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PERMIT APPLICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> (CONSTRUCTION - WITHIN ,PUBL1C RIGHT-OF-WAY <br /> All information must be completely <br /> City.oflephyrhills <br /> 5335 8 Street,:Zephyrhills, *FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> t;71: <br /> tr71 03. r , t':"4 ..7- <br /> PRWECTPOBSM: PROPERT7WN, <br /> Address: 5 Name: t4114feM <br /> Unit #: Address: c" <br /> Parcel Identification Number: City, State,Zip A.} /) <br /> PhoneR— 7Z ' , ax: <br /> 2 7- 3- 't921 <br /> ZONTRACTOR•Ap <br /> , /1 <br /> com.an : <br /> / • <br /> Name: f v-i16 5 i f:12 • 6 154vk <br /> Contractor's License #: 4C E-Mall - - — - e <br /> Phone: 2' - Cell: , / ? O • Fax: 3' - • , '6 <br /> ARCHITECT/ENGINEER: <br /> Name: :-// Firm Name: <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br /> Description of Project <br /> • <br /> TYPE OF DRIVEWAY / LENGTH OF DFLIVEWAY X CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY al_WIDTH OF DRIVEWAY y 2 ( ) REINFORCED CONCRETE <br /> ›C COMMERCIAL DRIVEWAY R.O.W. EXCAVATION ( ) CORRUGATED MATERIAL <br /> _PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEET ( ) BOX CULVERT <br /> ( ) OTHER (EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REOUARED <br /> ASPHALT YES NO <br /> CONCRETE <br /> JIEADWALL REOUIRED? 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 REOUIRED: CALL BEFORE YOU DIG: 1.800432.4770 <br /> Page 1 of 3 <br /> • <br />