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PERMIT APPlICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> All information�be fllied-in comP�Y <br /> City of Zephyrhilis <br /> 5335 8"'Street,Zephyrh;(Is, R 33542 <br /> T'ei�hone 813.784.0000 Fax 813J80.0005 <br /> Dabe o�appitcation: pE,�gy; <br /> P�#:����a <br /> ��PYEo�ENrg Dep�►h7�t igaf�aeaenr�Euseoni�) <br /> QQ�to Pubic waks <br /> PR07ECT JOB SITE: MtOPERTY OWNER <br /> Add�ss: -� c� L� rU � rvame: KeYsTdrve , e , f=�, <br /> Lr�t#: Ad�: aLt2,"S,FLo,e,a��9�N Uni� <br /> Paroei Identlficatjon Number: Sta#e Zi L �o�' <br /> ' �� -�7 � 4-oOUOO- p ' O Phone: �7�Y3,��.7a6 Fax: 7a 7- �9=;s ' <br /> CONTRACTOR: <br /> Comaanv: ��c�Ve�V� .vt e5 L.�.c <br /> Name' T,�t/,Q W1�Li�-rn S <br /> Contracbor's Lroense#. G G � O�'� E-Ma�h ci�t�i;�i/�-r�s �� ,F. Co.y/ <br /> Phone: Cdl•���- Y - 7;� Fax: -.`3��-3 r <br /> a�t3 a�a <br /> ARCHITECT/ENGINEER: <br /> Name: Firm Name: <br /> Address: �y. ��, <br /> State Uc�ense# p�. �R <br /> ��� Fax: <br /> Y �D/ L.ENGTfi OF DRIVEWAY ;u��U•w �lt�BTS NEEDED <br /> R6IDENTIAL DRIVEWAY ��VYIDTtI OF DRNfWAY :N J�0,W_ ( )RQNFORCED CONCRETE <br /> �hIM�tCWI DRiVEWAY ElCGVATION ( )OORRUGATID MATERIAL <br /> PUBLIC AOCESS DRiVEWAY r� p�H LZNEAR FEET ( }80X CUIVERT <br /> ( )OTHER(D�lAIN) <br /> �T YES „�_NO - ll/l�'t%e <br /> OONCRETE <br /> YES .,�.NO <br /> NOTICE TO l��rr��T. �acbuai worlc eocceefls <br /> �1 ye���. gO°i�°f�h�s de�criPnon.additional permrts or drawings <br /> CALL BEFORE YOU DIG: 1.800A32,4770 <br /> Page 1 of 3 <br />