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<br />City ofZ IpnyrhlllS Fi~--' <br />'Pennft plication._ <br /> <br />Phone 00I'Ita!lt for'Permit . <br /> <br />JAN/29/2008/TUE 01 :56 PM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />~13-780-OO20 <br /> <br />.Date 'ReceiVed . <br /> <br /> <br /> <br />Owner's Name <br /> <br />rY]D./Jc-;. <br /> <br />FAX No. 813-780-0021 <br /> <br />. P. 0~3 .' ~ V <br />F~-81~7~~ 1 <br /> <br />. OWn.,.. Phone' NuinIier <br /> <br /> <br />. J..l <br />III g~Jl~(.h;~J <br /> <br />. OWner's Address <br /> <br />Y315S <br />I N~ <br /> <br />rL-' <br /> <br />....,....f~ ~~~ne~&.;.I~17 rr <br /> <br />n <br /> <br />." <br /> <br /> <br />BIo-:H8za~ W.., Sigrage ~ ANN~ ,': ) . 0 FumJg&tlon Tent. . <br />Com;" Exh8ust KItohen HoOdlou~ ',' '0: . H~~ M.rta'.(TIef II or RQ FacUlty) ,A~~ <br />. CQntroIIeP Bum '. · .' 0 : Hood I~ilallon '. . , <br />Emergency Gen...tor ~ SOkW . 0 : " LP/NaturBJ Ga..lnstalllltion . . <br />. E~nCY ~~r~ so'kWD,L~~I.GU~AL &ode,. . <br />~ Protection Maintenance. ANNUAL D. P1agee; of AAembI)'.,.ANNuA~': . <br />,Sprlnkler ..' 0.. . .' ' .... D. ~1l~tIonala\!m "" <br />f ~ ,h,S o..lr:~..J..t 'D. . ' , <br />FlreAl8rm . ~~~ ,LdJ )'''S~~P: . ~~IB. . <br />'. Hood CIe..nlSuPPf8M1on 0 '--(owlc:l . ~1.1- '. : D Sprinkllllr Sys1IIm 1~II8tioIla, <br />D. Fl- A1ann.'.......'O-'&"- . o..bo...J f,v""if- D:. .....-..-.....;. (5 ....."....Sys)' '. <br />,- ...........-., .);o~ ne~:-: ". ..<>ID!....I"t.'"'- P.II- <br />o fire Pu.nipi "'. D Torot! RQOtIng. . <br />'D Fire Worb . D WesteTl,. stonage ANNUAL '. <br />,[j . F~mable ~'ANNUAL_ <br /> <br />D . Fuel Tank5 . <br />D Other: ' <br /> <br />Fee. Simple ~er Name <br />Fee Simple TItIehoh:t.r Address <br /> <br />Job Address' <br /> <br />SUb DlVlIlon <br /> <br />D <br />',0' <br />:D' <br />'D. <br />'0 <br />"fgJ <br /> <br /> <br />Contractor <br />, Signatuni <br />AckIntu I fJofS'i- ?S'[ I HoNoJASSA ~~ I ~(/tI'I"2 !. r <br /> <br />.'=~Nl ". .. .',' . , '.,0. <br />. Address I iJ ' <br />==-! - .....~ .. <br /> <br />MECHANICAL <br />Signature <br /> <br />AddreB8 <br /> <br />OTHER <br />S/gnetunt. <br /> <br />. Addre8S <br />DlnKlllons: <br /> <br />.1 <br /> <br />. Lot., <br /> <br />: Lf'i'jq I <br />, <br /> <br />Pa~# '. <br /> <br />c. <br /> <br />. I": <br /> <br />) f / ;;<'0 ,CD <br /> <br />l Valu.tion of Proj~ <br /> <br /> <br />Co,np~r .' r CVt\A. +' L. (:- T t; f /l.Jc.\t;l..nwJ" , <br />RegIatered [=-Y..(N2] 'FeeCwmrt I Y .(~ <br />'uo.nae# . j. (ir ;toooo-~39' "'-J <br /> <br />. ::d.1 'Y/N Fe.Current--:-'J ~'NI" <br />uOenee# I I <br /> <br />=.." "'N F"Current ~I' Y/N) <br />ue.nseil I I. <br />.1 <br />I <br />I . '~ <br />Y I N I Fee Current <br /> <br />] <br /> <br />~ <br /> <br />'] <br /> <br />qo.mpany <br />. Registrnd <br />,LIcenIe# <br />I' JI~ .j., <br />, . R41stered <br />, <br /> <br />,Y I N .1. Fee'Current. ,I .Y.I N 1'--, <br />I. <br /> <br />Y/N ] <br /> <br /> <br />'1 <br />FdI out appUceUon completely. . .1 . '. '.' . <br />Owner & Conlr8c:tor sisn b8ck of appllOlltlon. notarized (Or, COF1' of signed contract .....,,~.) <br />, If over $2500, . No1Ice of Commel1Ollmetlt. iIIl'l!Iquired (Med'laT Work <MIr $l5OOO) . <br />SUpply two (2) &ell of dravt1nga v.4ln appIlaable dooumenlBtIon . <br />~ 1o.~4 days for ~atl8r ~I datll. . <br /> <br /> <br />FEB ,1 3 2008 .' <br /> <br />