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, „p`v 5, <br /> ��! <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 Zephyrfiills <br /> 5335 8"'Street, Zephyrhills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> Date of application: Processed BY� �Permit#: <br /> �C.opy#o Buiiding Departrnen# to�r area tor sratt use oMy} <br /> �Capy to Public Works <br /> PRO)ECT/]OB SITE• PROPERTY OWNER <br /> Address: ���;<' - �- a � Name: ' '�^ � -�^ � <br /> Unit#: �� ,�_ - Address: '^;-:-,�,� ' � � Unit: <br /> Parcel Identification Number. Oy l� � t`-' - v Ci State Zi �-� - - ���, ,=� <br /> Phone: 2=,1 `' -Fax: ' s �(� <br /> CONTRACTOR: <br /> Com n � > <br /> Name: — i=i Q,"� ^ 1 <br /> Contractor's Li se #: � ' 2 �� � I n E-Mail: �a��``�����,�L ���y�,�� -. <br /> Phone: 1 ' ��, ;_ u,' � Cell: — <br /> Fax: }�J1 <br /> ARCHITECT/ENGINEER: <br /> y" <br /> . <br /> Name:v ��.. �a�i��.` � � ��C'l " Firm Name:��;� 1(�" _ � ;- <br /> Address: �'�' s%c`� 1 j;"!�;�X� L Ci : ''"� ; .�.� <br /> State License #: � `�, Phone: -��" .���r State: Zi , ,; � <br /> Fax: , �- j � <br /> . <br /> pescriotion of Project <br /> P F DRNEWAY �i� � LENGTH OF DRNEWAY CULVERTS NEEDED <br /> _ RESIDENTIAL DRNEWAY �WIDTH OF DRNEWAY ( )REINFORCED CONCRETE <br /> COMMERCL4L DRIVEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEET ( )BOX CULVERT <br /> CONSTRUCTION MATERIAL ( )OTHER(EXPI.AIN) <br /> CURB CUT REOUIRED <br /> ASPHALT YES NO <br /> �CONCRETE <br /> / <br /> HEADWALL R�OUIRED� 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 1 of 3 <br />