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<br />~~~ G~~J0~rHU 09:21 AM <br /> <br />813-'180-0020 <br /> <br />Da!e Hooalved <br />~-~~ <br /> <br />~")\j.'n~;~ Name, <br /> <br />':;.....mere Address <br /> <br />FAX ~o. 813-730-001l1B~'V <br />City of Zephyrhills'1=I(o':' " ' <br />. Permit Applloation <br /> <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />f:ee 5'1111)1(: TllIehold.r Nllme <br />F~~ Simple Tilleholaer AcldrN" <br /> <br /> <br />Job AOQ(GSS <br /> <br />Svt. DIVI"lor. <br />!!lijjJ~' <br /> <br />[] <br />[J <br />o <br />1~.J <br />D <br />~ <br />&11edJeA~ <br />[f'\ay ~ l S~ , <br />( wednesday) <br /> <br />.~ <br /> <br /> <br /> <br />'.'< ,0 <br />'~",..~~ <br />Cr'nh'l'lof <br />Si;'Jflo!lture <br /> <br />,.\.jOTiJ:iS <br /> <br />[: L.t-:;:"r f{1~IMII <br />019"\.11"'(1 L_ <br /> <br />Ad.;lr'f&$ C- <br /> <br />:~~:;~:R f <br /> <br />Addross ! <br /> <br />M~CHANICALI <br />S!grll!ltUre , <br /> <br />Adcru.ss l <br /> <br />~;:~,f~~~r& f <br /> <br />Adoltlll:> r- <br />:::~~~~Jti~... <br />l)l! d";: l,ons: <br /> <br />6io-H8:tard Was~ Storage ..ANNUAl <br />Comm Exhaust Kitchen HoodJDucl <br />, , ' <br />Conlmlled Bum <br /> <br />Emergency Gener.tor <; SO kw <br />Emergenoy Generator> 30 kw <br />Fire Protecllon MIIlnumance - ANNUAL <br />t3:!!!21'~ ~ <br />CJ 0 a <br /> <br />IVII",r <br /> <br />P. GO: <br /> <br />Fax-813-760.0021 <br /> <br />',' ''''hone ContllClt'for FJermlt <br /> <br /> <br />Sprinkler' <br />FIre Al8nn <br /> <br /> <br />o 0 <br />o 0 <br />o Cl <br />t.j- (y)01H1s <br /> <br />J B"~ <br /> <br />qlOD <br />I fo> 37 ().: <br />--.-J <br />l[ 1 <br />::J <br />"L~ <br /> <br />o <br /> <br />Tilleholder Phone Number <br /> <br />II <br /> <br />Hood Cleaning <br />ppl1lllSlon <br />Fire Alarm Installation <br /> <br />'~ <br /> <br /> <br />LoU <br /> <br />Fire t:>ump$ <br />Fire Woriq; <br />FI~unmabl8 ApplIcation- AN!IlUAl <br /> <br />Fuel Tanks <br /> <br />c <br /> <br />~_ 1: IIll r <br /> <br />111111 <br /> <br />o <br />D <br />D <br />8 <br /> <br />Fumlgatl~n Tent <br />Hazardau. Material (Tier U or RQ Facl/lty) ANNUAl. <br /> <br />Hood In.a.llatlon <br /> <br />. <br />lPlNlItural Gea-lnstaUatlon <br />LP/Natural Ga~NNUAL Sale . <br />, Pt.CN of Ass.embly-ANNUAL <br /> <br />~ <br /> <br />I <br />./ <br />, I <br />I <br />, <br />I <br /> <br />~ Rec,,-adonal Bum <br />, Sparkl.~ <br />. Splfnkt.r Syslem In.hill.tlons <br />Standpipe. (Sptlnkler 5YI) <br />'8 Toreh Rooli~ar Kettle <br />, Wasle TII'8 Storage ANNUAL <br /> <br />l, <br /> <br />. I J Valuation of Project <br />lU 'i\IIIIr J 11 nl If r \~ i'MlUmr ,,- <br />Company I Y/N I F..II Cunent , L .Y I N ~ <br />Revlswred I <br />LI~t~e, '. , J I <br />Com~hY I 1 <br />RegiaWl1Ml Y/N Fee Current L Y/N <br />License #, I , <br />Company I - Y/ttr <br />Regi....d Y/N I Fee CUrrent 1 <br />license # I - I <br />Company I Y.~N <br />Registered Y/N Fee Curl'1lnl 1--- <br />LlcenH * I ~ ' I <br />Company I Y/N DlliJ <br />Regiat.r.d I 'ee Curr,nt <br />li"r'lSe# ~ - ~. )1M. <br />L T rVln'JIRl lff.-e <br /> <br />- <br /> <br />~ <br /> <br />FlU out application completely. <br />Owner & Contrllc:tor ,Ig" bttck of epplicatlon. nohl~ed (Or, copy of signed contlilCt with owner) <br />!' over $2500, 1II NotIce of Commencement il raqlJlr~ ,(Me<lhanlo.l work over $6000) <br />Supply \Wo (2) set, of dl1lWingl with applloable doc:umenta1iol1 ' <br />Allow 10-14 day& for reVieW atler submittal date. Pan;e1'- obtained from Property Tax Notl~ (http://appralser.p.,QQgov.cOl'l'l) <br /> <br />---"'~~ <br />