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PERMIT APPLICATION <br /> Y <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 /> EE1 i _ m r '� 1 w, a <br /> PROJECT/JOB SITE: PROPERTY OWNER <br /> Address: Name: o.-4o�, _J"n C <br /> Unit#: lof Address: j_t2d,.oQ Unit: <br /> Parcel Identification Number: City, State Zip <br /> -o/io o -Do&a Phone: 7 <br /> CC��v�I-�c-t-w ��b��u��.�� �,.z�d)► r✓�v r-� 8 r. [�d'�+—r <br /> CONTRACTOR: <br /> Name: <br /> Contractor's License #: G� C 0� E-Mail: L) ,-)f <br /> Phone: rye) Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: �'� f�r-S c'i-� Firm Name: <br /> Address: 6e.4City:-�� �,,�,� State: �L_ Zip: <br /> State License #: Phone: Fax: <br /> Description of Project <br /> TYPE PEPRIVEWAY LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY WIDTH OF DRIVEWAY ( )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 /> PHALT 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 />