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<br /> -PERMIT=APPL7CATION •' ` � `=
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<br /> �.DRIVEWA�(:PERMIT:APPL�ICATION
<br /> �CONSTRUCTION�W : �HTN'P.UBL7C-RIGHT�OF=WAY �
<br /> All informati n must be�filled-in completely
<br />' � <C ty�of-iZephyrhiils
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<br /> �5335.8 treet,Zephyrhills,�FL 33542
<br /> �Telephone.8i .780.0000 Fax 813.780.0005
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<br /> j PR07ECT .]OB�SIT�: PROPER �OWNER
<br />! Address: 5oS / T.S��TiPee Name: �!�. G �
<br /> Unit#: � Address• b ./�,P� Unit: ��
<br /> Parcelldentification�Number: Ci State .Zi ,a � /7 p �
<br /> Phone:�i7-y�S-g.�"� Fax:
<br /> �_CONTRACTOR:
<br /> Com an : �
<br /> Name:
<br /> Contractor's License#: E-Mail:
<br /> Phone: Cell: Fax:
<br /> ARCHITECT/ENGINEER: _
<br /> �Name: Fir Name:
<br /> Address: Ci State: Zi
<br /> State License#: Ph ne: Cell: Fax:
<br /> escri tion of Pro'e
<br /> TYP OF DRIVEWAY a 3� NGTH OF DRIVEWAY CULVERTS NEEDED
<br /> RESIDENTIAL DRNEWAY 33 .� DTH OF DRNEWAY ( )REINFORCED CONCRETE
<br /> COMMERCL4L DRNEWAY R.O. . EXCAVATION ' ( )CORRUGATED MATERIAL
<br /> PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEET ( )BOX NLVERT
<br /> ( )OTHER(DCPLAIN) '
<br /> CONSTRUCTION MATERIAL CU CUT REOUIRED
<br /> ASPHALT �YES _�C NO
<br /> �CONCRETE-
<br /> HEADWALL REOUIRED? YES _�NO
<br /> NOTICE TO APPLICANT: If actuai work ex eeds scope of this description,additional permits or drawings
<br /> will be required.
<br /> UTILITY LOCATIONS RE U RED: CALL BEFORE YOU DIG: 1.800.432.4770
<br /> Page 1 of 3 ,
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