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1 4 <br /> -PERWr APKICATION ^' x <br /> r.DRIVEWAY P.ERMIT,APPLTCA7ION <br /> ,CONSTRIl: : • ON .WITHIN:P.UBLIC=RIGHT•-O.F-;WAY <br /> All information must-be-filled-In completely <br /> ;Cit V.of:Zephyrhills <br /> •5335:81'Street,2ephyrhilis,'FL 33542 <br /> 7elpphone.813.780.0000 Fax 813.780.0005 <br /> �1tt.11 'sss t0i ..y '-=T - •2t .:s3.,;.:• _x ; _ �y�+.i&' .; .- =•-••r _a.�, ":'£'ems„: 3"4'-`.' .� . -a. h +§ ` <br /> !E ez- q cs <br /> PENNE ER <br /> ':PRO3ECT JOWSITE: P PERTYfOWNER <br /> Address: s S•5Z / Ave, Name: ^ It-1 d s sb,C <br /> .-Unit*: Address: 1 'be--ee- a Unit: <br /> Parcel Identification'Number: - City,State Zip t r L-- 33 2, <br /> 3 — 61 8 Phone: 3 0 Fax: <br /> -CONTRACTOR: <br /> Company: ,, d <br /> Name: ��yf' U7t � . <br /> Contractor's License#: GIZ G/3 3:Zq E-Mall: : •cid j,,ve,s noen . t?, <br /> 'Phone:? 3-9173-5",?_56 'Cell:9/3-2,4_5'1 y4.5 Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: Stag: Zip: <br /> State License#: Phone: Cell: Fax: <br /> pescription of Protect <br /> TYPE OF DRIVEWAY Z LENGTH OF•DRIVEWAY CULVERTS-NEEDED <br /> ,,,//""RESIDENTIAL.DRIVEWAY WIDTH OF DRIVEWAY ( )REINFORCED CO.NCRETE. <br /> COMMERCIALL,DRIVEWAY R O,W. EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY Ll EPTH LINEAR FEET { )BOX CULVERT <br /> ( )OTHER(EXPLAIN) <br /> COIUSTRUCTIORN MATERIAL CURB CUT REQUIRED <br /> PHALT YES NO <br /> __yNCLZETE . <br /> HEADWAL 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 I of 3 <br />