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.-- - — - � <br /> i � y ��` .. <br />� • <br /> /A u :t:i1��+t�� <br />, ., .tR <br /> r,� <br />' PERMlT APPLtCATlON <br /> QRIVEINAY PERNIIT APPLIGATION <br /> CQNSTRUCTIt}N INITHIN PUBLIC RtGHT-OF-WAY <br /> AN Information must be filled-fn compfetely <br /> Ci#y af Zephyrhilts � <br /> 5335 8=h Street, Zephyrhilis, FL 33542 � <br /> Telephone 8�3.780.0000 Fax 813.780.0005 ; <br /> Date of application: Procassed By: Permit #: � <br /> , (gray area#or aiaff ase naty} � <br /> ❑Copy to Building Department OCtipy to'Public Works � <br /> k � <br /> PR4dEC /JQB S..1TE: PROPERTY OWNER j� <br /> Address; a 9n,� Name; U x2 �' <br /> Unit #: 3 Address:� .� !$,(nit: � <br /> i, I <br /> Parcet identificatian Ntimber. Ci ,State,Zi ' 2�' '7 F , ?; <br /> Phone• ����/ Fax: , <br /> � r <br /> i �. <br /> � CONTRACTOR: � <br /> � <br /> � Cornpany: ; <br /> , Name: , <br /> Contractar's License #: E-Mail: � „ <br /> Phone: Cell: F�: � <br /> ,� <br /> , $ <br /> ARCH lTECT/EN�G I NEER: ;: <br /> � <br /> ' Narne: � Firm Name: <br /> Address: City: State: Zip: g� <br /> State ucense #: Phone: " Cell: Fax: �� <br /> d', <br /> {f" <br /> f• <br /> Description af Praiect �' <br /> �° <br /> TYPE OF Dfi1VEWAY �b�LENG7H�F pRIVEWAY CULVERTS NEEDED i` <br /> �_RESIDENTiAL pRiVEWAY `„�WID7H OF DRIVEWAY O REINFORCED CONCRETE i; <br /> CdMMERCEAt.DRiVEWAY $;O•W- EXCAVATION { )CORRUGATED MATERIAL � <br /> PUBLIC ACCESS RRlVEWAY DEPTH L[NEAR FEET ( )80X CUI.VERT `' <br /> t` <br /> CON�T�iUCTtbN MATERIAL CURB CUT REOUIRED ( ) OTHER(EXPLAIN} �f <br /> ASi'HALT YES _�NO a. <br /> �CUNCRETE <br /> NEADWALL RE UlRED? YES NO � <br /> , � <br /> - � <br /> NQTICE T4 ARP�.tCANT: !f ac#ua1 work exr.eeds scope of this descr�ption,additional permits or drawings { � <br /> will be reqteired. ° � <br /> S <br /> U?ILITY I.00ATIUNS RE+t�UtREd� CAtL B�Ft�RE Y4U DiG: 1.B00.432.47T0 <br /> i' <br /> i <br /> ;. � <br /> = Pag� 1 af 3 {y <br /> 6 <br /> a <br /> M <br />