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PERM/T ' <br /> DRIVEWAY PERMIT APPLICATION <br /> (CONSTRUCTION WITHIN :PUBUC:RIGHT-OF;WAY <br /> All information must be completely <br /> City.oflephyrhills <br /> E335 18 th Street, lephyrhills, 'FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> " `7 . •.„ <br /> 3-- <br /> 7.4`‘ .'3L1 • • <br /> 'PRO3ECT/.30BSITE: PROPERTY'OWNER <br /> Address: ",I) • - Name: „ - ma r,- 1 • - <br /> Unit #: Address: t5. 'T Fiord(' t: <br /> Parcel Identification Number: , -MO - Ci State 21. A. <br /> 6 /* / Phone: •g/t,',?)-12.445 <br /> CONTRACTOR: <br /> Company: e l - y p r f , Ztiticfrrs Ft) -ffrierbrS, Lnt <br /> Name: 3 ‘YrCire )Aianarr <br /> Contractor's License 1 K E-Mall: 6,u t , <br /> Phone: Vac) - ct Cell: Fax: 6"731 - 45 3g53Lp (.1e cais eir4_ <br /> ARCHITECT/ENGINEER: <br /> Name: gm M _•• 11 1 Firm Name: a.* I S <br /> Addre S /Sir-1 City: oral v-ity Stat L. Zip: 3 <br /> State License #: 4 . Phone: • - 4' Fax: ty - • - <br /> MESIlatkpdeinka <br /> TYPE OF DRIVEWAY 31 l LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY /6) --7- TWIDTH OF DRIVEWAY ( ) REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY R.O.W. PCCAVATION ( ) CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY t!DEPTH 4 912 1.- 110 LINEAR FEET ( ) BOX CULVERT <br /> ( ) OTHER (EXPLAIN) <br /> CONSTRUCTION MATERIAL .CURB CUT REOUIVD <br /> ASPHALT YES /No <br /> — 7 - CONCRETE <br /> HEADWALL REOUIRED? YS %/ 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: 1.800.432.4770 <br /> Page 1 of 3 <br />