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. t;�j <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 application: ,�'j�3 Prooessed By: • Permit#: /S/()8?� <br /> �Copy to Building Departtt�ent cwar ror s�► �r) <br /> L�idpy to Publk Works <br /> PR07ECT 70B SITE• PROPERTY OWNER <br /> Address:3(Qa-�' � Name: <br /> Unit#: �� ` Address: ' Unit: <br /> Parcel Identification Number: Ci State Zi � _ r <br /> - �` ` l �- � Phone: _ �' ^ Fax: -� � - U <br /> CONTRACTOR: <br /> Com n <br /> Name: ; - , <br /> Contractor's License #: �� 7 ` � E-Mail: � � � � � -� � . <br /> ` `' ;Lt� <br /> _Phone:�,1?�-`��4 c�� Cell• Fax• �',i� ZC� !C��V � — <br /> ARCHITECT/ENGINEER: <br /> Name:� ' � Finn Name: C i 1 �` �� <br /> Address: � �`�' <br /> " � State: �= Zi ; � <br /> ��� � Ci • <br /> State License #: ��,� Phone: 13- _ Cell: �x: -���- � � � <br /> ��scriotion of Proiect <br /> TYPE OF DRIVEWAY �-�: ) LENGTH OF DRNEWAY CULVERTS NEEDED <br /> �RESIDENTIAL DRNE4VAY ,�•�WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE <br /> COMMERCIAI DRIVEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEET ( )BOX CULVERT <br /> rnyy-TRUCTION MATE Ia� CURB CUT REOU ED O OTHER(IXPLAIN) <br /> ASPHALT YES NO <br /> �CONCREfE <br /> HEADWALL R�OUI ED? YES NO <br /> _NOTICE TO APP Ic NT: if actual work exceeds scope of this description,additionai permits or drawings <br /> will be required. <br /> UTILITY LOCATIONS REOU RED• CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />