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<br /> :PERMIT'APP.�CATION =�'�
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<br /> :DRIVEWAI(:PER IT:AP.PLICA;PIOIV
<br /> �CONSTitU�ION�UVITMT bp.UB�C-RIGFiT�O.F=WAY
<br /> All information must be-filled-in completely
<br /> • zCity.of-; _phyrhills
<br /> "5335�8�'Street,Z phyrFiills,'FL�3542
<br /> Telephone.8i3.780.0 00 Fax 813.780.0005
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<br /> ':PROJEC'P .JO��SITE: 'PRO�ER7Y�OWNER
<br /> Address: 5 G//� �; �'� ,c`:` Name: �, , r�;2,�- �rs ��1/, ,�-�-�
<br /> Unit#: � Address ��J�f��- ��)� j� e) ±� Unit: -
<br /> Parcel Identification Number: .� °-,� � -..;: � ���1� - Ci State Zi
<br /> 6-� r�, � ��c��r,°� Phone• � Z.2�5`� Fax:
<br />' ��COIVTRAC'TOR:
<br /> Corn an �fc.�.c',-6_ �� �=;�r.�:��M�r��.-� ;f�. �.�
<br /> Name• ,�.-r f��,� �� � �s .
<br /> Contractor's License#: a-� # ,���. ���5 U� !.r�-� r?�, �.� .:� E-Mail:
<br /> �Phone: �`.35 �4�- I '�F``� �Cell;'�1.-j? �i`f-�3�1 �,:� Fax:
<br /> ARCHaTECT/ENGINEER: _
<br /> �Name: Firm Name:
<br /> Address: Ci State: Zi
<br /> State.License#: Phone: Cell: Fax:
<br /> Desc ' ti n of Pro'ect
<br /> TYPE OF DRIVEWO.Y �o��LPNGTH OFDRNEWAY CULVERTS NEEDED
<br /> _RESIDENTL4L DRNEWAY !�WIDTH OF RNEWAY ( )RIINFORCED CONCRETE
<br /> COMMERQAL DRNEWAY R.O.W. �EXCAVA'L'ION ( )CORRUGATED MATERIAL
<br /> PUBLIC ACCESS DRNEWAY �DEPrH � LIN�EAR FEET ( )BOX CULVERT ,
<br /> ( )OTHER(IXPLAIN)
<br /> CONSTRUCTION MATERIAL CURB CUT RE UI D
<br /> ASPHALT YES NO
<br /> � CONCRETE
<br /> HEADWALL REOUIRED? YES �!� NO
<br /> NOTICE TO APPLICANT: Iff actual work exceeds sco e of this description,aciditional permits or drawings
<br /> wilt be required.
<br /> U�'ILETY LOCATIONS ttEOUIRED: ALL BEFORE YOU DIC:1.800.432.4770
<br /> Pag 1 of 3
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