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�� <br /> � � � <br /> ,�:;�;t� �/,�- �D�'- %j'�.? <br /> ;;,• �, <br /> ; -.�e.,r .. <br /> RERMIT APPLICATION '`R'� <br /> -.h <br /> DRtVEWAY PERMIT APPLICATION <br /> CONSTRUCTIOI� 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 813J80.0000 Fax 813J80.000 �� <br /> Dabe of applk;adon: 3._Z�.-(3 Proce�sed By:. �;�^� P'ermit#: <br /> cpay a�to►sdtf uoe or�Iy) � _ , <br /> _ OCopr Uo euildin9 D�ar�r�eM �Copv eo Public.worics <br /> PR07ECT 70B SIT : PROPERTY OWNER <br /> Address: �� .� �,- ,,�� Name: � d ,( � ,// <br /> Unit#: Address: t� �( <� Unit: -�`� <br /> Parcel Identification Number: ' .�' ,m,� � Ci State i ,c // ���/ <br /> Phone: i - 7� - �o� ax: <br /> CONTRACTOR: � <br /> ComPanY� /��r--��S °rf �ss"�c. <br /> Name: ,,�i, - ,.� <br /> Contractor's License #: LC�•- ' � E-Mail: ✓�� -� � �,.� 4 �-�: c�wr <br /> Phone: _�s�_��?�-�03 7 Cell: �5�3a_. �ozf� Fax: ���- ",�y-- ,�/ � <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State• Zip• <br /> State License #: Phone: Cell: Fax: <br /> Desc�iution of Proiect <br /> TYPE OF DRIVEWAY y� �LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY /5"�yyIDTH OF DRIVEWAY ( )REINFORCED CONCRETE <br /> t�C COMMERCIAL DRIVEWAY R•O•W EXCAVATIOI�! ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEEf O BOX CULVERT <br /> �OTHER(IXPLAIN) <br /> �ONSTRUCTIONI MATERIAL CURB CUT REOUIR�D ,�,�,,1� <br /> ASPHALT YES �_NO <br /> ,y�CONCRETE <br /> HEADWALL REOUIRED? YES �NO <br /> f�OT'ICE TO/f►PPlICAN'T: IE actual work exceeds scop�cf this description,additional permits or drawings <br /> wil! be required. <br /> UTILITY�OC/4TION&REOUI ED• C�LL BEFORE YOU DIG: 1.800.432.4�I0 <br /> Fage S of 3 <br />