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<br />NOV/!4/20C7tNED 02:45 AM ZEPHygHI~ tlllLUI~ <br /> <br />nu, NO, ~Jj- !':lU-UULJ <br /> <br />r. 'JUJ <br /> <br />8'l3-780.0020City of.lephyrhills Fire Fax-81301ao.ooz1 , <br />. #:a.~ 01 / . .Penni\ApplIcaIIon ....... . .. <br />Date Received ,L:=' _' ,:t: . . . . . ~ CQotacl fDr Permit ~ * - H <br /> <br />~~ .~f~~~~1~- .~~ :L~~ <br />OYmer~;AddreSS ~~.~~~~~~. 1J_~_ ...titi)..&r. rY'~~: .~~= <br />Foe _ ,.".,.,.;...;..,. .. .. ... ... . .. ......,;,.... P..... ...... · l II .. . <br />. Fee Si",ple 'l'1teboJder A!Xhss. <br /> <br /> <br />D <br />0' <br />',0 <br />'0 <br />o <br />o PIacel; of Asstlm~ <br />o .~~Bum. <br />'D~"" <br />D ~ System instalatiDns <br />" 'OSl8rldpIpeS (Spmder Sys) <br />. ',0 . TDJCh fiOoting <br />D Wsste Tnt Storage A....~. <br /> <br />Job A~ <br /> <br />SUb 0Msi0n. <br /> <br />.0 Bio-HaZanl Wliste StonIge - ANNUAL <br />D eonlnl ellhEiust KltdiefI ~ <br />o Controlled Bum <br />o ,Emfll'lltlflC'l (3GnenI1Df' < 30 kw <br />o Emetgef1CYGenerator;'30~, . <br />o Flfe~'~nce-~MUAL, <br /> <br />. Sprinlcler . . /- f-J.Y D. <br />, Fi~' ~'j<; '. 0 .' <br />~~', <br />o Rr9~'~ <br />D . FIre Pumps <br />: 0 FIre.Works; <br />,D" FIammable~~NUAL' <br />o Fuel ra.ntai <br />D Other: <br /> <br />Lot'" <br /> <br />l.' .' <br /> <br />.' ~# <br /> <br />FurnI!;;don Tent <br />HazsrdGUS MatwIal (Tiel' II or I<<J F~It)') ANNUAL <br />Hood'lnstalllltkm <br />LPINeturaI G8l5-In&tlIIlaiIon <br />LP/Nalt.&iIt aa.ANNUAL We <br /> <br />. '.' ;,-} () <br />. '---;'v <br />~0'" . <br /> <br />r <br /> <br />J . ValuatiOn of Project <br /> <br />i!~I!!CT~ell'\N h:1JA <br />SlljlflBture . <br />..Addressl <br />PLUMBER r <br />S1gl'lllture' . <br />AddreU, I <br />MECHANI1' <br />Signature . <br />~11ISS I <br /> <br />:=.1 <br /> <br />, Addre8s , <br />~~: <br />All out appI\C8llCln completely. . . <br />owner & ContJ:8ClOt SIgn b8ck of ~.'n.nar~ (Or. Qapy of slgned c:ont\'8Ct with ~) <br />If over S250Q, a NoGceof CommIn8llftIs requIred(Ml.<.t_lh..aI work O\IW $5(00) . . <br />5uppIy two (2) MIS r:I c:lnNings wilh IlJlplk.... doc:umeo"'INo, . <br />AIIOIIl! 10-14 dBl'5 for I'MII8w 8III!r !IUbrntllaI daI8.. <br /> <br />~ <br /> <br /> <br />~ <br />, 5ignatunl <br />AddnI$S <br /> <br />. '. ' <br /> <br />'J <br />1 <br />r <br />J <br />'1 <br />I <br />I <br /> <br />.'='1 Y/N <br />~# I <br /> <br />.'~'I Y/N <br />~.. I <br /> <br />.='1 <br /> <br />..,~c# 'I <br /> <br />.='.F' Y';N '1' "F~CUlJent' I <br />LicenSe. I <br /> <br />=1 Y/N <br />Liolrnae # I <br /> <br />Y/N I <br />I <br /> <br />'Fee Cuinlftt <br /> <br />I' Y/N J <br />3" ,'" '. <br />" . <br /> <br />Fee Cun8nt <br /> <br />f Y/N] '" <br />, I <br /> <br />Y/N I ,FeeCumri I Y/N I <br />. I'. <br /> <br />Y/N I. <br />, ,I <br /> <br />F_ Cooenl <br />