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�°t�°""__�`C�,i <br /> PERWIIT APPLICATION � "��'����'�� <br /> � � <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, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> �Date of application: Processed By: Permit#: � � <br /> (gray area for staff use only) ' <br /> ❑Copy to Building Department ❑Copy to Public Works ' <br /> I PRO]ECT/ OB SITE: PROPERTY OWNER �� -9����y� <br /> Address: S ' � /�' Name: C/,� LO�r/� ,7�✓�' <br /> Unit#: Address: "' �F4 S Unit: <br /> Parcel Identification Number: Ci State Zi Z � �/ L <br /> Phone: � � -� �Fax: <br /> CONTRACTOR: <br /> Company: �t3a� �Lj/�/BG <br />�� Name: <br /> Contractor's License #: E-Mail: <br /> Phone: Cell: Fax: <br /> ARCHITECT/ENGINEER: <br />�;� <br /> Name: Firm Name: <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br />� <br /> Descriation of Proiect <br /> TYPEA�DRNEWAY ;�LENGTH OF DRNEWAY CULVERTS NEEDED <br /> ' RESIDENTIAL DRIVEWAY �WIDTH OF DRNEWAY ( )REINFORCED CONCREfE <br /> COMMERCIAL DRIVEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLiC ACCESS DRNEWAY DEPTH 11NEAR FEET ( )BOX CULVERT <br /> ( )OTHER(IXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED <br /> A�PHALT YES NO <br /> �ONCREfE <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 <br />