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HERMIT APPLICATION <br /> r' fr <br /> DRIVEWAY PERMIT APPLICATION <br /> 1� CONSTRUCTION"WITHIN PUBLIC RIGHT-OF-WAY <br /> ' All Irifornriabon must be fllied-in completely <br /> at of ZePhyrhills <br /> 5335 8 Street;zephyrhiiis,FL 33542 <br /> Telephone 813.7810000 Fax 813.780.0005 <br /> pate;o appli tatia c m.ti._ $roce d By ice''�9 mil a <br /> s : <br /> Ptv 8u; 3.n A tttr►eslt. . r SO <br /> .s; y= CiCAPYj�';Pab1 'h(R = <br /> .. <br /> PRONCT/300 91TE: PROPERTY OWNER <br /> Address: Jgqj1j. i R t!L 4vd � i Irt�.S.FL.315,-yA. . Name: AicXAt2 r't�ft: - <br /> Unit#: Address: 53: !� = Unitc <br /> Parcel Identification.Number: CO;State ZIP X;15 t.x <br /> Phone: i .= - Fax:. . . <br /> CONTRACTOR: <br /> CompanY6 A-* A-s?xrrClc"�i#Anf fNSTIZLpcndw <br /> - <br /> Name: M,.Gh�41.61z W <br /> Contractor's License #• GEC f33a3y E-Mail: rlgtAr ec�o'Sd�T7rirs)c iG•e�ryj <br /> Phone: -Cell: 813_ , i Fax: - <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State: zip: <br /> State License #: .Phone: Cell: Fax: <br /> •Descdoelon of Proiect. <br /> TYPE OF DRIVEWAY NGTH OF DRIVEWAY '� CULVERTS NEEDED <br /> ram—RESIDENTIAL DRIVEWAY WIDTH OF DRIVEWAY I ( }REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY KJO. /. EXCAVATION ( }CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY ,_—DEPTH LINEAR FEET ( )BOX CULVERT <br /> ( }OTHER(EXPLAIN) <br /> CONSTRUCTION M RIAL CURB CUT REQUIRED <br /> ASPHALT YES NO <br /> _,,_CONCRETE <br /> HEADWALL REQUIRED? YES _- NO <br /> NOTICE TO APPLICANT: If actual worts exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILITY LOCATIONS REQWRED: CALL BEFORE YOU DIG: 1.800.433.4770 <br /> ` Page 1 of 3 <br />