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PERMIT APPLICATION l r <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 8 Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> Al Date of application: 3 . I Processed By: e . & Permit #: <br /> (gray ar o r staff use only) <br /> ElCopy to ,Building Department Copy to Public Works <br /> - Address: PROJECT JOB SITE: G _ PROPERTY OWNER <br /> P.. . - - • f hl I�S fc- Name: r e -. a u l::riT , � N • <br /> Unit #: ,/is 3 , a ►� � � �; `• �r �l <br /> Unit #: _____— __ -_ Address:1335 Le r� , ,: <br /> Parcel Identification Number: __ City, State, Zip • • <br /> 0 ZZ( l 00 40 00 0 / OO Phone: 813 -67Sgi Z7S$ Fax: $(3- - <br /> CONTRACTOR: <br /> ' <br /> Name: r(\ £l T, 11 t k.W. <br /> — - — <br /> Contractor's License #: C(3 (..._ 03 V-13 E_Mail_ .5S -RC_ . v i ME o I •' . Cc) Irh <br /> Phone: S3-0 Sc( Z1 SS Cell: 8't3 Fax: Wl3 - <br /> ARCHITECT /ENGINEER: . . <br /> Name: . 1t artk . i-i -( C � Firm Name: 4 1 4 y'_en1 <br /> Address: (g58l C� w <br /> eoo AT City: ( ct. . 1 Stat -. Fe- Zi .•., <br /> State License #: 3-a Phone:' 3 -fog (,SO cell: Fax: 803 �Y <br /> Description of Proiect <br /> TYPE OF DRIVEWAY 3 % 4 � 1f I LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> 1/ F RESIDENTIAL DRIVEWAY 17 t 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 REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />