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7 i n <br /> ' 1'`j eon ir'Cr , <br /> PERMIT APPLICATION � ! C.41i <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 813.780.0 0 Fax 813.780.0005 <br /> Dateeg a POI itatio Processed Bpi ` „; !" Permit # (/ � 6 <br /> -1404pKto C]copy`t 'Palk Wo ... <br /> PROJECT/30B SITE: PROPERTY OWNER <br /> Address: 5101 13 S +ree+ Name: LARRY Cos TICAN <br /> Unit #: Address: 57oI 13 ST Unit: <br /> Parcel Identification Number: Il cclO -o84 City, State, Zip "Z ,Phyrh;I1s FL 3 <br /> - o O S O Phone: 25i3- 788'-200 a Fax: <br /> cc. lI f5I3- 7I3 -1144 <br /> CONTRACTOR: <br /> Company: 7i^ ,19f <br /> Name: <br /> Contractor's License #: E -Mail: <br /> Phone: Cell: Fax: <br /> ARCHITECT /ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br /> Description of Proiect <br /> TYPE OF DRIVEWAY LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> X RESIDENTIAL DRIVEWAY WIDTH OF DRIVEWAY ( ) REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY R.O.W. EXCAVATION ( ) CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEET ( ) BOX CULVERT <br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED ( ) OTHER (EXPLAIN) <br /> ASPHALT YES NO <br /> X 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 REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />