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;P.ERMITAM ICAIION <br /> SMVe EWA"�f"�P.ERMtFT.A PP U C M 12 0 N <br /> CONSTRUCUMN VMNIN-PUBLIC=PIGHT-OF-"111dAY, <br /> AD fnfarmatian ii bevemn complewv <br /> - cCity.ctf�epllyr�llls. <br /> 3335:gth Street,3ephyrh11lsiT133542 <br /> Telephone 813.780.0000 Fax 813780.0005 <br /> PRONCT JOSSI rE: PROPERTMOWNER <br /> Address: Name: at'rzv <br /> 'Unit#: Address,. - `,r Untt <br /> Parcel Mentification'Number: city,State zi r - <br /> _,? 'Phone: ax: <br /> :CONTRACTOR: <br /> -com n : v <br /> Name: <br /> Contractor's License#: P&C <br /> -Phone: 'Cell: Fax: <br /> iG1RCItiI1ECTjENGINEER: <br /> 'Name: Firm Name: <br /> Ad Mr. v I ITState: rip; <br /> State ijoennse#: Phone: Cr'11: Fax: <br /> Desc+iPtlRG of Ptoiect <br /> TYPE oz;DRIVEWAY ,p:�r! MiM MDRIWWAY CULVERT MEEEDED, <br /> -X_RfSt ENM DRNEWAY WIDTH OF DRIVEWAY { )RMNFORCED Ommm- <br /> 00MMERC7AL DRIMAY RAW €—PAYMON { j ODPLRUGA?ID MATERIAL. <br /> ,_,,,_PUBLIC AMESS DMEWAY DEPTH LINEAR FEET ( )am CULVERT <br /> ( OTHER(SA ) <br /> CONSIBUCTION MATERIAL CL)'t R IRED <br /> ASPHALT YES ND <br /> -CDNGRETE <br /> WA v YES N4 <br /> a <br /> .NOTICE TO APPL If actual work exceeds scope of this description,additional permits or drawings <br /> -win be required. <br /> UTILITY lOrrATr6NS REQttIRED: CALL,BEFORE YOU DIG:LBODA32,4770. I <br /> Page I of 3 <br />