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:PERMrT-.APP.LTCATION ` <br /> ' F <br /> ® eOAfAMPRERM ITAPPUCa'i ON <br /> +CON •U.CTION WITHIN PUBLIC RZGI T�-O.F=WAY <br /> All lnfnrmation-m=-be-fllled-in completely <br /> City.off2ephyrhills <br /> •5335 ie Street,Zephyrhills,'FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> Y .H IiC3ElOf1:F`r it - i:r,i ;r.'i�t "t rr i=yip s,:;.:: <br /> in`;`r, <br /> :[' r:_ _ .;i__ fix:. c •1. .:t.. _ -;-d� <br /> • �ihner�t:��:•�";'.`.:=. ___ r� ����•�e:- - d.-5?i?� _ - ::e-.�: - -- �'ii'_•:::r�Co P.Citilic;`arls��:J - <br /> AY.�bQ3 W.. ..•r_, ,, <br /> Pit®7ECT' JOB;STYE: •PROPERTY.,OWNER <br /> Address: 531 E - e_Almn1 DK, Name: K=l 1 IA <br /> Unit#: I Address: 5I _ . e" i LZ R4 Unit: <br /> Parcel 1dendfir2tion'Numbe'r: g state zf� 535beia <br /> Phone: Fax: <br /> g�-c�sa-�13 <br /> -,CONTACTOR. <br /> Company: PTO :� k Ll—FF �I:PUIC�I; <br /> Name:Contractor's Ucense#: E-Mall: <br /> Phone• Cell• Fax: <br /> ARCHrmdT/ENGINEER: <br /> Vane: Firm Name: <br /> Address: City State: 7jp• <br /> State License#: Phone: Cell: Fax: <br /> IDescripfion of Proiect <br /> TYPE OF DRIVEWAY 41q,LENGTH OF DRIVEWAY CULVERTSWEEDED <br /> RESIDENTIAL DRIVEWAY ,(_WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE. <br /> COMMERCIAL DRIVEWAY RC+•W EXCAV O1N ( )CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY T//DEPTH- LINEAR FEET ( )BOX CULVERT <br /> . ( )OTHER(EXPLAIN) <br /> GOt15TRUCTION MATERIAL CURLS CUT REQUIRED <br /> _ASPHALT YES 7)C—ND <br /> NCRETE <br /> HEAD-WALL REQUIRED? YES NO <br /> NOTICE TO APPLICANT:.If actual work exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILITY LOCATIONS REQUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br /> I .. <br />