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<br />813-180-00,20 . City Of~~PhY~hi/l~ Fir~
<br />" . . , ,. .. . 'Permlt~pp/lcatlOn ,. .
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<br />'"~~~':f 1]J,~~:1;~L",-l~2ll ,LIN,__H&l:T T rL Phone ~,~~~~r permLJ"- ~'--....ll"'<"iJ .,,.,jJ.
<br />CNfi'C tp 1'\l ~~I{':)' t! \ ~I Owner's Phone Number
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<br />Fee Simple Titleholder Name I, l' I 'TItleholder Phone Number
<br />Fee SImple Titleholder Address I i
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<br />I' ~ J1, Parcel'#
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<br />Owner's Name
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<br />Owner's Address
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<br />, Job Address.
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<br />SUb Division
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<br />ZEPHYRHILLS BUILDING
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<br />Contractor
<br />. Signature
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<br />Address ,I
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<br />ELECTRICIANI
<br />Signature
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<br />AddreSS I
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<br />PLUMBER
<br />Signature
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<br />Addre5s !
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<br />MECHANICALI
<br />SJ(jnature
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<br />Address j
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<br />OTHER
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<br />Bio-Hazard Waste Storage - AN~UAL
<br />Gomm Exh~II.l5t Kitchen l-ioodfDuct
<br />Gontrolled Bum
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<br />Emergency Generator <: 30 ,kIN
<br />Emergency Generator> 3D kw
<br />Fire Protection Maintenance - ANNUAL
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<br />~_Ij~k..I~____./
<br />Fire Alarm
<br />
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<br />FAX No. 813-780-0021
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<br />Hood Glean/Suppression.
<br />Fire Alarm Installation
<br />Fire Pumps
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<br />Fire Works
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<br />Flammable Appllcatlon- ANNUAL,
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<br />Fuel Tanks
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<br />Other:
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<br />Fax.8'13C780.0021
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<br />I Lot# I !
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<br />Fumigation Tent . , ' \ .
<br />Hazardous Material (TIer 11 or R.Q' FaCill~) ANNUAL.
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<br /> Valu,atlon of Project
<br />. Company l
<br />Relglstered Y/N I Fee Current Y IN-'
<br />. LIcense # I 1
<br />Company I
<br />Registered Y IN .1 Fee Current Y/N I
<br />LIcense #' I I
<br />Company. I
<br />Registered YIN I F@e Current Y/N j
<br />LIcense -# I I
<br />Company , J
<br />Registered .Y iN I Fee Current Y/N
<br />LIcense #
<br />Comoany
<br />Registered
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<br />:;-ifl ':'lIt application campletely,
<br />Owner & Contractor sign !;JaCK or application, notam:ed (Or, copy cf signed contract With owner!
<br />If ovsr $2500, a Notice of Commencement ;:;; requirea (Mechanicai work over $0000)
<br />SUPPlY two ~2) ~ets of dfawlng~ with applicable documentation .: '
<br />Aliow '1 O-'j... days for review aitar submiilal oate. !
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