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r <br /> :PERM APPL'ICAIONi <br /> U1, <br /> 7DRr4E1NAY P.ERMr.r:AP.PL,ICATZON <br /> }CvN 1't __ N-V�1ITMTN VUSUC=RIGHT-OF-WAY. <br /> AM lntnrmation-m be-fliie+d4n completely <br /> OW02gphyrhills <br /> 3335'.EP Street,Zephyrhiils,-FL 33542 <br /> e3ephone B13780.000D'_ Fax 813.780.0005 <br /> Nal <br /> fill <br /> mu <br /> Wig <br /> e, . 6 ,:•. w� '�4.v33�.S' 4e.d3� .,'S,i tl 8,. r- � l�r a <br /> MIM 613 SITE: -PROPERTY'OMER <br /> Address: 4 /Vit?A POW000 LOOP Name: o �S1Pm I clo P <br /> Unit*: Address: 5'3 Li3 (off Unit <br /> Parcel Idm 0cation'Number. Ci ..State Z f'Pf4 YrefitCV5-r'(- �3 <br /> 13-arv-at -01 go -6 ©tJ(�- a ,Phone: - a8! 7l Fax: <br /> ;CONTRACTOR: <br /> company: 01 <br /> Name: M1Cj:jAiFL PM9Y <br /> Contractor's Uc ertse` : c'-RC(33 I 11,E E-Mail: !Yt t�c� c=oNS+�U'/t�F�•cm�-► <br /> -Phone: 913-9.4$•-!q?! Cell: Fax: <br /> ARCHITECT/ENGINEER: <br /> Name: PRZANK OCJUSL5� Firm Name: r��C GlM tn[6° d�t�l6tq( GLC, <br /> Address: 3 3lp W�3fhlr�u rlG"J2D CSCy' i P/a SCdte: Zip' 3�vll <br /> State License*: •7 3 S-3 9 Phone: Cell: <br /> pew <br /> oban o Protect <br /> MMIE QE DRIVEWAY J LENGTH or-m EWAY CULVERTS"NEEDED <br /> __g—RESIDENTUU.DRIVEWAY WIDTH OF DRIVEWAY ( )REINFORCED CONCRETE. <br /> COMMERCIAL DRIVEWAY $AMA VA= ( )CORRUGATED MATERIAL <br /> --PUBLIC ACCESS DRIVEWAY ,NTH. LINEAR FELT ( )BOX CULVERT <br /> ( )OTHER(E)(PIAW) <br /> CflNSTRUCn0N MATERIAL CURB G!IT RECt, 1 ytED <br /> ASPHALT YES NO <br /> .CONCRETE <br /> HEADWALL,REOWRM YES _ _No <br /> NCMICE TO-APPLICART If actual work exceeds scrape of this description,additional peen is or drawings <br /> -will be required. <br /> UTILITY LOCATION6 R_E0U11RED: CALL BEFORE YOU DIG:1.800A32A770 <br /> Page 1 of 3 <br />