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a / <br /> r r. <br /> ERMIT APPLICATION •� <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 8t'Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> Date of applrcatron v Processed By ;: Permit.# <br /> ( z '(grayare ldra <br /> oP.Y Building.0epaitment - dopy to Public <br /> PROJECT/JOB SITE: PROPERTY OWNER <br /> Address: Jed i;ttl Ave- Name: AlcWACL J-� <br /> Unit#: Address: S3 qv3 — S Unit: <br /> Parcel Identification Number: City, State Zip G4 7j5_Kd_ <br /> //-q&—) _od _63 vU _ am Phone: 81 - Fax: <br /> CONTRACTOR: <br /> Company' /Y1A5�72CT/►!T ,T1Y57I2rl�t3N �ifan��3v�cD��G <br /> Name: m c,#Ae,7 <br /> Contractor's License #: C,CC 133a 3 ya E-Mail: lnjge-a <br /> Phone: Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br /> Description of Proiect <br /> TYPE OF DRIVEWAY WENGTH OF DRIVEWAY ' y� CULVERTS NEEDED <br /> _,g_RESIDENTIAL DRIVEWAY WIDTH OF DRIVEWAY— i V (o ( )REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEET ( )BOX CULVERT <br /> ( )OTHER(EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REQUIRED <br /> ASPHALT YES NO <br /> [_CONCRETE <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 REQUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />