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• <br /> % �. <br /> PERMIT APPLICATION 1 . ,: <br /> ^, �,. i•1 t0. \� <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 8 Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> Date of application: 34.09 Processed By: Permit #: <br /> (gray area f staff use only) <br /> ❑Copy to puilding Department rOopy to Public Works <br /> PROJECT JOB SITE: _ _PROPERTY OWNE <br /> Address: i. M • e_ • ' . ►..0 Name: �t � ' <br /> Unit #: Address:1335 Lewis er <br /> Parcel Identification Number: City, State, Zip Dovert <br /> 0 <br /> Z-2-( 00c{ 0 00 800 0 / 00 Phone: 213 -foSq Z7S8 Fax: %/3- <br /> CONTRACTOR: <br /> Come : , l=1= i►..- : — • <br /> Name: f'C - cc. el 11-3v( <br /> Contractor's License #: C-2 5C- o3""/ V'13 E-Mail: SS p. he b u i d. -"fors &A. • cry ry' <br /> Phone: b."3- Sc(Z SS Cell: &3 32:3 '"S 2 t LC Fax: 'KS 9 <br /> ARCHITECT /ENGINEER: n ' <br /> 1111 <br /> Name: . �� �-� C� Firm Name: ��� <br /> Address: (cis ewoo C ity: (.a- to rc Stag - Zip: ?� <br /> State License #: 3 7a art Phone: (,3 -fo&tf (,SO& ell: Fax: &,3 � <br /> Description of Proiect <br /> TYPE OF DRIVEWAY 34 LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> (/ RESIDENTIAL DRIVEWAY 17 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 REOUIRED <br /> ASPHALT YES NO <br /> ✓CONCRETE <br /> HEADWALL REOUIRED? 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 />