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<br />DEC~/Og/20t 7 <br /> <br />Owr~ Addrosll <br /> <br />Job .AAdresS <br /> <br />SubDIvision <br /> <br />,,;'E~lftJ'T.~illl!ll!ftm._~ <br /> <br />[J <br />~' <br />[J <br />CJ <br />o <br /> <br />[J <br />CJ <br />CJ <br />r-......, <br />I ' I <br />....- <br />C:J <br />LJ <br /> <br /> <br />PM ZEPHYRHILLS BUILDING <br /> <br />, . <br /> <br />FAX tic. Bl3-7BO-OQ21 <br /> <br />P,003 <br /> <br />Fai..a1S-Yf30.0021 <br /> <br />City ofZephyrhftls FIre ' <br />:permff ApplIcatiOn <br /> <br /> <br />F'tlone ,C~for i"onnft <br />I <br /> <br />~ 1~~"~ <br />~~ fll~t1z.fo5i~ <br />J . . <br />\ . <br />[1,1 <br /> <br />813-781).0020 <br /> <br />, , ~'Ei/ <br />:::~~~ ~---~. <br />~ '3 <br /> <br />FGQ SlmplG i1jtehold~ Name ' I <br /> <br />Fee Simple TlttehQld~r Adi.f1"eS:l ' " <br />l> ',__Ill" ] . <br />I '7 Wt1 '~' (oil iSlvd <br />'- ' " , " ' <br /> <br />J Ownet's Phone N\.ImJ:ler <br /> <br />, Tllleholcef' Phone Number .[ <br /> <br />J-r <br /> <br />:- <br /> <br />!mrl~ tl !i.lll 1Il <br />81o-Hazard Waste storage. ANNUAl. <br />" <br /> <br />COmm E;xhaust l<ItChel:l HOod/[)uct <br />(',ooll'olled Bum <br />,Smergency Generator, < 30 kw <br />Emergency GenerirIor,. 30 ~ <br />FIre Protection'Millntenance - ANNUAl- <br />SprinKler D <br />Flm All'lnTl " D <br />Hood CleanlsUpFll'ession ~ <br />nre.Alarm lt1$!liatlon' ' <br />Flrtl Pumps <br /> <br />Fire Worn:s <br /> <br />Flammable AppllqItion- ANNUAl.. <br />Flolel Tanks <br />Other: <br /> <br />Contractor <br />. SlgMtUre <br /> <br />~, <br /> <br /> <br />ELECTRlC1A'l - <br />Signature L_ <br />AdOras; r 'I <br /> <br />PLUM, 6ER '1-,- ',' <br />signature' __ ' <br />'Ad~!"{ 1. . <br />MCC~ANICAl.r-'I" <br />$lgl1ature . L ' <br />AddlT;S!cL I <br />OTHER r- ~] <br />Signature j <br />l~, .... <br />I- ' <br />DI ~.r"1<iI~":C;JI:'''''';''''~~~_'''7 ' I ~i r ,I <br />re one. " <br />, ~ ot:It applicatloncomPI~" " ' , , ' <br />'1- &- conlTacloT.l:Iadt.at'aPP/lc8tion.'flI1tlIr1zed (Or, copy af~ eorrl'%lGt..mn owner) <br />Lover $2500, a Notice of Commencement 1$ requjrad (Mechanleal work over srocx;) <br />;3upply twc (2) setS of ~WUh appIicabkl dooumantatioo ' <br />Allow 1{)"14 days for review a1ter submlllal date. <br /> <br />r. <br /> <br />~ <br /> <br />": .I <br /> <br />,A; <br /> <br />1ffi~i4~, ('~. [I ">d <br /> <br />. Parcel # I ,; '; " <br />, \VO I ,\If'l~LJ t'KvM r:~VI"'l:Klr j~ "!V II~)-".. <br />.LA~Rl / ~ <br />.0 FU'TllsallonTont. ' .' '1' ',/' 19, /, <br /> <br />D <br />, 0 Hood Jtltitallalion <br />o 'L?/Natl:;n!l Gas-lnstalIalion <br />o l.P1Natl.iral Gas-AHNUAI.. S_ <br />D. Places;-f Assembly-ANNUAl. <br />o R8=liQnal B!ollT1 <br /> <br />o =__.,.ft~I~811.-/ r",,~fel/i) <br />d :::::-s,o) :. .~'" ',~'~ ,01 :~' <br />o " " <br /> <br />o Waste ':ir$ Sto.~ ANNUAl- !. I <br /> <br />c: J.~oi~c~~~) <br />/~ <br /> <br />//// <br />,/""w/ <br /> <br /> <br /> <br />Ccmparf)i' _ <br />Regisb:%&d <br />~loJf [ <br /> <br />Cc:;1l".p$rlY I <br />Regiut.tred , <br />Ucen:m:/l I <br /> <br />Gom;llmy ',I <br />'RQg!stnred , <br />UC_Il~1 <br /> <br />~;:::o I <br /> <br />UCE!l'llm '# I <br /> <br />Y/N <br /> <br /> '; <br /> Fee CUlT'emt ! ' Y/N <br /> : <br />'! Fee Curn;nt L YIN I <br />" <br /> . I <br />" ; <br />1 Fee ~t Y/N <br /> Fee CtJl'l'9nt Y I N-r <br /> . -~ <br /> Tn I 1 UJ; <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Company I <br />RftGiS!Brecl I <br /> <br />Y/N <br />