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<br />lVIIUV1JlLUUIIlnu UI:UL roo aYtlTKtlILL;) l:SUILUIf~ll <br /> <br />rAlt J~O,Olj-'OU-UULl <br /> <br />r, UUIl <br /> <br />(113-780-0020 <br /> <br />City of .Zephyrhill5''FIr.e~ .. <br />. .Permit Application <br /> <br />~ '-113 '"1-813-780-0021 <br /> <br /> <br />,-- . . <br />. ~ - 'Phone Contactfor Permit <br /> <br />:l~ <br />.Ede <br /> <br />Date ReceIved <br /> <br /> <br />~ 4 7 t08 <br />"""'......~ "t ~<e~!!Fh; 11: r i np:, ~n . <br />Owner'sAddIllSS .16:848 .~all.'Blvd., . Ze hvrhill, <br />::::::==:...f;;;;Y" R,u,t;;;, '. I <br /> <br />:= "t""~~ <br /> <br />J <br /> <br />PvceI # . <br /> <br />'.[' <br /> <br />fa, ;~~~2cIIJ SPQ1"" <br />8'13.1171.41.l'2494.1 <br />: ~ <br />I <br />I <br /> <br />Lot' <br /> <br />" <br /> <br />~I <br />1 <br />~] <br /> <br />1.1 C\,1 ?: <br />TItleholder Phone lI\umber' <br /> <br />0Wner'& Phone Number <br /> <br />- . <br />--....------....- <br /> <br />D. Blo-Hazard Waste Stor. ~:AN"'U~ <br />o '- Comm ExhaUlt KItchon I-loodIDuct <br />,0 CortImlled 811m <br />D... E:mo.rg~.(J.n.~wf<'~Okw '. . <br />o Emel'lleney G8nenl~r,> SO kw . <br />. oa . Fire P~tectIon MBlnten~1W8 -.AN~ I!!!!J ~ B <br /> <br />Sprtnkler 0 . [J iJ', l:J'. <br />FIleA'.nn ..CX1 p. 6' IX '.' <br />tigod Cleaning O. iJ 0'0 . <br />HoOd Suppreselon 0 : () [) 0 'C:=J <br />~ . FIfB Alann 'n&tailallon .. . <br />Fint Pumps , : . <br />: .FireWor]<& . '.. ' <br />FliImmable Application- ANNUAl.. <br />. F.ueI T.nk& '. <br />D. other: "1' <br /> <br /> <br />Contrac:tor I . i ~ . ,. .....,'. ..' ~ company~"" ~m i ne <br />Signawre The H rt i e A ~ ;il r () ". RegIStered' '. N FeeCumlnt <br />. ......." 40 I '5rt~ ~ce01C ~w~.;, L~~: ~ w_ 1 p'., E"~'.: EF 00 -- - <br /> <br />:~:~1 . ~ 3F.'~ ~ :;::d \.. ~ I N 1- Fa. CwI1Int <br /> <br />Addre9 I : I I.k:en&e II I <br /> <br />;~=~ ~. .\ ~=~ lY/N I' Feecunnt <br />AddlW$s I '. ~ =-, I lJceIW8 tt. L <br />~1:=ICAlI I ~~d I Y' N <br />Address I . I 'lIcenee tI. l-=-. <br />~::re I I . '~m:~ F yiN <br /> <br />Address I I Licen&eI I <br /> <br />Olreclion&: <br />. Flft out lIppllce!ion compIMIly, <br />OWner & ContnlcliDr &111" back of application. ~ (Or. copy at slgl\ed connct with owner) <br />If DY8C' $2500. a Not1ce of Commencement b 18qulttld.(rMchanlce' work over 56000) . <br />Supply two (2) set. ofdnlWlng, with appllc:8ble docI.I11entatlon . . <br />Allow 10-14 day~ for review llItBr &ubm/ltIl date, PatDeI' - obtained from Property TBJ( Notice (http://appr.alser.pll6cogov.com) <br /> <br />!.... <br /> <br />'0 Fumigation T.ant <br />.'. 0 HazM\OuB Material mer II or RQ FacllIV) ANNUAL <br />. D HaocI"~l8l1on <br />E3 LPIN~llnl Gas-lnsieilatlon ' <br />. ' LPIN~~i G........':JAl Bale . <br />. .' . Pia_of AIIII~JlUAL <br /> <br />o Recreal10nal Bum <br />:0 Sparlder& <br />. D Sprinktlll' S~ lneteIIatlonl <br />D. ~P'I~& (~~nid.rsyej.' <br />o TofcIl RopflnglTar K.ta. . . <br />D W" riAl Storage ANNUAL <br /> <br />: . . App.r{;c- <br /> <br />$ 1 7' C\ <br /> <br />~ 0 ,1 Valuation ~ Proj~ <br /> <br />~ 1 '. <br />I Y/~~ CQ. <br /> <br />~ <br />I <br /> <br />. .. <br /> <br />Y/N J. <br />.~ <br /> <br />Y/NJ <br />I <br /> <br />Fee Cunwnt <br /> <br />, Y./N 1 <br />I <br /> <br />F_ Current <br /> <br />Y'/N J <br />~ <br /> <br />J <br />