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2-0 1q"" <br /> f <br /> PERMIT APPLICA71ON <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All Information=be filled-in Completely <br /> City of Zephyrhilis <br /> 5335 a Street,Zephyrhilis,FL 33542 <br /> Telephone 813.760,0000 Fax 813.780.0005 <br /> €atd of up lice on: Processei!`8'"; Petmlt:#c T <br /> ❑CoPYao, .• ..,.: .:.= .:ao�;�reatarstatruseimN) .;.: ; ::"..::;-:':` : ..�.: :,, . . <br /> - &ii(dltig.•Departrt�nt..: .. :.....:....a:__,::.:..:. - :::;1]Gi>pY,toi?ubiic lNorks�.::;:.:.. .., . <br /> PR03ECT/JOB SITE: 1 PROPERTY OWNER <br /> Address: FtC7 2 ���_�' R. 1 Name; t/.rls �,++.:P�j�+��•�/� ' �•K�r�� <br /> Unit#: Address: A. llnit' <br /> Parcel Identification Number: I Citv,State Zip 7- f'S d2 <br /> Phone:sic.yc- si z Fax: <br /> CONTRACTOR: <br /> Name: <br /> Contractor's License#: E-Mail: <br /> Phone: Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State: Zip: <br /> State License#: Phone: Cell: Fax: <br /> Description of Project <br /> TYPE OF DRIVEWAY �11--ZLENGM OF DRIVEWAY CULVERTS NEEDED <br /> RESIDENTIAL DRIVEWAY /_Q'WIDTH OF DRIVEWAY { )REINFORCED CONCRETE <br /> COMMERCIAL DRIVEWAY O.W ]EXCAVATION ( }CORRUGATED MATERIAL <br /> PUBLIC ACCESS DRIVEWAY ' DEPTH ___LINEAR FEET { )BOX CULVERT <br /> { )OTHER(EXPLAIN) <br /> CONSTRUCT ON MATERIAL CURB CUT REQUIRED <br /> —_ASPHALT YES NO <br /> K CONCRETE <br /> HEADWALL REQUIRED? YES NO <br /> NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILM LOCATIONS REQUIRED; CALL BEFORE YOU BIG: 1.800.432.4770 <br /> Page I of 3 <br />