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� <br /> . � <br /> a>� . ` j <br /> PERMIT APPLICATION <br /> ^� <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTIOH 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 /> . .._ �.. . .. . <br /> �Dabe of-appikaf�on: - ' , <br /> � - �, ',� .'_ �i#:_ . <br /> (yrsyaia tor sblr use oNr) ` -. <br /> ��PY to 8u117fing.�ti"r�ent ' �Cbpa►;b�Pu'b'lic=WoikS ' <br /> PRO�ECT )OB SITE: PROPERTY OWNER <br /> Address: � - Name: �� C � � <br /> Unit#: Address: G -�S ��i Unit: <br /> Parcel Identification Number: Ci State Zi Ze � r , l �f S� <br /> �'�-�1 �'2— �� �GO— • a Phone: ax: <br /> t_ za't—�t�—l�S$� <br /> CONTRACTOR: <br /> CompenY� C:�. c,c- CE c�t('u-�h'� ��ti.3 c e�, �v.-� <br /> Name: p <br /> Contrador's License #: c�. y , E-Mail: C � c ^ G' 1-C <br /> Phone: _u Cell: 3- i -� Fax: s��-1 ; � m �. c <br /> � Qo c�'V� <br /> ARCHITEGT/ENGINEER: <br /> Name• ��{�p�i� Firm Name: U�.,�r;� �.S'v�� �.y�����a;Jr,�-ol <br /> Address: 'h �� ui� I I c�C-�.y2�.�J�lr.a CitY: �}r.�g State: � Zip:3ZSz S <br /> State ucense #: _�'Z ,� Phone• � <br /> 4� .��- i-a�S ,S Cell: Fax:3S1 S2�—�Y�� <br /> Description of Proiect <br /> Iv�BZ,YE�A,1� -��•6` LENGTH OF DRNEWAY CUWERTS NEEDED <br /> RESIDENTIAL DRIVEWAY I�WIDTI-I OF DRIVEWAY ( )REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY EXGVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY ..�DE�PTH �SZ- LINEAR FEEf ( )BOX CULVERT <br /> ( )OTHER(IXPWN) <br /> CONSTRUCTION MATERIAL <br /> ASPHALT YES NO <br /> �CONCRETE <br /> HEADWALL REOUIRED? YES �NO <br /> NOTICE TO APPLICAI�T: If actual work exceeds scope of this description,additional permits or drawings <br /> will be n�quired. <br /> UTILITY LOC/►TIONS REOUIREDs CALL BEFORE YOU DIG: 1.800.432.4770 <br /> i <br /> Page i of 3 <br />