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r.�i` ' <br /> PERMIT APPLICATION � �� <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All information mu 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 /> ���.0 , � „ s �, � � �,�. �., � : <br /> y .,'7f� �� � �� + 'i?. � 8 ;�3., , � `� ,a�" ' �,y y - � � ., q ,,,� � �k �'�v <br /> �tb�ii� .. t £ , " � '�'�..,��: , <br /> PR07ECT 70B SITE: PROPERTY OWNER <br /> Address: �102 'l� 5r z ►u.� Name: T DoR� W��.►SS <br /> Unit #: Address: S 21 Unit: <br /> Parcel Identification Number: - -Z -Op�p-��Za�- Ci State Zi GAN OA1��� ., Z <br /> � Phone:5S5 281-�3Z Fax: <br /> CONTRACTOR: <br /> ComPa�Y' �11a►,aN Gon1STQ.wr,T�on1 a� �►.eR.tOA ��,t� <br /> Name: kf,v►N"�.y�aN <br /> Contractor's License #: Gvt.151't'1"12 E-Mail: K�.V�N(�{l.yt�q�lco�ls cort <br /> Phone: g�3�-��_ p$�5 Cell: Fax: 8�3 /"T88-�'i't3 <br /> ARCHITECT/ENGINEER: <br /> Name: �'ot�l � qa�Sor1 Firm Name: �'• 1.. �-�l14cN5on1 ��S .�r�• <br /> Address: '{ o.'$px �`1Z8 City: �ApE.��y State: p�, Zip: 2b <br /> State License #: �.85F�3o Phone: 35z SZ�-S�FBCeII: Fax: <br /> Q�criotion of Proiect <br /> TYPE OF DRIVEWAY 13� LENGTH OF DRNEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRNEWAY 10� WIDTH OF DRIVEWAY () RQNFORCED CONCREfE <br /> COMMERQAL DRIVEWAY R.O.W. EXCAVATION () CORRUGATED MATERIAL <br /> �PUBLIC ACCESS DRNEWAY (p,"DEPTH I3 LINEA� R FEET () BOX NLVERT <br /> CONSTRUGTION MATERIAL ( Z�ER (IXPWN) <br /> No C�ulgR.� N�EO�D <br /> ASPHALT YES � NO <br /> �_CONCRETE <br /> HEADWALL REOUIRED? YES C NO <br /> NOTICE TO APPLICANT: If actual work e�cceeds 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 i of 3 <br />