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<br /> PERMTT"APP.CICATION �'3.` ,
<br /> :�iR;IV'E WAY:P.ERMIT rAPPL�ICAT:IC?N
<br /> �CON�i'RU:CTION aWITHTN�P.UBL�C-RIGHT�O.F=WAY
<br /> Atl infarmatian must be-fiiled-in complete{y
<br /> ��City.ofrZephyrhilis
<br /> '5335:8�'Sfi eet,Zephyrtiills,.'F.L�3542
<br /> Telephane.813.780.0000 Fax 8I3.?80.00Q5
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<br /> . `PR�7ECT .]OB:S -: ° OPERTY'QWNER
<br /> Address: Name:.
<br /> Unit�#: .� � Fiddress: nit: _ -
<br /> Parcel Identif cation`N mber: Ci .State Zi
<br /> _� �. p �—p Phone• �ax:
<br /> :CONTRACTtJR. �
<br /> Corn an : ,�,, r'c�
<br /> Name: ��
<br /> Contractor's Lic nse#: E-Mail: �v : ' . O �
<br /> �P.,�or��; d .-. Cell• � Fax: ����
<br /> 7R�RCHITECT/ENGINEER: ,
<br /> Name: � Firm.Name: +
<br /> Address: City: - � State: Zip:
<br /> State.License#: Phane: Cell� Fax; �
<br /> Descriotion of Proiect
<br /> • � . ..
<br /> TYPE OF DRIVEW_�Y . ,��LENG"fF10F•DRIVEWAY �UC;ttERTS NEEDED
<br /> RESIDEMIAL DRIVEWAY = �WIDTH OE DRTVEWAY ( )REINFORCED CQNCREI'E
<br /> COMMERCIAi.DRIVEWAY � � R,O,�AI. �CGAVATIt?N � '( �'CORRUGATED MA7ERIAL
<br /> PUBLIC ACCESS DRNEWAY �DEPTH �LINEAR FEET ( )�BOX NLVERT ,
<br /> . ( )OTFSER(E}CPLATN}
<br /> C01�tSTR17Ct`ib11t.MATERIAL CURB`GU'1°`REOUIRE� - -
<br /> �PHALT YES �y,LNO-
<br /> ONCRETE ,
<br /> HEADWA�L,REOUIRED? YES v NO �
<br /> NOTICE TO APPI.ICANT: If actual work e�rceeds scape of this description,addifiionat permits or drawings
<br /> �will be required. �
<br /> UTILTTY LOCA'TIdNS REOUIRED: CALL BEFORE YOU DTG:.1.80Q.432.4770
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