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.1 - I ...e..." ....7 ....-, <br /> " . j l: <br /> 2 ' i ( 7 i 4' <br /> ..._, <, A <br /> PERMITAPPLICATION 1-t, <br /> DRIVEWAY ;,PERMIT AP,P.LICATION <br /> CONSTRUCT1ON - WIT.HIN PUBLIC RIGHT-OF-MAY <br /> All information must be completely <br /> • City_ofZephyrhills <br /> '5335 8 Street,:Zephyrhills, 'FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> 'PROJECTPOBSITE: 'PROPERTY'OWNER <br /> Address: / 1 /?i7 SIXZer Name: Milta " 6 - 6o1 a4 <br /> Unit #: Address:39/o Co90 Unit: <br /> Parcel identification Number: City, State, Zip <br /> 8 - 2 6 - -/--- - 26 /00 — 0 0 6 0 Phone: 8/3 -355-// 95 Fax: <br /> CONTRACTOR: <br /> Company: iie /)?, e) r.t.) A / zie pwryr <br /> Name: WI IL/ ,g-rri 4 - 6A cx. <br /> Contractor's Ucense #: E-Mail: <br /> • Phone: 19 /3 355-)Il5 - Cell: S /1% E. Fax: <br /> ARCHITECT/ENGINEER: , <br /> Name: At 4 - Firm Name: <br /> Address: City: State: Zip: <br /> State License 4#: Phone: Cell: Fax: <br /> ' - <br /> TYP OF DRIVEINAY 5_,.01 LENGTH OF DRIVEWAY ,9-' CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY 20 ' WIDTH OF DRIVEWAY ( ) REINFORCED CONCRETE <br /> ' _COMMERCIAL DRIVEWAY R.Q,W. 'EXCAVATION ( ) CORRUGATED MATERIAL <br /> PUBLIC ArrFcS DRIVEWAY 6 DEPTH 04 LINEAR FEET ( ) BOX CULVERT <br /> ( ) OTHER (EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REQUIRED f A -- <br /> ASPHALT ApAcglemy maeg5.--YES NO <br /> • - <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 1 of 3 <br /> , . <br /> - . - - -- <br />