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PERMIT APPLICATION <br /> DRIVEWAYPERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-{N'AY <br /> Alkhformatlon-must,be'filled-in completely,' <br /> f Ze i i <br /> " <br /> C O pftiyrh !s! <br /> 533.5 a Street,Zephyrhllls,.FL 33542 <br /> Telephone 813,780.0000 Fax 813.780.0005 <br /> Date of a ilcatione. Praoess d 8y ,f ..PP Permitam <br /> Copy to Building Deperbm!nt [JCopy to.Publk WorkS:. <br /> or stiff use an <br /> PROMCT/JQl3"SITE. PROPERTY OWNER :. " <br /> Unit#: .9 .' <br /> Addressk• d Name:f.;,:aw . Kr cY"R�rcr�c,4l~+' "tom- <br /> 3 : <br /> dress:2 s v � :.. <br /> Parcel Identification Number: <br /> Ci State Za 8�h)i:�c <br /> Phone:: Fax;:. . . <br /> CONTRACTOR:' .. . <br /> Company:. &Qo Wa .41 C. <br /> -Name: <br /> Contrdctoi's license "�1c rns�r ay,js Vry <br /> E-MM. ro <br /> 7. <br /> Phone:- d X _917 2eVO" Cell:_: " - . . . Fax:.. <br /> .ARCHITECTIENGINEER: <br /> Name: : . Firm Name. <br /> Address: <br /> :City' State` Zip` <br /> State License#: Phone` Ce1f:" Fax: <br /> Description of Protect " <br /> oi�.u�tivsWAv ..- 3 'LENM of <br /> P DRIVEWAY GULII RTS:NEEDED <br /> ••_RESIDEMIAL DRIVEWAY _/ WIDTH OF DRIVEWAY ( ) FORCED WNCRE7E . <br /> _CommERCXAL:DRIVEWAY" .. EXCAVATION " ' " CORRUGATEDMATERIAL ' <br /> -PUBLIC ACCESS DRIVEWAY EPlli CINEAR FEET ( X CULVERT: <br /> ,rONSTRUOTION MATERAL . . <br /> CURB_CUtR1,QUIRED <br /> ( )OTHER(EXPLAIN). <br /> _.;._ASPHALT - <br /> _�CONCRE E YES HO <br /> HEADwALiL REQUI D? YES ,�NO <br /> NOTICE TO APPLICANT: It actual work exceeds scam of this:description,additional permits or dravitings <br /> will be required.' <br /> UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG:1.$Oa'432.477R <br /> Page 1.of 3 <br />