|
<br />JAN/24/2008/THU 10:57 AM ZEPHYRHILLS BUILDING
<br />
<br />FAX No, 813-780-0021
<br />
<br />P. 003
<br />
<br />'313-780-0020
<br />
<br />City OfZ~phYrhlUs Fir~', .' .
<br />.' :Permlt V\pplication .
<br />
<br />,Phone Conta~ for Permit .
<br />
<br />Fax-81~78o.-0021
<br />
<br />Owners Name
<br />
<br />SA-I ;r,fl
<br />
<br />oWner's Phone Number
<br />
<br />7~?117;C .l".1/t?3
<br />
<br />
<br />Date'Received
<br />
<br />
<br />'.n m~holder ~one NlDnber"L . II I ] ,
<br />
<br />'1111';1 '11 -'. :~!
<br />Lilt)- :J~ # H' yJ!..,h' / .?L. 5.F L.. . .Lot# ,I
<br />
<br />I' . . p -- .
<br />ParcEll # : 'lV~1 A1NI::~ rKVM r'KU I::K r y I ~ 1'l.Y_' 1t;1::)
<br />
<br />Owner'l> Address
<br />
<br />A fJf?/!~o.s:A' ~.o ~ ~.k?A'.i:7..J . :;:,P~/,J?s . F'-'. .3 ~ e~
<br />
<br />Fee, Slmp~ Tltleho~der Name
<br />
<br />Fee Simple Titleholder Addr~sl>
<br />__ ""'Q" II!r
<br />
<br />. l- ,
<br />: . i
<br />
<br />
<br />~. . "
<br />
<br />Job Address .
<br />
<br />~&a'~",
<br />
<br />/J /-4-'
<br />
<br />Sub Division,
<br />
<br />", ..
<br />
<br />..0
<br />'D
<br />Cpntl'olle~ Bum 'D" Hood Instaitatlon '
<br />Emergency Generator < 30kW . D . LP/Natural Ga~-lnst8I1atlon .
<br />Eme~ncy Ge~e1'8ior> 30kW ','D .L~/NBturaIGas-~NNUAL Sale.. .
<br />Fire Protection Maintenance - ANNUAL 0 '. Places of ASG~mbly~ANNU.iu.
<br />'Sprinkler ' [j, ' 0 Recreational8l1m,',
<br />Fire Alarm 0 . , 'i:::J Sparklers .' .
<br />. ~~suppresllio'n '~~~t :'D SprinklerSystem'lnstallations
<br />, D, Fire A1ann Installation 0 : Sta~dpip'es (SprinklerSys)
<br />D Flre Pumps' , D Torch Roofing
<br />,0 Fire Works . 0 Waste Tire Storage ANNUAL
<br />. d Fla~mable Application.: ANNUAL.
<br />o Fuel Tanks r
<br />~ Other:. e:x... 1-11'1 k.5.r
<br />ml 'lrl. :1
<br />. "0"'. Compan~
<br />_ Regi5tered .
<br />! ], Llcense# "
<br />J]" ~pany
<br />, , ' '. " . . Regietllred'
<br />o ' Ueen5$ #
<br />
<br />.,.n
<br />
<br />,I. I
<br />..0' ". .,.' q01:rlpany
<br />_ ' Regiaterad
<br />! I
<br />.:n. .
<br />
<br />
<br />.....,!- ".Lt II' ;u
<br />'\
<br />Fill oLlt application completely.' , . I . , '
<br />Owol;lr & Contractor sign back of app~catJon. notarized (Ot. coPY 01' slgnlild contract with owner)
<br />If over $2500. iii NoUca of Commencement iB required (Mechanlr work over $5000) ,
<br />Supply two (2) sets of drawings with applicable documentation .
<br />Allow 10-14 days for review after S~bmiltal date. . . . ,
<br />
<br />D
<br />'.D
<br />D
<br />D
<br />D
<br />123
<br />
<br />Blo~H8Z8rd, Wa$~e Storage ~ ~,NNUAL ". .
<br />Comm EXMUst Kitchen Hood/DU~ . ' "
<br />
<br />F':Imlgatl.on Tent " , ' . " ,
<br />Haza.rdo~s Material. (Tier" or RQ Facll1rY) ,AN{'lUA,L
<br />
<br />~.Ih..
<br />
<br />
<br />
<br />l Valu~tion of ProJeot
<br />
<br />() L..~/1 / "
<br />~~
<br />
<br />I
<br />~~.
<br />I
<br />
<br />~
<br />
<br />, I
<br />
<br />Contractor
<br />Signature
<br />
<br />AddreS5 I
<br />
<br />ELECTRICIAN[
<br />Signature .
<br />
<br />Address I
<br />
<br />PLUMBER I
<br />Signature '
<br />
<br />AddrealO L '
<br />
<br />MECHANICALI
<br />Signature ,
<br />
<br />Address I
<br />
<br />~i::~re .~~ ~.
<br />
<br />
<br />i~ . AddressL 1 .........1-'1"" -"'_.- - -' ~ ' .
<br />Olrectiorn;;
<br />
<br />I,' YI N 1 'Fee Current
<br />-E
<br />
<br />.I" Y IN, I . FeEl' Current .1
<br />I
<br />
<br />Company, , 'I,
<br />,Registered " Y /' N
<br />L.iCl;lnae # I
<br />
<br />'I.:.y I N ,I ' Fee Current
<br />L.ioense# 'I J.
<br />Company" ~..v .l)vr-sr;eM1 L--, :s-ro-"., d '-elf ;<J/-1:J'"
<br />Registered L Y I N I Fee Current L Y I N I '
<br />
<br />LiCC:~S~:.wJ "~n....' ;-_~____.~.~ ':I:J-~: J ' ~V""
<br />
<br />r
<br />
<br />Y/N 1-
<br />.1
<br />
<br />YINI'
<br />I
<br />
<br />Y Iii I
<br />=:J,,'
<br />
<br />.Y/N I
<br />
<br />I
<br />
<br />Fee Current
<br />
|