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<br />.C,r: !/' ~J'~:7,/n:U os: 21 A~! <br /> <br />1113-780-0020 <br /> <br />ZEPHYRHILLS BUILDING FAX !~o. 813-7.30-0021 . '. 8!>7 P,OO: <br />oity ofZephyrhiJls'!FIr'e~ ',,' ~ 1 Fax-813.780.0021 <br />. Permit Application <br /> <br />~. rJ J.. <br />DOl!€' H(l'~IlI\'ed <br />~.,L_~ "..~ ....... v__., nllll rr T <br /> <br />O'J.ln~;"'~ Nam~ <br /> <br />':)~:r:ere AdcJrell' <br /> <br /> <br />'.JAM <br /> <br />-'1M] <br /> <br />Fee S,mpl€: Tllleholdar Name <br />Fl,ll; Slm~le TilIeholder Addn,lu <br /> <br />[] <br />C:J <br />o <br />o <br />o <br />.~ <br />Schebled~ <br />TYVltI ~ t Sf <br />( Loe&oesdQr) <br /> <br />. ~. J A'. A."" """..don <br /> <br /> <br /> <br />Fu.ITanks <br /> <br />o Other: <br />~:'.S~',"i,"".d'~' -'"'1 . <br />I. -;}. ' <br />G('n:'<ll'h'r L._ W c. <br /> <br />Job Ad~Ul)ss <br /> <br />Svt. Dlv/s!on <br />:~l<liJtJIl:3:i:' <br /> <br />Sj::irl~t\Jre <br /> <br />A~dra.~ <br /> <br />aE:::-rHI~IMII <br />6Ig',ul\."" L_ <br />AddrfJ&$ r- <br /> <br />PLU,'.mER <br /> <br />f <br /> <br />::~'9n~+.u(t <br /> <br />Addre5~ c== <br /> <br />MErCHANrCAL! <br />Slgruliura <br /> <br />Adclru,sS [ <br /> <br />Bio.Haurd Wute Storage .,ANNUAl <br />Comm exhaust Kitchen HoodJDucl <br />.' . <br />ConlrtJUed Bum <br /> <br />Etnefgency Generalor ~ SO kw ' <br />Etliergtnoy <;;en8na\or:> 30, kw <br />Fire Protectlon MalnwnaflCll - ANNUAL , <br />IB!!!2J .~ ~ <br />o [J 0 <br /> <br />14 ,. <br /> <br />lurner <br /> <br />Sprinkler <br />FIre Alann <br />Hood Cleaning <br /> <br /> <br />o D <br />CJ D <br />D 0 <br />fYJti1HJ S <br /> <br />'Goeftt 3 <br /> <br />Fire ~LJmpS <br />Fin. l,'Vork, <br />Flllmmable ApplIcation- AN~UAL <br /> <br />.:::... '~~1e ContBct'for frrmll J~?J -~ !J~~~, lJ!j ~ ~: <br />.I8),~ Il7% d 1'[350;; <br /> <br />I'L ._ <br /> <br />II <br /> <br />PafQ.l t1 <br /> <br />ti. 3 i'V<: 5 <br />L <br /> <br />~J Lot# <br /> <br />.. <br /> <br />'L <br />~. <br /> <br />D FUmllJatl~11 T.nl <br />o HazarclClul Material (Tier II or RQ Fac::l/Ity) ANNUAl. <br />D Hood In.tallatlon <br />8 lj)IN~t..."" Gel-ln,taUatlon <br />LP/Natl,/11ll GaG-AHNUAL 8ale ' <br />,. , <br />, Place_ of Assembly-ANNUAL <br /> <br />~ ReerealloMI Bum <br /> <br />, Sparkltr. <br /> <br />. Sprlnk'-rSyslam In.tall.tIons <br /> <br />Stllndplpe. (Sprinkler $y.) <br /> <br />,D Totdl ROofif'grr.r Keltl6 , <br />D Wasta Tin. Storage ANNUAL . <br /> <br />. J <br /> <br />J <br /> <br />Valuation of F>rojElct <br /> <br />in -u r <br /> <br />,.. 1U~1 <br /> <br />-- <br /> <br /> <br />= <br /> <br />(lrHEH <br /> <br />Si~~j'oll1r& <br /> <br /> <br />~:~""JlR>>1!;~~- . rn......"QIllj,-:": W" <br />l)': ,a-:hons: . <br /> <br />-- <br /> <br />, .JI <br /> <br />- <br /> <br />'liD i <br /> <br />- <br /> <br />-L-j ...... <br /> <br />L ,'.TI <br />Company I <br />. Rl8iJlstered Y I N :r <br /> <br />'" LI~c~se. *., .I <br />CompahY I <br />Regi.tel'lld Y I N <br /> <br />I.lcense t. L <br /> <br />I Y/N I <br />I <br />J Y/N 1 <br />I <br />I <br />~ <br /> <br />- r- <br /> <br />Fe" CLJlTent . L .Y I N I <br />I <br /> <br />Fee Current L-fl.!:U <br />I <br /> <br />y I N~ r <br />I <br /> <br />" <br />'I <br />, I <br />I <br />, <br />I <br /> <br />- <br />Fee CUrrent <br /> <br />Company <br />Regie1ftd <br /> <br />license # <br /> <br />Company <br />Regl.lerecl <br /> <br />Llcenu * <br /> <br />Fee Curl1lnl <br /> <br />Y./N l-~ <br />I <br /> <br />Lr~ <br /> <br />Company <br />Regia.red <br /> <br />Llcal'll' # <br /> <br />Y/N <br />~ <br /> <br />"ee Currellt <br /> <br />"V III ,.._.,,'~ .Ill IU <br /> <br />..... <br /> <br />Fill out application completely. <br />Owner & Contraotor sign blQk of eppUellllon. notariJ:ed (Or, copY of signed contraot with ownar) <br />:. over $2500, ~ Nottee 0' CommeflQement j, reqlJlr~ ,(Meoh.nl~ wol'k ov.r $6000) <br />Supply two (2) sets of drewinga with applloable documentatiol1 . <br />Allow 10-14 days for I1Iview atter submittal date. Part:e1.". - obtaIned from Property Tax Notice (hllp:llappralser.pascogov.tlom) <br />