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<br />/: ,~- <br />A <br /> <br />/' <br /> <br />PERMIT APPUCATION <br /> <br />........'...................... <br />., . <br /> <br /> <br />DRIVEWAY PERMIT APPLICATION <br />CONSTRUCTION WITHIN PUBUC RIGHT-Of-WAY <br />All information ~ 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 /> <br />Address: V '€.A) Ln. <br />Unit#: <br />Parcel Identification Number: <br />0)- ~-2\-o2 0.00000- 00,"0 <br /> <br />LLG. <br /> <br />CONTRACTOR: <br /> <br />Company: Q.y"" (I.", Go/'t 5+ / (.< (.~: Q." 0 J F( ()/': do. <br />Name: \-\c.ro \). ~; I&'..u <br />Contractor's Ucense : c... ~ C - t ~ S- () if II.( <br />Phone: filJ -782.-092.> Cell: ti'II -7/"i- &S'q" <br /> <br />E-Mail: 1-\ 01}: I},~e <fi) er~a"" Co.,"\5-t-/'u ,-t: M , ~,"'l <br />Fax: ~ IJ - 7 8 g -- , 77 ] <br /> <br />ARCHITECT I ENGINEER: <br /> <br />Name: <br />Address: <br />State Ucense #: <br /> <br />FIrm Name: <br />Oty: <br />Phone: <br /> <br />State: <br />Cell: <br /> <br />Zip: <br />Fax: <br /> <br />DescrtDtion of Proiect <br /> <br />TYPE OF DRIVEWAY <br />RESIDENllAL DRIVEWAY <br />X COMMERCIAL DRIVEWAY <br />_PUBUC ACCESS DRIVEWAY <br /> <br />CONSTRUCTION MATERIAL <br />.lie ASPHALT <br />X CONCRETE <br /> <br />HEADWALL REOUIRED? _YES -LNO <br /> <br />_LENGTH OF DRIVEWAY <br />_WIDTH OF DRIVEWAY <br />R.O.W. EXCAVATION <br />_DEPlli _UN EAR FEET <br /> <br />CURB CUT REOUIRED <br />_YES ..LNO <br /> <br />CULVERTS NEEDED <br />( ) REINFORCED CONCRETE <br />( ) CORRUGATED MATERIAL <br />( ) BOX CULVERT <br />( ) OTHER (EXPLAIN) <br /> <br />NOTICE TO APPUCANT: If actual work exceeds scope of this desaiption, additional permits or drawings <br />will be required. <br /> <br />UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> <br />Page 1 of 3 <br />