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PERMIT-APPUCA'TION <br /> ORMWA, PERMIT:AP.PLI. All- ON <br /> CONSTRUCTION IT.HZN�P.UBL1C=RIGHT.OF-;WAY <br /> Ail information must-befilled=in completely <br /> k0ty>of,Zephythiils <br /> '5335-8'h Street,: phyrhills,-F.L 33542 , <br /> }wry Telephone:81 .7 0.0000 Fax 813.780.0005 q' y <br /> .,a .y-a+'4 7�J. .�:•Tw,ey_ r .. M <br /> �r�- f. =3-7 <br /> -# = r'- �*M en <br /> iC.p^ CONAN <br /> > P '", .�4 xr"yYaA.ir <br /> 11, <br /> "PRU3ECT JOB;SITEc. -PROPERTY OWNER, <br /> Address:. . Name: '. i'1a n 6 o <br /> Unit#• Address: ' 1 Unit: _ <br /> Parcel Identification'Number: Citvr.State 21" N <br /> 70, <br /> Phone` Fax' <br /> A01' 75(oA <br /> ::CONTRACTOR: " <br /> Company: <br /> Name: <br /> Contractor's Ucerise#: 150 E-Mail: <br /> •Phone: —3 "Cell: i 0 Fax: I <br /> ;ARCHITECT/ENGINEER. <br /> Name: Fun Name: <br /> .Address City' State: Zip. <br /> State Ucense#: Phone:' Cell: Fax <br /> Description of Proiect <br /> -PE O DRIVEW t�Y, R! LENGTH OF-DRIVEWAY CULVERTS NEEDED ' <br /> 'RE DENTIAL DRIVEWAY WIDTH OF DRIVEWAY { )REINFORCED CONCRETE. <br /> CbMMERCIALDRIVEWAY `�`TF" pCCAVATION ( )CORRUGATED.MATERIAL <br /> PUBLIC ACCESS DRIVEWAY ,_(�F DEPTH. LINEAR FEET ( )BOX CULVERT. <br /> { )OTHER(EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REQUIRED <br /> ASPHALT- YES NO <br /> METE <br /> HEADWAt,L REQUIR ? YES _,A_NO <br /> NOTICE TO-APPLICANT:.If adUal Work exceeds scope of this description,additional permits or drawings <br /> -Will be required. <br /> UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: L800.432.4770. <br /> Page 1 of 3 <br />