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<br /> ;D�RI�t'EWA. :PERNI : :AP.PL=CA7'IC1N
<br /> �CCINSTRU.CTION= .ITHTN�PUBLIC-1�'[GHT�t�F=WAY
<br /> Ati informa ion mu -be-fiiled-in completely
<br /> • ~ � it�.af�Zephy:hitis
<br /> 'S335:8�'Stre�t,Zephyrti'sils,:FL�3542 '
<br /> � Telephone. 3.780.OQQQ Fax 813.780.(lQQS .- - - -
<br /> � 's��L�.i_�z" .3rka•°:Es.xas--=r—k„, sutt� r. *=::�%i..—.—.� - �"e:.°s4,.. ,� ... f...., �s,..,.«.;fi:'=._ r,° �-�Mr?��c°�� wraz.;.
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<br /> `PRQ7ECT .JQB;SI"T�: �PROPERTY'OWNER
<br /> Address: 2 ' �... � • Name: �P�-�t�1.�. �rz vhH- ��5
<br /> , Unit#: � „5' �?L Address: f�B �i� ' ��'�" �
<br /> Parcelldent icati n Number: L °Z 2 l"'� Ci .State .Zi L- �
<br /> ��.--„2 �. � �-=,. r�'� D -- r� oe D_5"� Phone: --'yF's2-� ax: n.1r�
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<br /> �:CONTRACTt3R: '
<br /> Com an : '�" — � Y � � ' ,
<br /> Name: ��a � o�,ts�, ,— .�s �o�-p �
<br /> Contractor's License#: ���� E-Mail: � �'e �" �t- a � - '
<br /> �Phone: 8'l3�'Z —07 b��"- �Cell: F�: 3 �-- 7 t 1� .� �
<br /> �2 c—�d �o".v.�-[3('e 0
<br /> ARCHZTECT/ENGINEER: _ �
<br /> �Name: � •F :Name:
<br /> Address: - C � State. Zi •
<br /> State License#: P one: Cell: Fax:
<br /> _ escri tion �Pro'�ect
<br /> PE F DRIV�WAY �{O _CENt,TH OF�DRIVEWAY ` CULVERTS�NEEDED.
<br /> ;RESIDPMIAL DRIitFWAY � WIDTH OF DRIVEWAY { )REINFORCED CONCftETE.
<br /> COMMERQALDRIVEWAY • R. :W.., EXCAVATlON � ( ):CORRUGATED MATERIAL
<br /> PUBLTC ACCESS pRIVEWAY DEPTH' LINEAR FEEf ( )BdX Ct1�VERT ,
<br /> COPlSTRklC7'Idhl MATERIAL ` . GU CUl'RE .UIRED � { ��/v��C/��c�)
<br /> ASPHALT YES =�,..NO- �
<br /> —�CONCRFfE ' ��
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<br /> HEADWALL REOUIREb? YES NO �`�,.,��G� 1 /
<br /> N07ICE TO APP[SCANT: If actctat wark ceeds seope of this descripiion,additional permits ar drarrvings �
<br /> �wiii be required, � .
<br /> UTILITY�.00ATIONS RE IRED: CALL BEFORE YOU DIG: 1.800.432.4770 �-
<br /> Page 1 af 3
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