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PERMIT APPLICATION <br /> DRIVEWAY PERMIT APPLICATION <br /> CONSTRUCTION WITHIN PUBLIC RIGHT-OF-WAY <br /> Ali information mu be filied-in oanpletely <br /> City of Zephyrfiiiis <br /> 5335 8'"Str+�,Zephyrhilis, FL 33542 <br /> Tei�hone 813.780.0000 Fax 813.780.0005 <br /> Da�ee af appli�ation: Proo�sed Brc PenniE#c �r�-�'7 v <br /> (gray aea ta saif use my) <br /> [�CflpY bo Buildi�g Dep�bt�t �CApy Lo Pu6iclAFarls <br /> PROJECT JOB SITE: PROPERTY OWNER <br /> Addr+ess: N � Name: KeYS TONE.' e �' r'=ci — <br /> ,� #: Addness: a -s,FC�,ero,4�t' unit: <br /> Parod Iderrtiflration Number: C Stabe Zi L �o�' <br /> _ -- r-�7 � robvoo-- i Pl,one: a�a Y�� :��a� Fax: 7�7- �9=.3s <br /> t70N7RAGTOR: <br /> ComP��Y� �`c�V2/t.J� G�'v(E5�Lit,� <br /> Name; j,�-r/Q Wi�Gi�n,S <br /> Contracbot's Uoense#: G G"a..>��y� E-Maii: cil tv;�i/�-rns ��. ..�. �.�/ <br /> Pt�ne: Cell: ?�"�,ay - �:� Fax: -s3�`'t-3.5��{ <br /> a43 a�a <br /> ARCHITEGT/ENGINEER: <br /> Name: Frm Name' <br /> Addres5: aty: Stat�2: Zlp: <br /> State i�oense#: Phor�: Cefl: Fax: <br /> � <br /> I SS LENGTti OF DR11fEWAY i�,Q•rJ�LW CULVER7'S NEEDED <br /> _RESIDENTUIL.DRiVEWAY �_WIDTH OF DRIVEWAY %��0 W_ ( )RQIyPpRC�CONCREfE <br /> OOMMERCIN_DRIVEWAY � ( )flORRUGATED MATERIAL <br /> Puei.tc nocESS oruvEwaY �'� �rri ur���r ( )80X QILVERT <br /> CUtiB CUT RECULt� ( )��(�N) <br /> � <br /> '�pHALT YES ,�_NO <br /> QONCREI'f <br /> YES . ►� NO <br /> NOTIt�TO APPLIGNT: If acbuill wotk exCeeds�oope of this de�cripRioty additlonal pey7fli!'S Or drawiegs <br /> wNl be�red. <br /> UTILITY t OC.ATIONS REOUIRED: GLL BEFORE YOU DIG: 1.80a.432.4770 <br /> Page i of 3 <br />