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PERMIT MPLiCATION <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION W1T'HIN PUBLIC RIGHT-OF-WAY <br /> AII infiormation m�be filled-in cornpletely <br /> City of 7xphyrhilis <br /> 5335 8"'Stnee�t,Zephyfiftts, FL 33542 <br /> Tdephone 813.780.0000 Fax 813.78a.0005 <br /> Dabe of appiieation: p�gy; p,��; _`c f <br /> OCoPYto BuNding De�hnent t�+'iearorsrat►use«+iy} : to WblfrYi►aefs <br /> �AP1+ <br /> PRO]ECT 70B SITE: PROPERTY OWNER <br /> Address: bso L� N � wame: KeYsrrrve � , e , /_� — <br /> #: Address: o��bS�S.FLJ,Q�Dr¢/�L' Unit: <br /> Parod Ider�tifi�Number: Stabe Zi L �.���' <br /> � � !-�7 ?fJ-OUlJOO- OOyO Phone: a7�Y'3 -�7�6 Fax: 7a7- �9.3s <br /> CONTRACTOR: <br /> CorilpanY: (,'r�[�2/Vi9" /N�S Li►.c <br /> Name. ]�t/,Q W,�Li�-nr s <br /> cAntiac�or's uoense#. G G/��c;�s �-t�at1: dr,v�c�.i�-rrrs �- ��. _ Co�t <br /> Phone: C�lI:a�?� Y 7� Fax• 7�'?-5�6`r-�s'y7 <br /> a�3 a�a� <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address• �y ��. <br /> Zp. <br /> Stabe Uoense#. Phone: Celi• Fax• <br /> i <br /> I� LENGTH OF ORNEWAY ;��Q C7�W C�1L.VERTS NEEDED <br /> �_RESIDEM'L4L DRIVtWAY ��WlDTH OF DRIVEWAY :N�.0,�(/_ ( )RQNFORCED�ETE <br /> OOMMERQAL DRIVEYVAY EXGVATiON ( }OORRUGATED MATERL4L <br /> PIiBIIC AOCESS DRIVEWAY i� p�H �p�� <br /> ( )BOX QIWERT <br /> T � )� ��eN) <br /> (:l/RB Cl/T REOU <br /> �� � '�� <br /> OOMCREI'E <br /> YB ., '� NO <br /> : ���WO1'k���ao1����desca'iP�on,addidonal permits or drawings <br /> wNl be�r+ed. <br /> CALL BEFORf YOU DIG: 1.800,432.4770 <br /> Page 1 of 3 <br />