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PERMIT APPLICATION <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 /> Date of applicadon: �Z—( Z Prooessed By: PermR#: <br /> (9ray sdff ) <br /> �co���,�a��o���,c ;�oar ao�,�wo►� Q�C°✓ �'Z�-l y <br /> PR07ECT 70B SITE: PROPERTY OWNER <br /> Address: t �� ST �G� Name: [ SRP��L f�C3�� <br /> Unit#: Address: y I t�O�'�� 5 . Unit: <br /> Parcel Identification Number: Ci State Zi z�Y '�F�L L� < <�.- 33'�`t� <br /> Phone: 6 �c�i- Fax: <br /> CONTRACTOR: <br /> Company• 7` � 1�!-'��C C l.-, �S �-� (�'�� � <br /> Name� � t-�t�4 (` (�NL�r3t=c._ c_ <br /> Contractor's License #: E-Mail: <br /> Phone: �� 5�13 �-�- �fa-`I 1 Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State: ZIp: <br /> State License #: Phone: Cell: Fax: <br /> Descriution of Proiect <br /> �p �_LENGTH OF DRNEWAY (�) CULVERTS NEEDED <br /> � RESIDENTIAL DRNEWAY �vP(�EX (0' WIDTH OF DRNEWAY O REINFORCED CONCRETE <br /> COMMERCIAL DRNEWAY R•O•W EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEET ( )BOX CULVERT <br /> ( )OTHER(EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED <br /> �ASPHALT YES NO <br /> �' 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 i of 3 <br />