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<br />OCT/ll/2007/THU 01: 11 PM <br /> <br />813-780,0020 <br /> <br />Date Received <br />.m... ~I <br /> <br />Owner's Nama <br /> <br />Owner's Address <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />FAX No. 813-780-0021 <br /> <br />P.OOl i:V1( ~5 <br /> <br />CIty of.Zephyrhllls Fire Fax-813-780-0021 <br /> <br />Permit Application . <br /> <br />PhoneCo~!,B~forPermlt .177'-1 .lJ "','.Z.../\ II <-.IL-? I <br />-~r -. ~ lia!l 11 ......~_ a; -_ iv~Ia;'f"'~~"r ___~~ <br /> <br />I 1'1' It <br /> <br />J.L:,~.1I>_---' ..-. ~ M".~~ I <br /> <br /> <br />II <br /> <br />II <br /> <br />Titleholder Phone Number <br /> <br />Fse Slmple Titleholder Name <br /> <br />'Fee Simple TItleholder Address <br /> <br /> <br />Job Address <br /> <br />Sub DivIsion <br /> <br />"4" <br /> <br />mU!Iil. <br />D <br />D <br />D <br />D <br />D <br />kR1 <br /> <br />D <br />D <br />.D <br />D <br />D <br />D <br /> <br />Contractor <br />Signature <br /> <br />Address <br /> <br />L:LECTRICIAN <br />Signature ' <br /> <br />Address I <br /> <br />I <br /> <br />PLUMBER <br />Signature <br /> <br />Addre5.. I <br /> <br />Me=CHANICA~ <br />Signature <br /> <br />Address I <br /> <br />l'lI'~a... - V'"W <br /> <br />Jtd~ <br /> <br />iliil F9 - f ~ ~1lMI U 1!4 iJ1lfl~ ~~II~-..-;_AIIll~~U W t ---, <br /> <br /> <br />~~~dJM-~;';'9~;,c~ <br /> <br /> <br />-, .~.._-';...~ <br /> <br />l: lillll'll" <br /> <br />ililll <br /> <br />--~ <br /> <br />Blo-Hazard Waste Storage - ANNUAL <br /> <br />FumIgation Tent <br />Hazardous Material (Tier II orRQ Facility) ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct . <br /> <br />Controlled Bum <br /> <br />. Emergency Clanerator < 30 kw <br /> <br />Emergency Generator> 30 kw <br />Fire Protection Maintenance - ANNUAL <br /> <br />Spl1nkler <br /> <br />D <br />~ <br />o <br /> <br />J Fire Alarm <br /> <br />Hood Clean/Suppression <br /> <br />Fire Alarm Installation <br /> <br />Fire Pumps <br /> <br />Torch Roofing <br />. Wasw Tire Storage ANNUAL <br /> <br />Fire Works <br /> <br />Flammable Applicatlon- ANNUAL <br /> <br />Fuel Tank.. <br /> <br />., <br /> <br />Valuation of Project <br /> <br />Other: <br /> Company <br /> Reglst&rad <br /> Licen6l'f # <br /> C~mpany <br /> Registered <br />I License # <br />l Company <br />Registered <br />I LIcense # <br />I Company <br />Registered <br />I License # <br />I Company <br />Registered <br /> <br />- <br /> <br />I~mtr( ;0.1 J:",'(e +. ('~fnI )n,'col,'an) <br />'. Y / N I Fee Current J n N I / n( . <br />I~~ oan~~"') I <br /> <br />I .y / N I Fee Current I Y / N , <br />I I <br /> <br />I. Y / N I FeeCurrent I Y / N I <br />'1 I <br /> <br />I Y I N r Fee Current Y I N I <br />I -= I <br /> <br />I <br /> <br />OTHER <br />Signature <br /> <br />__:"ddr~L, .....'r~~~-~rRI..'''ll.~,~.~ <br />Directions: <br />FlU out application completely. <br />Owner &: Contractor sign back of application, . notarized (or. copy of sl9ned contract with owner) <br />If over $2500. a Notice of Commencement Is required (Mechanical work over $5000) <br />SUpply two (2) sets of drawings with applicable documentation <br />Allow 10-14 days for review after submittal date. <br /> <br />- <br /> <br />Y I N I Fee Current I Y / N I <br />LiOlMi:can15B#.."L_. -~-__~~t~J <br /> <br />ru~ <br />