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<br /> PERMIT-APP.CICATION ��.�
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<br /> r`�tRIVEWA'Y:PlER . IT:AP.PL�£AT:��?N
<br /> ��CONSTRt1:�tON aWITHT , ePUBL�IC-R:IGHT-��F='WAY
<br /> A(( information n,r�,.c st� �filied-in compieteiy
<br /> � zCity.of�Z _phyrhills
<br /> �5335:8�'Street,.Z phyrtiills,:F.L"33542
<br /> Te(ephane.8f3.780.00 0 Fax 813.780.000�
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<br /> ':PROJECT .�08:SIT�: °PRC�P�RTY't}WNER
<br /> Address: � S� i-��'� s i Name: J �a t N�' �' f '� l. �t�t N L Y
<br /> tJnit#. � Address: .5l ° +r +� R+1 "�Jnit: -
<br /> Parcelldentification�Number: Ci StateZi � ri�'l�'t,t ��/�►�.s � � ,3��a.
<br /> Phone'1 ��n 6�i S �'��i'�Fax: �--
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<br /> �=CONTRACTOR: '
<br /> Com an :
<br /> lVame•
<br /> Coniractor`s Ltcense#: E-Ma9l:
<br /> �Phone: �Ce!!: F�t:
<br /> ARCHIT�CTi�NCINl�ER: .
<br /> Name: Firm Name: �
<br /> AddrPSS: Ci : State: Zi :
<br /> State License#: Phone: Ce1i: Fax:
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<br /> Desc ' o»of Pro'e
<br /> TYPE OF DRIVEINAY �LENGTH O DRNEWAY CULVERTS NEEDED
<br /> _,RESiDEMIAL DRNEWAY ,�,,,_WIDTH OF RNEWAY �i2QNFORCED CONCREi'E.
<br /> COMMERCIAL DRIVE:WAY R.ti.W. EXCAVA'Rt�[�i ( }'CO{tRtlGATEQ MA`�ERIAL.
<br /> PUBlIC ACCESS pRIVEWAY DEPTH 1INEAR FEEf ( )BOX Ct1LVERT ,
<br /> ( )OTHER(DtPLAIN)
<br /> Ct3� STRUCTIOPi MA�^ERIAL CL1R8 C CJ RED -
<br /> ASPH,4LT YES N4
<br /> �CONCRETE
<br /> liEACfWAU.REOUIRED? YES �NO
<br /> NOTICE TCt APPI.�CANT: If actual work exceeds pe of thes descrip#ion,additiona!permits or drawings
<br /> wilt be required.
<br /> UTILITY LOCATIONS REOUIRED: CAl.L BEFORE YOU DIGa 1.800.432.4770
<br /> P ge-1 af 3
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