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M, ' . <br /> 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, Zephyrhilis, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> �ate o��pli�oiil: , ���i.ror��tairiuecfiy) . ��`� . - � <br /> �.�1�_ , �.' . ' , <br /> �: <br /> PR07ECT )OB SITE: PROPERTY OWNER <br /> Address: u Name: � � — ,� <br /> Unit#: Address: ,4�r,� � nit: <br /> Parcel Identification Number: Ci State Zi ' 2� ,�� =� <br /> Phone: ��, ax: <br /> CONTRACTOR: <br /> Company�"iI���2.�.5 f A��n� _ <br /> Name. DA v,,� S�c � r !� <br /> _Contractor's License #: ("�% - O.,�b 7�l'7 E-Mail• <br /> Phone.3Sa. 3ay��0 3 � Cell:����-Z��� Fax• <br /> ARCHITECT/ENGINEER: <br /> Name:,I* Firm Name: <br /> Address: Citv' State• Zip. <br /> State ucense #. Phone: Cell: Fax: <br /> A�rintion of Proiect <br /> TYPE OF DRIVEWAY �LENGTH OF DRNEWAY CULVERTS NEEDED <br /> _�Ij�SIDEMZ4L DRNEWAY �WIDTH OF DRNEWAY ( )REINFORCED CONCRETE <br /> ��COMMERCIAL DRIVEWAY EXCAVATION ( )CORRUGATED MAIERIAL <br /> PUBLIC ACCESS DRNEWAY �DE�pTH LINEAR FEET ( )BOX CULVERT <br /> CONSTRUCTION MATE��L c��CUT R�OUI ED O OTHER(DCPLAIN) <br /> ASPHALT YES L�b <br /> _�EONCRETE <br /> HEADWALL OUI DT YES � <br /> NOTIC�TO APPL - NT: If actual work exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILITY LOCATIANC aFn��TaFn• CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page i of 3 <br />