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<br /> �ERMI'P-APpLICA'1�ON
<br /> I�►R=VEWA1t:P.ERMIT:APPL�ICAT:�Ot�
<br /> 3CC�NSTR1t.CTtON�IA�ITHT(V�PUBL�IC-t�TGHT�CbF�WAY
<br /> Atl information must be-filled-in complete(y
<br />� :City.ofaZep�hyrhills
<br /> 'S335:8�'Street,.2ephyrhills,�FL 33542
<br /> Teiephane.813.780AOOQ Fax 813:780.0005
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<br /> `PR4 ECT .�t�B;SITE: PROPERTY'CtWNER
<br /> � Address: D Name: t L.s�' �
<br /> UNt#: Address ' nEt:
<br /> Parcel Identification Number: � C' State Zi Z,.
<br /> Phane: -- � Fax:
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<br /> ', �-CONTR.ACTI�R: ���1 ga,Y` '
<br /> Comt3any;
<br /> ' Name.
<br /> Contractor's License#: E-Mail:
<br /> �Phone: �C�II: °- d Fax:
<br /> ARCliYTECT/ENGINEER: . I
<br /> Name• Frrn iVeme:
<br /> Address: City: State: Zip:
<br /> State�cense#: Phone. Cell: Fa�c:
<br /> i Descriptiora af Proiect
<br /> TYPE G1F DRIVEWAY l�j'��j!� �LENGTH OF DRNEWAY CULVERTS'NEEDED
<br /> �_RESIDEMIAC AittVEWAY ��}',.�„��WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE
<br /> CCIMMERQAL DRNEWAY • R.t'l.W, ,�7CCAVATI0IU ( )CORRlJt"sA'fED MATERtA1.
<br /> PUBLIC ACCESS DRIVEWAY DEPTki LiNEAR FEEr ( )BOX CULVERT
<br /> ( )OTHER(IXPIAIIV)
<br /> CONS1'RUCTION MATERIAL CURB CU7 REQUIRED
<br /> ASPHALT YES �X_NO
<br /> �CONCRE fE
<br /> HEADWALL REOUIR�D�' YES NO
<br /> NOTiC�TO kPPLICANT: If actua�worlc exceeds scope af this descriptian,additional permits ar dravuings
<br /> �wilt be required.
<br /> U7TLITY LOCATIONS REOd1IREDt CALL BEFORE YOU DIG: 1.800.432.4770
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