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s {'���* f <br /> PERMIT = APPLICATION m TM <br /> DRIVEWAY PERMIT :APPLTCAT:ION <br /> ICONSTRU:CIION `WITTHIN PUBLIC :RIGHT-OF-MAY <br /> All information must be -in completely <br /> City of:2ephyrhills <br /> 5335 :8 ' Street,Zephyrhllls, *FL 33542 <br /> Telephone 8.13 78 000 1 Fax 813J80.0005 <br /> - ': - <br /> 'PROJECT JOBjSITE: 1 PROPER A ' • VINE •4 <br /> Address: G/ 7 /? '445? Name: / s r 'fi i t <br /> Unit #: Addr� -. . , 44 Unit: - — - <br /> Parcel Identification 'Number: C State Zi• 0 0�1� .�9Wr <br /> Phone: fig -1/ 9 Fax: <br /> :CONTRACTOR: <br /> Com•an : -f.. 7F- , 3 p4/ 0- — <br /> Name: T � <br /> Contractor's License #: E -Mail: <br /> - Phone: ge/3 - ,395 - 4/ d/ Cell: '13 - 7i 41 3 Ter, Fax: 0 /3 — 3f'.5 - ( <br /> ARCHITECT /ENGINEER: <br /> Name: N /q Finn Name: <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br /> Description of Proiecii <br /> TYPE OF DRIVEWAY i'f LENGTH OF DRIVEWAY k , ` P° CULVERTS' NEEDED <br /> It RESIDENTIAL DRIVEWAY ti WIDTH OF DRIVEWAY " (.k) REINFORCED CONCRETE. <br /> COMMERCIAL DRIVEWAY R.O.W. EXCAVATION () CORRUGATED MATERIAL <br /> PUBLIC Af rFSS DRIVEWAY DEPTH LINEAR FEET ( ) BOX CULVERT <br /> ( ) OTHER (EXPLAIN) <br /> CONSTRUCTION MATERIAL CURB CUT REQUIRED <br /> ASPHALT YES k NO <br /> .. CONCRETE <br /> HEADWALL REQUIRED? 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 REQUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />