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PERMIT APPLICATION. <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF"WAIF <br /> All information must be filled-in completely <br /> City of Zephy+rhi!!s <br /> 5335 a Street,:Zephyrhilis, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.00.05 . <br /> ��f <br /> Oiate;o a �caC one'. <br /> rOCeS�@tt s'a <br /> _ y.A <br /> r;r a.: <br /> fb <br /> 'ra rea.for:sta 's <br /> r' <br /> 'c 1orks:a: :.to'FciEak 1N <br /> r- - o" .,i�i it n' a s•ts►ie t'.::;;_-., C <br /> C .tp�g i <br /> Q- PY. 9. R - <br /> PRO7ECT/70B SITE: PROPERTY OWNER <br /> Address:39621 Name:. u e,7 <br /> Unit#: Address: /5 Z. w C,- ,_ <br /> Parcel Identification'Nurnber: city;State Zip0 e 6 rL 33523 <br /> 1/_2 42 1'Q C?0 -6 6 Phone:3/3- 73-52_5 FNI- <br /> CdNTRAJCTORN <br /> Company: ec i{C mei► . v, 'c . <br /> Name:- <br /> Contractor's License #:C-&C' .. 5: E-Mail:bc4 i. 1 �n ycr <br /> Phone:313 /11,q S Cell: �L/3 -2'q5- /LYls- Fax: ' <br /> ARCHITECT/gNGiINEER: <br /> Name:. Firm name: ' <br /> Address: City: State: Zip: <br /> State License #: Phone: Cell: Fax: <br /> Description of=Project' <br /> TYeg OF DRIVEWAY LENGTH OF DRIVEWAY CULVERTS NEEDED <br /> _RESIDENTIAL DRIVEWAY WIDTH OF DRIVEWAY { )REINFORCED CONCRETE. <br /> COMMERCIAL DRIVEWAY K.O.W. EXCAVATION ( )CORRUGATED WERIAL <br /> PUBLIC ACCESS DRIVEWAY DEPTH LINEAR FEE_T ( )BOX_CULVERT <br /> { )OTHER-(EXPLAIN)' . . <br /> CONSTRUCTION MATERIAL CUR_B CUT REQUIRED <br /> ASPHALT YES NO <br /> =CONCRETE <br /> HEADWALL REQUIRED? YES ✓NO <br /> NOTICE TO APPLICANT: If actual work exceeds scope of this description,additional permits er drawings <br /> wi11'be required. <br /> UTILITY LOCATIONS REOUIRED: CALL BEFORE YOU DIG: 1.900.432.4770 <br /> k <br /> Page 1of3 <br />