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ERMIT APPLICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> fi elffil�k_ <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All information must be filled-in completely <br /> City of Zephyrhills <br /> 5335 e Street, Zephyrhills, FL 33542 <br /> Telephone 813.786.0000 Fax 813.780.0005 <br /> Date rt �,6nv L V VNFAURI W. 2,11 112q1z <br /> -fMac, ' V 6,466 <br /> _603ECT/30113 SITE: PROPERTY OWNER <br /> Address: A 77-77-1 -rk C--9 Name: P, Z_A L,7 <br /> -Unit#: Address: R,31 Wk&:& Unit: <br /> Parcel Identification Number: Citv, State,Zip 5 rz_ <br /> -.6 D b5l 6 <br /> Phone:F/,3_?F;?_:7,Lkb-9ax: <br /> CONTRACTOR: <br /> -Company: <br /> Name: <br /> -Contractor's License #: E-Mail: <br /> Phone: Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> --Narne: Firm Name: <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br /> Description of Project <br /> TYPE OF DRIVEWAY ENGTH OF DRIVEWAY CULVERTS NEEDED <br /> X, RESIDENTIAL DRIVEWAY WIDTH OF DRIVEVVAY <br /> 81 REINFORCED CONCRETE <br /> —COMMERCIAL DRIVEWAY R.O.W. XCAVATION,�,2 YE' CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY /-�DEPTH `LINEAR FEET BOX CULVERT <br /> OTHER(EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT Rvoulm <br /> ASPHALT YES NO <br /> 2CCONCRETE X- <br /> HEADWALL REQUIRED? —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 />