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' �7���� ��� <br /> ..w._".- <br /> PERMIT APPLICATEON N� ���=-`.Lt <br /> �_ <br /> ��� <br /> DitIVEW�4Y PER IT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All information must e filled-in completely <br /> City of Ze hyrhills <br /> 5335 8"'Street,Ze hyrhills, FL 33542 <br /> Telephone 813.780.000 Fax 813.780.0005 <br /> `D"ate of applicafion: ;Z.r���SG P�o���a:sy: , � Permit#: <br /> I � _ , - ,, (9ray.are�.f c ff use IY) - � : - - .' - <br /> ; , �Qopy.to Building Departrnent � �/�opy to Public Works - <br /> / <br /> PRO]EC�/70B ITE: PROPERTY OWNER <br /> Address: , � ' - <br /> , �` ` ' Name: 1 <br /> Unit #: Address: - 'J`Unit: Ci <br /> - _�. � , <br /> Parcel Identification Number: -Z - - �� b- Ci State Zi � �� , ' <br /> UU7U Phone: - - �U Fax: '; •� - <br /> COIVTRACTOR: <br /> Com an : � '1 ��..�� Q - <br /> Name: 1�� <br /> Contractor's License #: 'l ;� J � E-Mail: 1 � CjiCi <br /> Phone: r - (� Cell: - Fax: ���- G�1 �� <br /> ARCHITECT/ENGYNEER: <br /> Name:W � 1�U �a 1C � -�' Firm Name: � � � `�� � �� 1C� <br /> Address: !. �J �l� %'i:x'� �i' Ci �i?. ' ; Sta e: Zi 7 <br /> State License #: Phone: ^'>- �l � -�t�, I: Fax: <br /> Descri tion f Pro'ect <br /> P OF DRIVEWAY ��� LENGTH OF DRI EWAY CULVERTS NEEDED <br /> ' RESIDENTIAL DRIVEWAY �c U t�rWIDTH OF DRIV WAY ( )REINFORCED CONCREi'E <br /> 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 RE ED <br /> ASPHALT YES NO <br /> �CONCREi'E <br /> HEADWALL REOUIRED? YES �l NO <br /> r �� <br /> NOTICE YO APPLICANT: If actual work exceeds scope f this description,addotional permits or drawings <br /> will be required. <br />, UTILITY LOCATIONS REOUERED: CA L BEFORE YOU DIG: Y.800.432.4770 <br /> Page 1 f 3 <br />