|
<br />12/20/2007 THU 14:29 FAX 1 813 806 7190 ADT Security Services
<br />
<br />DEC/20/2007/THU 01:50 PM ZEPHYRHILLS BUILDING
<br />
<br />FAX No. 813-780-0021
<br />
<br />1dI002/003
<br />
<br />.10<0
<br />
<br />P. 001
<br />
<br />City of.Zephyrhills Are,
<br />, ' .Permlt A.pl?lication
<br />
<br />F~13-=780-DD21
<br />
<br />81l\-78o-0020
<br />
<br />Job Acdres&
<br />
<br />, .' 12 -2e:Oi l'.
<br />:~riJ~ .; ,-:pj..~A.t'dA- '~~- .1 Own.r'aP~~neNUmber
<br />}f()I Box ~1J6 "f)AiJA-S','~' ..
<br />'I .' ,\ TnlthO~; Phone Nu~er 1, 1.1
<br />I' , ..:
<br />~ ';: ~ '. '.' ,'. :
<br />r..ibilis ,'l{,-JIJ GAi.LB/JH: ~F~J.;tL 1, f:/., , I :1.ot#. ":1 ',' 'I
<br />-- .1, _ .,I~. -,..~Jltfj~~~d~, ..1
<br />
<br />. D B~8Zard w.. Stor~~,AN~U~ ' '; D FumlgaUon Tent
<br />o CommEJdlaUst I<itcI1en,HaodID.ul?l' . :. D HazardoUS Material ~ II otRQ, ~~~Ity) AN~U~,
<br />o Controlled Bum' , . 0' Hood ln81allatlon " "
<br />.0 ' Em~cy Generator < 3D kw ' , '" ; D LP/*tur8J'G!lB-lr5tauatlon ,
<br />,D ' Em~~cy Genel'iltOl' >'30 kw , , : 0 LPINIIIt\.l(aI,Ga!J..~NNUAL Sae.. .
<br />D ',: FIn, P1'aieation'MBintena~ce - ~NUAL :,' D 'PJIlc:ee of Assembly-ANNUAL .
<br />SprinkI-. 0 ", D' RecreBlion. Bum ..
<br />FIIlt Alarm D ' 0 SpaT1ders . ' '
<br />Hood CkNln/Suppr-..lon 'D " .' , D ,,' Sprinkler System IM1aIIBllonll
<br />Fire Alarm Insl1llleitDn " ' . ' '. ' '.. '., D \ standpipes (Sprinklel'~) ..
<br />FII'8 Pumps '0 , Torch RooIIng .
<br />FIre Works . 0 WMtit, Tire sto~ge ANNUAL'
<br />Flammable Application- ANNUAL .
<br />
<br />I'
<br />I.
<br />
<br />D_ Rec:eiv8d
<br />r
<br />
<br />-
<br />
<br />PtIone Coniaotiw pennlt,
<br />I
<br />
<br />'t-
<br />I,
<br />
<br />jJ
<br />II
<br />
<br />~
<br />
<br />owner'$ Name
<br />
<br />, ' ,
<br />
<br />Owner's Adlhll$
<br />
<br />. .Il
<br />
<br />F.. Simple T111o~r. Name
<br />
<br />Fee SimPle Tllieholde1' Address
<br />J
<br />
<br />~p
<br />
<br />,,"
<br />
<br />",~
<br />D
<br />D
<br />o
<br />D
<br />
<br />. .:-
<br />
<br />Fuel Tanka
<br />Other:
<br />
<br />'I
<br />
<br />~,QLj
<br />
<br />Valu~ion of Project
<br />
<br />ContRlctor
<br />, SIgnature
<br />
<br />" . Address
<br />
<br />E;LECTRICIAN!,
<br />S!gnature ' ]
<br />
<br />, . AddTes, I
<br />
<br />, PLUMBER' I'
<br />SlilnB1L1re, .
<br />. ~ddl'88S ,.
<br />
<br />MECHANICALI'
<br />Signature .
<br />
<br />Addr~S5 I
<br />
<br />OTHER I
<br />' Signatln .
<br />
<br />" "Ad~1
<br />'l!'l1I iiirJiaI
<br />lJlI'.clIons:
<br />AI cxlt appl~t1on completely. "
<br />OWnsr & ~ontrac:tor sign beck gf epp1ic.llUon. notarized (Dr;cop:v. of'signed centrad with owoer)
<br />If over 52600. . Nwce of Commencement is requir1!d (Uechanlcal Work over $60(0) ,., .
<br />Suppt)/ two (2) sets of drawlns- with ~plcable dogumM\llnon '
<br />Allow 1()"~4 days {or nlVlewaftersubmlttal,date. " ,.'. ,.' "
<br />
<br />
<br />,
<br />
<br />eomPanv "I
<br />Regl.~ " ' Y I N I,
<br />, UcenS8 t' "I
<br />'.31~~:11'" ,co~P8ny' ',1 .
<br />'~ .' ,RegifMred, Y/N.I
<br />l. 'UOen.e,~' I
<br />I Company: ,'.,E
<br />, Regi8ttnc1" ,Y IN .,
<br />, ,':, ' ,\..iCllnse# "I
<br />I, " CDf!1pany [.
<br />,', : Registered r . Y I N ~
<br />I .. "U~~# I
<br />I, ' Company, I' ' .
<br />. ' ~glstsred' '.y I N
<br />I :, 'U~se#" I ~
<br />. II V r .VIiIU_
<br />
<br />,ree ,C~rrent Y/NI
<br /> I "
<br />: 1
<br />F.. C(Jrrent Y/N
<br /> I
<br />Fee C~rrent , . YI-N I
<br /> .1
<br />Fee C~.nt " .Y/N -1-,
<br /> 1.':
<br /> I YJN .1 I
<br />Fee C~rrent
<br />i ~. ll~
<br />.........,'l7 - -.., . -+
<br />
<br />",
<br />
|