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<br /> PERMI'Y APPLYCATION -P"'�;t
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<br /> CONSTRUCTION WIT IN PUBLIC RIGHT-OF-WAY
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<br /> City f Zcphyrhills
<br /> 5335 8"'Stre Zephyrhilts,FL 33592
<br /> Telephone 8f3.78 .00pO F8x 833.7$0.0005
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<br /> PR07ECT ]OB S1TE: PROp RTY OWNER
<br /> Address: Name:
<br /> Unit#: Address: ' Q 1
<br /> Parcel Ide�tification Number: - G State Z Cj,j'7 3
<br /> Phane• - (} Fax; =jQ�
<br /> CQNTRACTUR:
<br /> Com n :
<br /> Name�
<br /> Contractor's License#: E-Mail: '. ��
<br /> Phone: Cell: -- Eax:
<br /> ARCHITEGT/ENGINEER:
<br /> Name: {�l �Irm Na e:
<br /> Address: y' G : 5 e: Z ;
<br /> State License#: Phone: I!; Fax;
<br /> ' tion of Pro'
<br /> IsfP�Q�WAY ��LENGTH F RRIVEWAY CULVE[3.T5 NEEDED
<br /> �RESIpENTlA7.DRIVEWAY �(�W[DTH ORIYEWAY ( )REINFORCEp CONCRETE
<br /> COMMERQA!DRIVEWAY R,O.W. EXCAVATI4N ( )CL}RRUGATED tfAl�E'RTAL
<br /> _PilBi.IC ACfFSS ORiVEWAY `DEi**T}f �LINEAR FEE7 ( }Bt7X NLVERT
<br /> �QNSTRUCTION MATERXAL ( )�ER(F�c�AIH)
<br /> ASPk2AZS YE5 Pf0
<br /> �CANCREtE
<br /> HEADWpLL RfOUIRED? _YES �NO
<br /> NOTICE TO APPLICAN7: if ackual work exceeda pe pf this description,additiortal permits oc drawiags
<br /> wilt 6e requ�red.
<br /> lCtII.TfY L.001lTIIDWS REOUIR9• CALL BEFORE YOU DIG:2.800.43Z.4770
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