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PERMIT APPLICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All information m� be filled-in completely <br /> c�ty of zepnrrn�us <br /> 5335 8"'Street,Zephyfiills, FL 33542 <br /> Telephone 813.780.0000 Fax 813.780.0005 <br /> �a s�t app�ica�; Phr"�C�ilii�t�ll�:'- � ' ��: <br /> > (pra�ra�aak�r�o9ear�} <br /> �Gopy t��ng� ��a�1M� ' <br /> PRO]ECT ]OB SITE: PROPERTY OWNER <br /> Address: � L� N� Name: eYSTl�N� e G� <br /> L6- #: Address: � �s,FG�,e�d•4 r9vt' Unit: <br /> Parc�e) IdeMification Number: Ci Stat�e Z� L �o� <br /> - - -� ?�-oa�oo- Da Pnone: a�a Y3-a�ad Fa�c: 7a�- 9� <br /> CONTRACTOR: <br /> ComPa�Y: �'i)VG/V+�l" rVl�S, uu <br /> Name• T,�/,Q Wi ui�m s <br /> Contractor's License#: G L a..>`bD�`� E-Mail: c�Gvi�i/�-r�s /rl Go.yl <br /> Phone: Cel I: ���- �! - 7:� Fax: —36�l—3.r <br /> a43 a�a <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: City: State: Zip: <br /> State License#: Phone: Cell: Fax: <br /> D�i�on of Proiect <br /> � <br /> i AY I� LENGTH OF DRNEWAY ����•�'W CULVERTS NEEDED <br /> RESIDEM7AL DRNEWAY �'_WIDTH OF DRIVEWAY �N ���W ( )RQWFORCFp CpWCREfE <br /> COMMERQAL DRIVEWAY D(GVATION ( )QORRUGATED MATERIAI <br /> PUBLIC ACCESS DRNEWAY « DEPfH LINEAR FEEf ( )BOX QILVERT <br /> CONSTRUCTiON MATERiAL CURB CuT REOUiRED O o7He��N} <br /> �ASPIIAL.T YES .�NO <br /> -,p�—� <br /> HEADWALL REOUIRED? YES �NO <br /> NOTICE TO APPLICANT: If actual work exoeeds soope of this description,additlonal permits or drawings <br /> will be required. � <br /> I�LITY LOC.ATIONS REOUIRED: CALL BEFORE YOU DIG: 1.800.432.4770 <br /> Page 1 of 3 <br />