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� .� ��� <br /> � �� s <br /> ---. l � �-/-� <br /> P.ERMIT=APPL7CATION - <br /> iDRIVEWAY:PERM�T AP,PE.I�ATION <br /> �COI�S"t'RUC��N'1f�IY1'MTN:P.UBl�C=RIGHf-O.F=Wi4Y <br /> All information must be�filled-in compfetely <br /> � -,Cit�r-of:Zephyrhills <br /> "5335.B�'Street,_Zephyrhllls,:FL�33542 <br /> Telephone.8.13J80.0000 Fax 813.780.0005 <br /> , .'j �.. _ ti. y_ - _��� ''��, ; i{t •: <br /> _ . .. . <br /> � . � ..,..� - : , <br /> _ , - <br /> � ; � , . ,��"' `� � <br /> .� ... : ., . . 1��'it.,_'. ����aj+��±z�t a'4i� �r�.,_i'u a �' ��V .�' �"�/��y F�.t ?`r . <br /> - � . <br /> �PRO�ECT .]OB�SITE: '•PROPERTY'OWNER <br /> Address: bo `� 5� - i/ Name: � , <br /> �Unit#: Address: lvo�/ / T Unit: . <br /> Parcel Identification Number: Ci State Zi ' � k S�y <br /> Phone: 3 d o7.�Z Fax: <br /> ______-------... ...__ , <br /> :CONTRA�1'OR: <br /> Com an : <br /> Name: ���'1� 1 <br /> Contractor's License#: F-Maii: <br /> -Phone: �Cell: Fax: <br /> ARCHITECT/ENGINEER: . <br /> "Name: � �(/v�v� Firm Name: <br /> Address: City: State: Zip: <br /> State License#: Ph�ne: Celf: Fax: _ <br /> Descriution of Proiect <br /> TYPE OF DRIVEWAY �,_LENGTH OF DRNEWAY CUL:VERTS NEEDED <br /> _�RESIDENTIAL DRIVEWAY f�_WIDTH OF DRIVEWAY ( )REINF�RCED CONCRETE <br /> COMMERCIAL DRIVEWAY R•O•W EXCAVATION ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRNEWAY DEPfH LINEAR FEET O BOX CULVERT <br /> ( )OTHER(DCPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT U <br /> ASPHALT YES NO <br /> f CONCRETE <br /> HEADWALL REOUIRED? YES NO <br /> NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings <br /> wilt be required. <br /> UTZLITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.500.432.4770 <br /> Page 1 of 3 <br />