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PERMIT APPLICATION " <br /> t <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 8th Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> j`" ,Y'^..C'°"'.V'.J.r '� 3LF"! ��t`�� 9W' 110010711, <br /> , RO:'.�M ` <br /> p�.._;'$ 9.:. .rf%rri-,F �K� �'�.s .�: x_ r_.�` ���,=-'- ��,�,;�it�,?f`Ttirt".'ntI:lE��� <br /> PROJECT/JOB SITE: PROPERTY OWNER <br /> Address:3s i Name: o,-4r,,, _:7nc <br /> Unit#: Address: i-:2 --rf Unit: <br /> Parcel Identification Number:SZZS City, State Zip <br /> O Phone: ,/5G Fax: <br /> G <br /> CONTRACTOR: <br /> Company: tea,-4,o <br /> Name: L k-D y C>0 6 -L3 ._Pe- g <br /> Contractor's License #: CR C UL E-Mail: jP L)e)�C. <br /> Phone: 'F/-3• SyGl 3Y7 Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: A R Firm Name: <br /> Address: State: �L Zip: <br /> State License Fax: <br /> Descriition of Project <br /> TYPE PEDRIVEWAY 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 /> 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 I of 3 <br />