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__ .. <br /> �� ' ,'.�° `'� <br /> PERMIT APPLICATION ,� <br /> ,, , <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All information must be filled-in completely <br /> City of Zephyrhilis <br /> 5335 8"' Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> Date of applica#ion: _ 2 1- ( Processed BY: ,. ' Perr»it #: <br /> (graY a statf h) <br /> �Copy to Building Departrnent �Copy to Public WoNcs ���/ <br /> PR07ECT/JOB SITE: PROPERTY OWNER <br /> Address: � �,,,Q D'-' Name: � E�� �,,�,,, <br /> Unit #: Address: 34S L D.- Unit: <br /> Parcel Identification Number: Ci State Zi � !., ../ GL- S3� 2- <br /> �-ZG.-Lt - v000 -- r�c o�- d 1 Z o Phone: 813-7/i' // Fax: ''d 3-Y3�{- zotp'L <br /> CONTRACTOR: <br /> Company: �! e� /,�.r�,s� 1rv t, �r.r,rv� � <br /> Na me: <br /> Contractor's License #: � ��-- E-Mail: ,` � � �,,' �. p, ;,��. �e,� <br /> Phone: / 3-7►.t =71 I Z •� 3- - 13m Fax: 3� N3 -�D� 2 <br /> , <br /> ARCHITECT/ENGINEER: � z ��� � <br /> �--. <br /> Name: T,.�c E S��'� �c- Firm Name• �. <br /> Address: Ci : State: Zi ; <br /> State License #: �L `�l�`/�� Phone• 013- ��b3/ Cell�/3 27.Q S3�Z Fax � 3�2 Z�2y <br /> Descriution of Proiect <br /> TYPE OF DRIVEWAY �Z LENGTH OF DRNEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRNEWAY � - WIDTH OF DRNEWAY () REINFORCED CONCREfE <br /> _�COMMERCIAL DRIVEWAY R.O.W. EXCAVATION () CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRNEWAY DEPTH '�/� LINEAR FEEI' () BOX CULVERT <br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED (� OTHER (EXPLAIN) <br /> - l � NnP�' <br /> ASPHALT YES NO <br /> .�CONCRETE <br /> HEADWALL REOUIRED� YES �C 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 i of 3 <br />