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<br />HRii~ <br /> <br />81 :i-780-0020 <br /> <br />Date Received <br /> <br />OC'7/MON 02: 1:, PM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />FAX No, 813-780-0021 <br /> <br />-lf1~ <br /> <br />;I~ ' <br />: 3Iic <br /> <br />city of Zephyrhills':Fh'et'. ':'.. <br />Permit Application <br /> <br />'Phor!l;l Contactfor Pennlt <br /> <br /> <br />,I S u/1;'1:;y ~ It! S (,( "GJW>>~ It" /1 f.J. I Owne~s Phone Number <br /> <br />Ownl;lr'sAddtMs f7325 C;4GA..- "(..vi/) l..t:/PJlYI2I#';(,~ R J)S'II <br /> <br />Fee Simple T1Ueholder Name I ~ Tdleholder. Phone Nwnber <br />Fee SlmpleTitleholderAddress ., <br /> <br />17'J2.,f CA (,{, 'B(..(./I) <br /> <br />I <br /> <br />Owner's NiUllB <br /> <br />Job Address <br /> <br />SubDivisIon <br /> <br />D <br />D <br />'0 <br />D <br />.D <br />D <br />(.()mp,e'n:'tJ ')/ r/o 8' <br /> <br />:I 8J3 I'l <br /> <br />Emergency Generator < 30 I<w <br />.l:metgency GerMntor > 30 kW <br />Are Protection Meintenance - ANNUAL . <br />'D~'~'~~ <br />Sprinkler 0 0 CI L-.J <br />~ Fi19AlalTl'1 0 CJ 0 CJ [:J <br />~pu;~ 3h4o Hood Cleaning ~ 0 ~ 0 CJ <br />~Hood Suppression ~ 0 tY' 0 C:=J <br />D Are Alann lnetalkltion <br /> <br />~ ::: ~o= <br /> <br />Flammable Application- ANNUAL <br />FUfilI Tanks <br />D Other: I <br />IlIIi:...... - <br /> <br />~~~:::r 'r'~~%. ., <br /> <br />Address 1/J~.1 ~",~/I'f- 111/4". CAHhUa~~P(. 'lJ~tl <br />~C~C~NI I <br />SIgnature . . <br />Addl'eSs I I <br /> <br />:~~~~: I I <br /> <br />Address I ] <br /> <br />~~~I I <br />Signature . <br /> <br />Address l I <br /> <br />I I <br /> <br />OTHER <br />Signatu.... <br /> <br />Addre&l> I <br />. 1lf <br />Directions: <br /> <br />"II C Y ~ r -.. <br />I <br />I <br />l <br />.1 <br />I <br /> <br />. <br /> <br />lFO <br /> <br />I"l <br /> <br />"L <br /> <br />--z,.e:P JI'Y/2.Ih ",,,~ F (. :1:1 J'fI / <br />I Parcel # J <br /> <br />J Lot# <br /> <br />-, <br /> <br />L <br /> <br />'T <br />aio-Hezard Waste Storage -.'ANNUAl <br /> <br />Comm Exhaust K1tehen HoodfOuct <br /> <br />Controlled awn <br /> <br />n <br /> <br />D <br />D <br />.D <br />o <br />D <br />D <br /> <br />o Recreational Bum <br />o 'Sparklert; <br />o Sprinkler System Installations <br />D <br />o <br />D <br />I <br /> <br />Fwnigallon Tent <br />Hazardous Materisl (TIer 11 or RQ Facility) ANNUAl <br /> <br />Hood In:lallation <br /> <br />LPlNatural Gas-Instalkltion <br />LP/Natural Gall~'ANNUAL Sale <br /> <br />!,>Iaces of Meembly-ANNUAL <br /> <br />Standpipes (Sprinklllr Sys) <br /> <br />Torch RoOflnglTar Kettle <br />Waste TIre Storage ANNUAL <br /> <br />,~ Valuation of Project <br /> <br />- <br /> <br />'. <br /> <br />- <br /> <br />Company I 'M:' u:rJl;/}UI" SY.T:Wn oS d "~ "t.. <br />Registered N I Fee Current I Y J N 1 <br />_hicen&B_#_..J I 81 Y1I t;) (J ~ D ,3. e" 7 I <br /> <br />~;=~ r '0 N I Fee CUrTenl l Y I N I <br />license tt- I I <br />Company I <br />Registered [ <br />LicBl'lS8 # I <br />Company I <br />Registered <br />. LIcense tt- I <br /> <br />:::~d 1- Y I N I. Fee Currant I <br />License it L <br /> <br />J <br /> <br />Y/N I <br />: <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Y/N I. FeeCUlTent I Y/N I <br />I <br /> <br />Y/N J <br />I <br /> <br />All out application completely, <br />Owner & Contraetor sign back of application. notarizsd (Or. copy of signed contract with owner) <br />If over $2500, a NotIce of Commencement is roqulred.(Mechanlcal work over $5000) <br />Supply two (2) Bets of drawings with applicable docl.ImBnlalion <br />Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax N<;rtic:e (http://appralser.pascolilOV.r.;om) <br />