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<br />. , <br /> <br />PERMIT APPUCATION <br /> <br />... ," <br />..:.'.............. '.' <br />,. ., <br /> <br /> <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 /> <br />Address: <br />Unit#: C\.v. k{.er 12c:l.. <br />Parcel Identification Number: <br />01-2"- ~ 1- 02'10- OOQO~- 0080 <br /> <br />CONTRACTOR: <br /> <br />Compan~: Q.YI'>\4A ~^rtl'<'(('.\-:~',\ "t Flor,'J-f.A. <br />Name: i-\"I'n \A ~. l bu <br />Contractor's Ucense #: <...f) (. - ( 2. 5 () q, 'f <br />Phone:7fil2 ~ 0 S 2., Cell: 7fl.f - ,,> '; & <br /> <br />E-Mail: i-\~dh€Q@ fY"'''/l(..,,.,s:fl"u{..r,,.,,, (U""'l <br />Fax: 799 - (; 7 .., r <br /> <br />ARCHITECT/ENGINEER: <br /> <br />Name: <br />Address: <br />State Ucense #: <br /> <br />Rrm Name: <br />City: <br />Phone: <br /> <br />State: <br />Cell: <br /> <br />Zip: <br />Fax: <br /> <br />DescriDtion of Proiect <br /> <br />TYPE OF DRIVEWAY <br />__RESIDENTIAL DRIVEWAY <br />--2!;:"COMMERCIAL DRIVEWAY <br />__PUBUC ACCESS DRIVEWAY <br /> <br />_ LENGTH OF DRIVEWAY <br />_WIDTH OF DRIVEWAY <br />~ EXCAVATION <br />_DEPTH _UNEAR FEET <br /> <br />CULVERTS NEEDED <br />( ) REINFORCED CONCRETE <br />( ) CORRUGATED MATERIAL <br />( ) BOX CULVERT <br />( ) OTHER (EXPLAIN) <br /> <br />CONSTRUCTION MATERIAL CURB CUT REOUIRED <br />~_ASPHALT _YES K-NO <br />~_CONCRETE <br /> <br />HEADWALL REOUIRED? _YES .A-NO <br /> <br />NOTICE TO APPUCANT: If acblal 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 10f3 <br />