|
f
<br /> 7 = I
<br /> PERMIT APPLICATION �'��`���
<br /> DRIVEWAY PERMIT APPLICATION
<br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY
<br /> All information must be filled-in completely
<br />� City of Zephyrhiils
<br />� 5335 8"'Street,Zephyrhilis, FL 33542
<br /> Telephone 813.780.0000 Fax 813.780.0005
<br /> - -x_1,•._-" " _ " ;.- - _ ,_ _ .,5�. _ .,4'".`- _ � - - " - - " - _-
<br /> ;Datecof a licatione�^ %�� �Processed:6" - "Perniit.#:' �
<br /> .- .PP.. - ���.�� - y' - - - -_i
<br /> - ,, ;. .: --- - -
<br /> _ _,.
<br /> I� y '� :.,. -. ,.,,.: . . _ _ , - - °�(yrby.ar� , �e.oq'lyj e _ - ; - - - - - - - '
<br /> . ,
<br /> �.. _
<br /> - - �for�'sta'ff . ;i
<br /> ' _ " ' ,{.�'_ ' _ ' _ "_ - _ _,1:
<br /> �,., ;.'
<br /> � .. .... �r.,,." ��;.� a,. .�T�},..,.,:.':.Y .. .,
<br /> 's-�- _`�aPY'to Building.DeParaiient - - ;.�W�PY�to Public-1fVarks _ - ',: = _-
<br /> ., ; .,_._; :� ,.,,: .,. �:•,_ . ., , ,
<br /> ._..._.
<br /> . _-�.- ,=, :� ,r :...':: •�,`.<'-.".:,�. , `. _ . ..-_...-° ''; : -., e. �=.;r::
<br /> PRO7ECT/]OB SITE: PROPERTY OWNER
<br />, Address: L Name:
<br /> Unit#: Address: , l nit: �
<br /> Parcel Identification Number: `C� p-- Ci State Zi �' �' �
<br /> (�j�j�,(j-C��� Phone: - l �7lci�jax: ��P�Q-�
<br />, CONTRACTOR:
<br /> Com an : i
<br /> Name: '
<br /> Contractor's License#: C G E-Mail: 11'1S I •C��
<br /> Phone: (p - -1, (� Cell: Fax: ( -
<br /> ARCHITECT/ENGINEER:
<br /> Name: �, 1��.�`-�'Y e� Firm Name: -�V I (�
<br /> Address: �- C��(Ci � State: Zi
<br /> State License#: Phone: -�p -�jOCell: -�. Fax:
<br /> Descrintion of Project
<br /> i
<br /> TYPE OF DRNEWAY 21 LENGTH OF DRIVEWAY CULVERTS NEEDED
<br /> RESIDENTIAL DRNEWAY ��WIDTH OF DRNEWAY ( )REINFORCED CONCREfE
<br /> COMMERCIAL DRNEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL
<br /> PUBLIC ACCE55 DRIVEWAY DEPTH LINEAR FEET ( )BOX CULVERT
<br /> ( )OTHER(IXPLAIN)
<br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED
<br /> ASPHALT YES �NO
<br /> �CONCREfE
<br /> HEADWALL REOUIRED? YES , C�NO
<br /> NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings
<br /> will be required.
<br /> UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
<br /> Page 1 of 3
<br /> J
<br />
|