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PERMIT APPLICATION "�` ` <br /> DRIVEWAY PERMIT APPLICpTION <br /> CONSTRUCTION iNITHIIV pUBLiC RIGHT-OF-WAY <br /> All information m�be filied-fn compietely <br /> CitY of Zephyrhills <br /> 5335 8�'Street,Zephyrhiils, FL 33542 <br /> Telephone 813.780.0000 Fax$13.780.0005 <br /> Dabe af ap�licadon; Pro�ssed By: Pernnit�tc �`�.�:(�� <br /> (9�Y�ea rar s�F use ony) <br /> QCAJl�GD 9UtId1iH,�D�t <br /> L7Copy#a A�bic Wo►1s <br /> PRO]ECT J�B SITE• PROPERTY OWNER <br /> nddre�s: a = f.� ,t� .. - <br /> L_,-, #: � lvame: Ke�s�z;�ve e ;� t�� � �� <br /> Address. ar�s�s".FC�,g,o,�,f+��� un►t: <br /> Parc�ei I d e r�fi c a d o n Num b e r: p State Zi � ��GN� <br /> � �� ��� �-ov�o�- On �o Phone: a7�?Y3 _�7a6 Fax: i�s- t- <br /> .�J <br /> CONTRAGTOR: <br /> ComDany: (�,r>R l2/c.J�� Orvf�S u'c,c" <br /> Name: T,y�t/,� Wi�L-i�m S <br /> �trdcbDr's License#: G/'G/��G�;?`�' � E-Mail• ci�Gv��-i/�-ryrs �°Ti�,�,o/1l�?Y i',C' ��/ <br /> Cei1. ?� ���--��7.� 3 Fax. ��7-53�`l-��tr7 <br /> � 3 �v b <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name; <br /> ��' � � State: � ; <br /> state Lic�ense#: Pnone: c,��: <br /> Fax: <br /> � Y ��' LENGIN OF DRtVEYVAY ,�V,"�G,l.tl <br /> �'_R6IDEnn7U��RNEwAY CULVERTS NE�DED <br /> ���WIDiN OP DRNEWAY ;N �.ri.LV <br /> COMMERCIAL DRIVEWAY ( )REIIVFORCED CpN(72EiE <br /> PUBLIC AaC�SS DRIVEWAY �� �F�ry LIIV�AR FEEf � )CORRUGA7ED MATERIA� <br /> ( )B�X CULYERT <br /> CURB CUT i�Fn�to n O OTHER(D�LAIN) <br /> �PHALT yES ,�_NO - ,�t�s`�uL° <br /> QOPICRE7"E <br /> 1'ES �NO <br /> NOTICE TO�l�s*�`��tr- If acival work exaeeds scope of tfiis descriPtion.additional <br /> will be r�cquir+ed. Penr�its or drawings <br /> ��L TI i���roFn �,�gE�p�YOU OIG: i.800.432.4770 <br /> Page 1 of 3 <br />