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<br /> PERMI7'APPL'ICATI4EV
<br /> :.DitIVEWAY:PERM T.APPLICATI�N
<br /> �CC?NSTRUCTION�WITHIN: UBL�IC RIGH:T-OF-IIVAY
<br /> All informatian must b filled-in completely
<br /> ;City of,Ze hyrhiiis
<br /> - "5335 8"'Street,Zep yrhills,'FL 33542
<br /> Telephone.8i3.78Q.000 Fa�c 8�.3.780.Q005
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<br /> PR{.13ECT .�4�`SITE. PROPERTY 41lViHER
<br /> Address: ..�S'd � �.r�:..► t� �_� ,r�r� ��� ame: .� �d: h.� a'�a;a.. ._t°;�`
<br /> Unit#: � ddress: ��f Y� c�k�l,��,�Jnit:
<br /> Parcel Identification Number: �Z - Z G —� j —���c� i .State .Zi , . `.�e�s .� f. ��S �
<br /> �€"��.'s"�c� -- �� �"� hone: Fax:
<br /> CiDN'8"RAC7'OR:
<br /> L�m �� . �f'—l.v.}`�....... �� ��,�d+xJ/�.__ ���'� a•-s .,t k.. � �,r
<br /> Name: ��y��rr..�, r��J, 'E c���=�
<br /> Contractor's License#:���1�� Y��,�;�_�;:f ;�� �;�:��..s`�� E-Mai3;
<br /> Phone: ,.'�°- Cell: ;��'�sr� «' `x-�,r���� Fax:
<br /> JARCHI7'ECT/ENGINEER: .
<br /> Name: Firm Name:
<br /> Address: Ci : State: Zi :
<br /> State License#: Phone: Ce1l: Fax;
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<br /> �fescri tio af Pro"ect
<br /> TYPE OF DRIVEW„AY �� � ��� tENGfFi OF D EWAY CULV�RTS NEEDED
<br /> ,�__RESIpENTIAL DRNEWAY �B� -��WIDTH OF D EWAY (. )REINFORCED CONCRETE
<br /> Cor�MERCLat DR�vEWAY RA.W. EXGAVATIt1N { }CORRU�ATEd MA'iERIAI.
<br /> PUBLIC ACCESS DRNEWAY � �frfH ^� LiNEAR FEEf ( )BQX CULVERT
<br /> • ( )OTHER(EXPLAIN)
<br /> �01ti4STRlJCTI�N MATEP2]tAL CURB CUT R IRED
<br /> ASPHALT YES NO
<br /> �CONCREiE
<br /> HEADWAI.L REOUIRED? YES �� NO
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<br /> [�O`PYCE TO APPf�CANT: �f acte�a!wark eacce'ects.se���`e�f this,�+¢e�riptiar�,additiana! perrttits or drawings
<br /> wila be re�quired. 5 , c.' _ . ::t� .,, , .,-,,"...,
<br /> � � ',, •W*kn...��.:4'�0..v�i.oMU°�DeF�
<br /> t!'C�LI"TY 1.4�ATId�NS�it�C�tfiRfE�e' C.L BEFt.�F�E YQt9 DIG: �..84Q.432.4770
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