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<br />NOV/~1/20G7/THu 09:47 AM ZEPHYRHILLS BUILDING <br /> <br />Date Received <br />... <br /> <br />Owner's Name <br /> <br />FAX N <br /> <br />..7~~ ..~~1 <br />011. /9 J. ,/)1oZ- :J] <br />g: J7t1t11 -- OUJ <br />~ I7JtL- '0 ] <br />/J1 ::Jq :!r' ] <br />~ ~f/Je/5 - ~ <br />r:YJ1.. ~r ] <br />'11' fl&-. d:5 ] <br /> <br />813.780-0020 <br /> <br />City of-Zephyrhil/s Fil <br />Permit Application <br /> <br />l,_~- I <br /> <br />l-rAPtCroR ~tJPPt.'t c..o~ ~~ I owru <br /> <br />l~ ~\).')€LL f>LACE J ~a>"1woot>/..,.t..J J ~>'1od1 <br /> <br />I'DA\I \0 L. LewiS I Titleht <br />J~~~ <br />liIl rJ n llllf <br />bAu.. PDJI E\)~ )Z.EPtt~M\l.L5 I <br /> <br />I . Parcel # <br /> <br />OWner's Address <br /> <br />Fee Simple TItleholder Name <br /> <br />Fee Simple Titleholder Address <br />-I;?n I <br /> <br />L '14; \ <br />I <br /> <br /> <br />Job. Addres5 <br /> <br />Sub Divl$lon <br /> <br />- <br /> <br />11111I <br />Contractor <br />Signature <br /> <br />PLUMBER <br />Signature . <br /> <br />Address <br /> <br />1I T <br />_D Bio-Hazard Waste Storage - ANNUAL <br />o Cornm Exhaust Kitchen Hood/Duct <br />D Contrulled Bum <br />o ,Emergency Generator <: 30 kw <br />o Emergency Gsnerator > 30 kw <br />D Fire Protection Maintenance - ANNUAL <br />Sprinkler D <br />Fire Alarm 0 <br />Hood Clean/Suppression 0 <br />o Fire Ali;:um Installation <br />D Fire Pumps <br />. D Fire Works <br />o . Flammable Application- ANNUAL <br />c=:J Fuel Tanks <br />~ Other: <br /> <br />Poor <br />IIIl- <br /> <br />= <br /> <br />" <br /> <br />.- <br /> <br />o Fumigation Tent <br />D HazardoU9 Material (Tier II or RQ Facility) ANNUAL <br /> <br />..0 Hood Installation ~ .. ~ ~ ,.< J-6~ [./I. <br />D LP/Natural Ga&-lnstaUation &;,~ I (f~ I.<f~: ' ~ . Of1j <br />~. LPlNaWnill Gas-ANNUAL sal:! ~fY.j)~1. ,rr j~ - t,qe-I/ c9 <br />D Places of Assembly-ANNUAL ~#l)~p? .V,- <br /> <br />DO Recreational Bum e(/tf." ,!~I,(fj <br />Sparklers I <br />D Sprinkler System Installations <br />D Standpipes (Sprinkler Syst <br />o Torch Rooftng <br />D Waste Tire Storage ANNUAL <br /> <br />l <br /> <br />'] Valuation of Project <br /> <br />I <br /> <br />- <br /> <br />I <br /> <br />I <br /> <br />Company <br />. Registered <br /> <br />License # <br /> <br />.~Y/N_I <br />I <br /> <br />I YfN .1 <br />, <br /> <br />L Y/N. I <br /> <br />Fee Current <br /> <br />I <br /> <br />Company <br />Reglsterlld <br /> <br />License # <br /> <br />Company <br />. Registered <br />. LIcense # -I <br /> <br />.I Company I. <br />.Regl&tered -. Y f N 1 <br /> <br />- Lioonse # I <br /> <br />C!)m~1tiny ., <br />Registered r--Y7r,rl---F;;ecun:~~t <br /> <br />L-iCElnse # <br /> <br />FiJI out <1ppllcation completely. <br />Ownor & Contractor_ sIgn back of appllC<lGon,notarll:ed (Or, copy of signGd oont1<lct with owner) <br />If over $2600, a Noltel;! of Commencement is required (Mechanical wort< over :paooo) <br />:3upply two (2) sets of drawings with appllcabie cDcumentation <br />A:!('./10-14 days for mvlew attar submittal dato. <br />