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PERMIT APPLICATION <br /> } <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> (i All information must be filled-In completely <br /> City of 4poyrhills <br /> Q� 5335 861 Street,Zephyrhills, FL 33542 <br /> Telephone 813.780.00OOA Fax 813.780.0005 <br /> a" <br /> Date.. 'IicaEio_n.. Processeai`B :> iA Pem #:. <br /> - Y - <br /> _ <br /> x <br /> �D'e rtiiiie - tti .ub cWiit#ss= <br /> - - .0Bai1 <br /> PR03ECT/30B SITE: PROPERTY OWNER <br /> Address: d Name: ,t t, S,L Sc o <br /> _ <br /> Unit#: Address: �-A Unit: <br /> Parcel Identification Numl3er. �7- - � Ci. Stat :ZI.: �t -T 1 2. <br /> Phone: : o 66 - 'Fax: <br /> CONTRACTOR: <br /> Company: <br /> Name: Zi <br /> Contractor's License#: E-Mail: <br /> Phone: Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: _ <br /> Address: City. State: Zso <br /> State license#: Phone: Cell: Fax: <br /> Description of Project <br /> TYPE OF DRIVEWAY S�� LENGTH OF DRIVEWAY CULVERTS NEEDED, <br /> .!�,_RESIDENML DRIVEWAY VZ=WIDTH OF DRIVEWAY (K)REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY R O.W. EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY ( DEPTH LINEAR FEET ( )BOX CULVERT <br /> CONSTRUCTION MATERIAL �IJi CURB UIRED ( }OTHER(EXPLAIN) <br /> ASPHALT YES NO <br /> CONCRETE 10 <br /> Xt— <br /> HIEADWALL REQUIRED? YES NO <br /> JJOTICE 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: 1400.432.4770 <br /> Page 1 of 3 <br />