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PERMIT APPLICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All 1nfonoati6n Mug be filled-(n completely <br /> CFty.of Zephyfillls <br /> 5335 8°istlEet,Zephyrhilis,_FL 33592 <br /> Teleomne 813.780.0000 Fax 613.790.0005 <br /> IDateoGappllcuti000- FrooestedBy:` PeirtliEx3: „ <br /> ,':uwy�.LD&�'R>ipgBeEnE'. _ .. :QCOAY.ZO P1ibAoLVOila <br /> PROIECr 10B.SITE: PROPERTY OWNER <br /> Address: d c t�- JG' , 1 Name: . , t <br /> Unit#: I Address, P&Ze P, Liwt rxJci �ke lot" 19(S <br /> Parcel Ident1fimtianNumber: ! - 6-�? --0C,0- Q state zip{:?rn �'�.4ulF�I pi ti;�y <br /> Ck05 I I Phone: i !3 g S(1 7�Fax: <br /> CONTRACTOR: <br /> Com n : i ?JA ,� r:• <br /> Name:. <br /> Contracloes Uoense i!: E-Mall: <br /> Phone: Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: CR;C_ 1�1th1J:11 Firm Name <br /> Address: QIv- state: ZIP: <br /> State Uoense#: Phone: Cft//- Fax: <br /> Descaiot(on of Prof <br /> TYPE OF DRIVEWAY --;23PLE! rH OF DMEWAY CULVERTS NEEDED <br /> RESmENTIAL DRIVEWAY SC- WMTM OF DRIVEWAY ( )REINFORCE CONCRETE <br /> COMMEf aAI DRIVEWAY R.O.W, EXCAVATION ( )CORRUGATED MATERIAL <br /> _KMC ACCESS DMENVAY ---PEPiH _LINEAR FEET ( )OU CULVERT <br /> ( )OTHER(DR XN).__ <br /> _ CONSTRUCTION HATERIAL CURB CUT REQUIRED <br /> CONOIETE <br /> T YES _HQ <br /> HEADWALLREOUIREDT YES --Jm <br /> NOTICE TO APPLICANT: if actual work exceeds scope of this description,additional permits or drawings <br /> will be required. <br /> UTILITY LOCATIONS REQUIRED: CALL BEFORE YOU DIG:1.800.432.4770 <br /> Page 1 of 3 <br />