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<br /> � •PERMIT APPLICATION �'��- �
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<br /> DRIVEWAY PERMIT APPLICATION
<br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY
<br /> All information must be filled-in completely
<br /> City of Zephyrhills
<br /> 5335 8"'Street Ze h rhills FL 33542
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<br /> Telephone 813.780.0000 Fax 813.780.0005
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<br /> P ]E /] PROPER 3AINE
<br /> Address: ame:
<br /> Unit#: Address: '� ` nit:
<br /> Parcel Iden 'fication umber: � � Ci ,State Zi
<br /> " Phone• Fax:
<br /> CONTRACTOR:
<br /> Com a
<br />� Name: .,
<br /> Contra 's License : E-Mail: . C ,CrC
<br /> Phone: Ce �—' Fax: - - ' I
<br /> ARCHITECT/ENGINEER:
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<br /> Name: 11 � " Firm Name: �
<br /> Address: (VCi : State: i :
<br /> State License#: Phone: -�', I: --- Fax: �
<br /> Descri tion of Pro'e
<br /> ct
<br /> TYPE OF DRNEWAY • O LENGTH OF DRNEWAY CULVERTS NEEDED
<br /> RESIDENTIAL DRNEN/AY DTH OF DRNEWAY ( )RQNFORCED CONCREfE
<br /> COMMERCIAL DRNEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL
<br /> PUBLIC ACCESS DRIVEWAY DEPTH LiNEAR FEEf ( )BOX CULVERT
<br /> ( )OTHER(IXPLAIN)
<br /> CONSTRUCTION MATERIAL CURB CUT RE UIRED
<br /> ASPHALT YES O
<br /> �CONCREfE
<br /> HEADWALL REOUIRED? YES �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
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