|
<br />. PERMlT~APPL:ICATION
<br />
<br />.............,..
<br />. .. . . . . . . . , . . - . .
<br />...... ....
<br />..... .....
<br />.... ....
<br />. . . . . . .
<br />. ."
<br />.' '.
<br />.. . . .
<br />". ..
<br />.. . . .
<br />. '
<br />. ;'::,: ..:='
<br />
<br />. . ..
<br />... .",.
<br />.... .....
<br />.. . . . . . . . .
<br />. '
<br />...... .....
<br />...... .........
<br />.. .," .
<br />...... .' -'. . -'-'~"""'"
<br />i , "..,., "..
<br />
<br />()htjy\ dYl e.2il/ +~
<br />r1u ~'fIr
<br />
<br />-
<br />1')~<b.1'Z~i!~t:'E~0;";'<" '." ,y~ ,=" <r~""'. '~1~..-' ~,:....r w, n < . -, ""'~~; '~?;~~"-"-_. ~ ,,=,.r. .="-~ ~-~,,= "
<br />
<br />',............ .' \ I '<- ~ V ...~ t .:. _ J) .......
<br />~~-~~~~~~~;~ - ..,,-
<br />
<br />DRDlEWA'Y ;P.ERMIiTAPPlICAiTION
<br />\CON5:rRUcnON 'wrrHIN~PUBUC :RIGHir-.OF..:WAY
<br />All. informationJIWSt be-filled-in completely
<br />(City .of~Ze!phyrhills
<br />, '5335Sth Street,2ephyrhills,'FL33542
<br />l"e1ephone813.780.0000 . Fax 813.780.0005
<br />
<br />
<br />0000
<br />
<br />
<br />',CONTRACTOR:
<br />
<br />Company: 06:A,LAI\WJeP /!1)A:)f~,<l/1_I.4/7 <:2d'nr/,'r!,f1lfS) .L?t?~ '
<br />Name: t!AI2L ~ <.S'dALArI~A;-e..
<br />Contractor's Ucense #: /it; t!! /51 i/% q h E-Mail:
<br />,Phone:Cell:_.{- Slfh-7..;l7"]-"' Fax: 8/3 -7f?R- ~O;JA
<br />
<br />ARCHITECT/ENGINEER:
<br />
<br />Name:i~.,~ ~. ~jfL
<br />Address:, J' .;,( jJ, i:~ ~~ ~ vA) ,
<br />StateUcense#: .,.... o. cQ,Q30ll./
<br />
<br />A~ Name: ::;;as ,q,,~Jt~<!-;IlI->!:.~, ftz
<br />City. /Am State. , Zi . _ oC!
<br />Phone:,G'J,:'? -;:??'h-5&61Cell: '. Fax:
<br />
<br />DescriDtion of Proiect
<br />
<br />0~1 tJ id,~ tJoNCR.?S-fd- ,g1;J2.~WJ~J../<.
<br />TYPE OF DRIVEWAY
<br />RESIDENTIAL DRIVEWAY
<br />-:?:COMMERCIAL DRIVEWAY
<br />LPUBLlC ACCESS DRIVEWAY
<br />
<br />CONSTRUCTION MATERIAL
<br />ASPHALT
<br />ICONCRETE
<br />
<br />LENGTH OF DRIVEWAY
<br />_WIDTH OF DRIVEWAY
<br />&QJ!lL. . EXCAVATION
<br />~DEPTH o.?~LlNEAR FEET
<br />
<br />~ CUT REOUIRED
<br />YES _NO
<br />
<br />CULVERTS NEEDED
<br />( ) REINFORCED CONCRETE
<br />( ) CORRUGATED MATERIAL
<br />( ) BOX QJLVERT
<br />( ) OTHER (EXPlAIN)
<br />
<br />HEADWALL REOUIRED? _YES ./ NO
<br />
<br />NonCE TO APPUCANT: If actual work exceeds scope of this desaiption, additional permits or drawings
<br />will be required.
<br />
<br />UTILITY LOCATIONS REOUIRED: CAli BEFORE YOU DIG: 1.800.432.4770
<br />
<br />Page 1 of 3
<br />
|