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<br />:PERMIT~APP.DCATlON <br /> <br /> <br />:I~J:~~:~;.~R~:~_'~ ~".'"=-""' ._~-_.- ':~~-~~j:,:",~ '~-~;;~'":i:,"T~~ '~'H;:J~~~?\~~:=~~"m~~;:~'"" ,: " ,', <br /> <br />~~lli~~~"'"" ",C.., '-,,-,,' <br /> <br />DRIVEWA.Y ~PERMU :A~PlICA1TlON <br />,CONS11RUcrION ~Wz;rHIN~P.uBllC ;RIGHir....OF-=WAY <br />All information 1Il1JSt be-filled-in completely <br />\Cit;y .of:Ze!Phyrhills <br />5335 :8111 Street,2ephyrhllls,'FL.33542 <br />"TelephoneB13.780.0000 . Fax 813.780.0005 <br /> <br />Address: <br />. Unit :#: <br />Parcel Identification .Number: <br /> <br /> <br />l, 3' 3.s '2... <br /> <br />1:0NTRACTOR: ' <br /> <br /> <br />l' CpA/57 t.- l..-- <br /> <br />E-Mail: <br />Fax: 8/3 783 1861/ <br /> <br />ARCHITECT/ENGINEER: <br /> <br />.Name: <br />Address: <br />State License #: <br /> <br />Firm Name: <br />City: <br />Phone: <br /> <br />State: <br />Cell: <br /> <br />Zip: <br />Fax: . <br /> <br />DescriDtion of Proiect <br /> <br />tt LENGTH OF DRIVEWAY <br />~WIDTH OF DRIVEWAY <br />R.O.W. EXCAVATION <br />_DEPTH _UNEAR FEET <br /> <br />,CURB CUT REOUIRED <br />_YES _NO <br /> <br />CULVERTS NEEDED <br />( ) REINFORCED CONCRETE <br />( ) CORRUGATED MATERIAL <br />() BOX aJLVERT <br />( ) OTHER (EXPLAIN) <br /> <br />~ OF DRIVEWAY <br />.---:RESIDENTIAL DRIVEWAY <br />_COMMERCIAL DRIVEWAY <br />_PUBUC ACCESS DRIVEWAY <br /> <br />CONSTRUCTION MATERIAL <br />_ASPHALT <br />"/CONCRETE <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 />Pagel of 3 <br />