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, ,.�...E?:i:L, <br /> PERMIT ARPLICATiON �l�;_ '^ � <br /> �•`~-+.- <br /> DRIVEWAY PERMIT APPLICATI0111 <br /> CONSTRUC7ION WITNIN PUBLIC RIGHT-OF-WAY <br /> All Informatlon�i be fllled-In oomplebe(y <br /> C'�ty of Zephyrhills <br /> 5335 8�'Stree�Z.ephytfiills,R 33542 <br /> Te{ep1�1e 813.760.4000 Fdx 813.780.�5 <br /> 'Dabo of appllotlorc Prooessed BY+ PermR�R: <br /> (g�ey��ea m.amR we mh') <br /> ��W�Y to Bulldlm�Deper6�t 17GaPY Lo PubCc Waks <br /> PR07EGT OB SITE: PROPERTY OWNER � - .Z7��yoZ <br /> /1ddre�: ` ' Name: la.. La✓� �ie <br /> Unit�: Addr�s: ' � Unl� <br /> Paroel IdentlHcatlon Number. � 5i�� � � ,� <br /> Phone: / -.7 y�F�c: <br /> CONTRACTOR: <br /> Companv: �r ��1�ry6C <br /> Name• <br /> Contractot's LJcense�: E-Mali: <br /> Phone: Ce1L• Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: FlIm Name; <br /> A(�I�C55: CiLY' S�Fi7tC' ZJp' <br /> State Lioense#: Phone: Oeefl: Fex: <br /> Descriotion of P►ofe <br /> TYPE O�DR�?NJAY �S / _LENGTH OF DR[VtINAY CULVERTS PoIEBpED <br /> " R�B�T7AL DRNEWAY ._J[_WlDTH OF DRNEVYAY ( )pmy��pp�� <br /> _COMMQ2QAL DRIVEWAY �t„o•w, p(CAVATIQN ( )OORRUGATED MA7ERTAL <br /> .�UBLIC A�DRIVEWAY _PFPi}i _LINEAR FEET ( )BDX CIJLVERT <br /> CURB Q1T REOUIRED � y���IX���- <br /> ��� _YES _NO <br /> H�DWALL RFOLlIIL j yg �p <br /> NOTtCE TO APPLIca►Nf: If actual work e�oceeds soope oP this deseriptlon,additional permits or drawings <br /> wlll be requir�. <br /> 4TILITY LOCATIONS�OLlIRED• CALL BEFORE YOU DIG:1.800.432A770 <br /> Page i of 3 <br />