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PERMIT ARPLICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> Ali information M_ug be filled-tn completely <br /> City of Zepityrhills <br /> 5335 a Street,Zephyrhlils,FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> oata of applicaition —7, :(7 Oracemed 8i/i _ Permit#: <br /> (gray tita!! arr) <br /> CICoFY to Augdiri'g'Depdttmert[ - _ ElCopy to F'.ubitc Works _ <br /> PRO7EC1' 3015 SITE: PROPERTY OWNER <br /> Address:562,1 20^rN :s7' — 144-S F'G Name:LR, MR L.eA _.l +Cb godA37s Y. <br /> Unit : Address:10 . PmmaP Rd Unit: <br /> Parcel Identilication NumbdP _ I city,State,Zip.ACORM :S`G . 01610 -�4'7.i3 <br /> Phone: Fax:AA. <br /> r <br /> CONTRACTOR: ` <br /> Name:W/4444M A.' 4 <br /> Contractor`iUoense#:GGC • 5F,10 E-Mail:. ' AQWK. - _o GOLti' . <br /> Phone: Fax .A• _ <br /> ARCHITECTjENdINEER: <br /> Name: firf..? ,t,>y: Finn Name: l� <br /> -Address- city: State: _ Zip; <br /> -State license#: y Phone: Cell: ft: <br /> beuscstation of Pnoiect, <br /> WO - F D 3_t LENGM OF ORNEWAY tULVERTS NEEDED _ <br /> _Y—J2ESMENTIAL DRNEWAY /Q_WIl7TH OF DRIVEWAY ( 'NF_ORCED <br /> COMMER=D WEWAY W EXCdVATION ( } - D MATERIAL <br /> _-_RWC AaZSS DRNEWAY af-PMH — _,Li M FEET ( CUL <br /> ER(EXPLAIN) ' <br /> GTIQIY MATERIAL CURET CUT REOUI - <br /> PHALT 'YES iy- ' <br /> CONCRETE <br /> },LAR&LL REOUIRED7 YES V NO <br /> NOTICE TO'APPLICANT: If at#taat work exceeds scope of this description,additional permits or drawings <br /> will be requiT+ed:- <br /> IMLM LOCATIONS REQ IU REQ: CALL BEFORE YOU DIG:IMO. 32.4770 <br /> Page 1 of 3 <br /> i <br />