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<br /> PERMIT APPLICATION '��`"'��'`
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<br /> DRTVEWAY PERMIT APPLICATION
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<br /> CONSTRUCTION WITHIN �PUBLIC RIGHT-OF-INAY
<br /> All information must be filled-in completely
<br /> City af Zephyrhitls
<br /> 5335 8�'Street, Zephyrhills, FL 33542
<br /> 7elephone 813.780.0000 Fax 813.780A005 '
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<br /> PR 3ECTj�OB SITE: PRQ ERTY 4WNER
<br /> Address: �, c " ^ � Name: � ��'�
<br /> Unit#: Address Unit:
<br /> Parcet Identification Number: - Ci State Zi
<br /> (� 'C� Phone: '1 03Fax: — -
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<br /> CQNTRACTOR: 3
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<br /> Name: � �'y�
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<br /> Contra r s 'cense#: ' E-Mail: . � "" � .(f(G�
<br /> Phone: ( Celi: ^[ ax:
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<br /> ARCHITECTJENGINEER: ,
<br /> Name: i�t �}'}�} ��{�'`�-{� � Firm Name: ` ` Y "Yt , t,
<br /> Address: '� t , i( Ci G° State: Zi � (
<br /> State Zicense #: Phane: '- (�- t ------ Fax: {,P2 --��.
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<br /> Description of Project
<br /> P t1F QRIVEWAY �l� LENGTN OF DRIVEWAY CU�VERTS NEEDED
<br /> RESIDENTIAL DRNEWAY I�WIDTH OF DRII/EWAY O REINFORCED CONCREi'E
<br /> CQMMERCIAL DRNEWAY R.�.W. �EXCAVATION ( )CflRRU6ATED MATEF2IAL
<br /> PU8l.IC ACCE55 DRIVEWAY DEPTH l.INEAR PEET ( j BOX ClJLVERT
<br /> ( )OTHER(IXPI.AIN)
<br /> C4NSTRUCTION MATERIAL CUFtB CUT REQUIRED
<br /> ASPNALT YES ' NQ
<br /> ��J CONCREfE
<br /> HEADWALt REQUIRED? YES � NO �
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<br /> NOTICE TO APPLIGANT: If actua!work exceeds scope of this description,additional permits or drawings
<br /> wilt 6e required. I
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<br /> UTILITY LOCA7EONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
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