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<br />~~~~~~~~~: '"'~ ~~,'~=~_.'''~-m,"~."~~~~~;,~~;:.a.'~ ,,- ,::~J1r~_~ '~',~"'~~~"":"'='''''' ~n"~:.~"', <br /> <br />,,,"'C iLf~ :-~~~.-...~ . <br /> <br />~~~ /.15 L'i^Jt>- <br />'-'t' I S.u,,~"b,"<-~oU' <br />\\\z..:\ ~.(~{' ~ r<- (}J1)~ <br />~:- cft'-'.~~ <br />~l\s ~ \J~" + <br />.IftRI,"'EW'A'V :PERM'r.'I" A' "pp. ~C''''TT.ON ~ ~ " t~\A~ <br />'II .W ."'.. ~. '. oL~1 ' . ,L,;,L ",ll.:oa. . \ 0 1 ~ t.-i,T~' ~ <br />~CONsrROCDON '.Wn7HIN ~PlJBllC :RIGHJ"~O~WAY \'~ \ O~~+ c..Wvt <br />All infonnation l!1l.!at be'filled-in completely uta ~. , <br />\City,of~~phyrhills f'(; \t\..l.- ~ -r <br />"5335Sth 5treet,2ephyrhills,'FL 33542 . \ \ ~.p~D-"- <br />"Telephone ,813.780.0000, Fax 813.780.0005 IP' ~ ~lIC- 's ~ <br />~ <br /> <br /> <br />,PERMIT'APPLICATION' <br /> <br /> <br />, <br /> <br /> <br />'(:ONTRACTOR: <br /> <br />'Company:' ~0ltf),1f>r~e~ Serllt'teS <br />Name: :Ro e rq, of erh e i <br />Contractor's Ucense #: d CJ i/; 0 c;oa 10 7 / <br />Phone: $? I ~ - 78':L -3 ~'Cell: <br /> <br />E-Mail: <br />Fax: <br /> <br />ARCHITECT IENGINEER: <br /> <br />~Name:j>,,,. '. <br />;6.ddress: <br />State Ucense #: <br /> <br />'..'.'i."..,,'; <br /> <br />Finn;Name: <br />City: <br />Phone: <br /> <br />State: <br />Cell: <br /> <br />Zip: <br />Fax: <br /> <br />CONSTRUCTION MATERIAL . <br />_ASPHALT <br />~CONCRETE <br /> <br />DescriDtion of Pro;ect <br /> <br />,0111~~GTH OFDRIVEWAY <br />'~DTH OF DRIVEWAY <br />.&QJ!![.. EXCAVATION <br />_DEPTH _UNEAR FEET <br /> <br />CURB CUT RE~RED <br />_YES NO <br /> <br />CULVERTS NEEDED <br />( ) REINFORCED CONCRETE <br />( ) CORRUGATED MATERIAL <br />( ) BOX OJLVERT <br />( ) OTHER (EXPLAIN) <br /> <br />Y::OF DRIVEWAY <br />RESIOEI'(TIAL DRIVEWAY <br />_COMMERaAL DRIVEWAY <br />_PUBUC ACCESS DRIVEWAY <br /> <br />HEADWALL REOUIRED? _YES _NO <br /> <br />NOTICE TO APPUCANT: If actual work exceeds scope of this description, additional permits or drawings <br />will be required. <br /> <br />UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> <br />Page 1 of 3 <br />