <br /> Name: �l C 5 <br /> , <br /> Contractor's License #: ' =� '(�'��:j�L� E-MaiL• r , � �� � (� , �' ` .G(�=� <br /> Phone: ';� �-7 f U�' Cell: � � Fax: •� � <br /> ARCHITECT/ENGINEER: <br /> Name: �V\;1 I� � � n�� ' � �l Firm Name: ` ' `° ` �,' �� .�L�j�,(i11.(�'1C <br /> Address: L�' • ' j �h Ci ',( State: Zi �� <br /> State License #: ' Phone: � l� - J ---�- Fax: — <br /> Description of Project <br /> TYPE OF DRIVEWAY L.�•.� LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY ��WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY R.O.W. EXCAVATION O CORRUGATED MATERIAL � <br /> PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEET ( )BOX CULVERT <br /> ( )OTHER(EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED <br /> ASPHALT YES 7 �NO <br /> �CONCREfE <br /> HEADW/!LL REOUIRED? YES .�NO <br /> MOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILITY LOCATIONS REOUIREDo CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />