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<br /> DRIVEWAY:P.ERMIT.AP.PLICA'I�ON
<br /> �CONSTRUCTtON�WITHTN'�PUBLIC-RIGHT.O.F=WAY
<br /> All information must be-filled-in completely
<br /> • °.City.of�Zephyrhilis
<br /> �5335:8"'Street;Zephyrhiiis,�FL 33542
<br /> Telephone.813.780.0000 Fax 813:780.0005
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<br /> :PR07ECT .70B�SITE: �PROPERTY'OWNER
<br /> Address: . l'7�''` 'tcee� Name: 5 �ven 0 sz
<br /> Unit#: � Address: (o :er .r Unit• -
<br /> Parcel Identification Number: Ci S ,7/S F� 3
<br /> P e• 13- �-��3 x:
<br /> ��CONTRACTOR:
<br /> Corr�pany: eG �
<br /> Name:
<br /> Contractor's License#: E-Mail: �
<br /> Phone• Cell� Fax• �
<br /> ARCHITECTJENGINEER: � ,
<br /> Name: Frm Name:
<br /> _Address: Citv: State: Zip:
<br /> State License#: Phone: Cell: Fax:
<br /> Descrintion of Proiect
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<br /> TY OF DRIVEWAY �LENGTH OFDRNEWAY CULVERTS�NEEDED
<br /> RESIDENTIAL DRIVEWAY �WIDTH OF DRI1/EWAY ( )RQNFORCED CONCRE�E.
<br /> COMMERCIAL DRIVEWAY R.O.W. EXCAVATION ( )CORRUGATED MATERIAL
<br /> PUBLIC ACCESS DRNEWAY DEPTH LINEAR FEET ( )BOX QILVERT
<br /> ( )OTHER(DCPLAIN)
<br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED
<br /> PSPHALT YES NO
<br /> ✓CONCREfE
<br /> HEADWALL REOUIRED? YFS NO
<br /> NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings
<br /> will be required.
<br /> UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770
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