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<br /> PERMIT'APPLICAYION
<br /> �RIVEWA�(:PERMIT.AP.PL�ICATION
<br /> 3CONSTRU�C;[ION�WITHTN:P.UBL�iC-RIGHT�O.F=WAY
<br /> All information must be-filled-in completely
<br /> � :City.of:Zephyrhilis
<br /> "5335.8"'Street,Zephyrhilis,�FL 33542
<br /> Telephone.8i3.780.0000 Fax 813.780.0005
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<br /> � R07ECT .70B�SIT�: PROPERTY'OWNER
<br /> Address: '7 / e Name: .�c Z� ,� Qi,�
<br /> Unit#: � Address: 3Z- o� Unit: -
<br /> Parcel Identification Number: i I " `6- `�/d'/i7 Ci .State Zi �r. 1, il� I- 3 2
<br /> ov sc� Phone: 1 - Fax:
<br /> �:CONTRACTOR: '
<br /> Company: f�fl � 1 H'��. Cc�v � $/i/�.
<br /> Name: bb�.� �. N i ��
<br /> Contractor's License#: G g�e y77�� E-Mail:
<br /> �Phone: $1�- 7u�,_c,��o Cell:g/3-�f�'?-o�(S Fax:
<br /> ARCHITECT/ENGINEER: ,
<br /> Name: Firm Name:
<br /> Address: City: State: Zip;
<br /> State License#: Phone: Cell: Fax:
<br /> Descrintion of Proiect
<br /> TYPE F D WAY �� LEN6rH OF DRNEWAY CULVERTS NEEDED
<br /> RESIDENTIAL DRNEWAY �a �IVIDTH OF DRNEWAY ( )RIINFORCED CONCRETE
<br /> COMMERCIAL DRNEWAY R.O.W. �CCAVATION ( )CORRUGATED MATERIAL
<br /> PUBLiC ACCESS DRNEWAY DEPTH LINEAR FEET ( )BOX N WERT
<br /> CONSTRUCTION MATERIAL CURB CUT REOUIRED ( )OTHER(IXPLAIN)
<br /> ASPHALT YES NO
<br /> �CONCRETE �i
<br /> IiEADWALL REOUIRED? YES 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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