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<br />MAR/l:/2007/THU 12:23 PM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />813-180-0020 <br /> <br />City of.2ephyrhill:iFIr.ei. <br />Permit Application <br /> <br />Date R.ecaivcd <br /> <br />:i[~~')c <#="~qO <br />. ~ :;, ZO GALl.-- B4Il~. <br /> <br />Fee Simple TltlehoJderNB[Tle ' " <br />Fee Simple Titleholder Address ' '1 <br /> <br />:::~d:::~ , T 7) 20 <br /> <br />~b Divislc: -..:...._J/! <br />o <br />D <br />D Controlled Bum <br />o <br /> <br />!@ <br /> <br />Owner's Nama <br /> <br />Owner's Addles!; <br /> <br />~- 1"l. I i IIIi <br /> <br />64Jt(1,LVP ~ <br /> <br />- <br /> <br />n<:r <br />, Bio-t-lazard Waste S~rage -ANNUAL <br /> <br />Comm Exhaust Kitchen Hood/Duct <br /> <br />Emergency Ql;lnerator '" 30 kw <br />Emergency Gimerator ". 30 kw <br />Fire Protection Maintenance - ANNUAL <br />, ~~~~ <br />Sprinkler ODD l!L L-J <br />Doooc=l <br />DOQoC] <br />Doo~c=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood SuppreS:'llon <br /> <br />~~~ <br /> <br />~ <br /> <br />lKJ <br />-- <br /> <br />I <br /> <br />"llIlIIlIII <br /> <br />Fll'El,Alarm Installation <br /> <br />Fire Pumps <br /> <br />Rre Works <br />Flammable Appticatlon- ANNUAL <br /> <br />Fuel Tanks <br /> <br />IExfl.Vf:,{;~HcP- ,NWCUlON <br />nl ~= 'r.r ~... Il'iII!' , -11' <br /> <br />FAX No, 813-780-0021 <br /> <br />P. 003 <br /> <br />Fax-813-780-0021 <br /> <br />'il:' <br />. ode <br /> <br />Phorie Contaetfor Pennlt <br /> <br /> <br />2C \ <br /> <br />Jl <br /> <br />"J <br /> <br />1 <br />j <br />-I.H~ <br />I <br />J <br /> <br />.A~_ <br /> <br />Owner's Phone Number <br /> <br />01 <br /> <br />'I Titleholder Phone Number <br /> <br />It <br /> <br />-II <br /> <br />.......l.L <br /> <br />u__ <br /> <br />~ <br /> <br />JllTif ~~l'JWJ.4.tslrrnr - <br /> <br />I Lot# 'I <br /> <br />Parcel # <br /> <br />I <br /> <br />~-- <br /> <br />~T <br /> <br />~T~ <br /> <br />Fumigation Tent <br />HazardotJs Materisl (Tier II or RQ l'aclIJty) ANNUAL <br /> <br />Hood Il1stallation <br /> <br />LP/Natural Gas-Installation <br /> <br />LP/Natural Gas-ANNUAL Sale <br />, . <br />Placeli of ASl;lembly-ANNUAL <br /> <br />1 ~~tf\ scllecl\eJ <br />-Q,( \l1lfScb~) 31zD ll)~ <br /> <br />~tandpl~ (Sprinkler Sys) <br /> <br />lorch RooflnglTar Kettle <br />W~ste IIr~ Slorage ANNUAL <br /> <br />Valuation of Project <br /> <br />Other: <br /> <br />- <br /> <br />~""H~ ... <br /> <br />r- <br /> <br />-_.- <br /> <br />=-J. <br />I <br /> <br />~ <br /> <br />I <br />1 <br />I <br />I <br />I <br />I <br />I <br /> <br />Contractor <br />Signature <br /> <br />AddrE'ss I <br /> <br />ELECTRICIANI <br />SignatuTl3 <br /> <br />AddTl3SS I <br /> <br />PLUMBER. <br />Signature <br /> <br />AddTl3SS I <br /> <br />MECHANICAl.r <br />Slgnawre <br /> <br />Address <br /> <br /> <br />OTHER <br />Slgneture <br /> <br />Address <br /> <br />Directions: <br /> <br />Li. ---" <br /> <br />Compa~y <br />Registered <br /> <br />License # <br /> <br />Company <br />~eglstered <br /> <br />License # <br /> <br />Y/N <br /> <br />Fee Currant <br /> <br />Y IN I <br />I <br /> <br />J <br />I <br /> <br />'I <br />J <br /> <br />"- <br />I <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N <br /> <br />Compeny <br />~egletered <br /> <br />L1censB # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Company <br />Reglatered <br /> <br />Ucense # <br /> <br /> <br />Company <br />Registered <br /> <br />,License # <br /> <br />Y/lf I <br /> <br />Y IN I <br /> <br />Fee Current <br /> <br />FjI( out application completely. <br />Owner & Contractor :;Ign bacK of application. notarized (Or, co'py of. signed contract with owner) <br />If OVE'r $2500, a Notice of Commencement Is requlred.(Mechanlcal work over $5000) <br />Supply two (2) sets of drawings with appllcable documentation <br />Allow 10-14 days for revieW after submittal date. Parcel # - obtained from Property Tax Notice (http://appralser.pascogov.com) <br />