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<br /> <br />Ci 2: iJ3 F:/! <br /> <br />ZEPKlRHILLS BUILDING <br /> <br />F <br /> <br />No R 1~-7RO-IJO'~i 1 <br />. ..' ~.J ,.J L. <br /> <br />iF1~OD <br /> <br />p, 005 <br /> <br />Date ~eceive~ 5, ~{;.9 g-..:... ! <br />~HfilI.~ :..:~~... T""~f1Q:II I ~ - <br /> <br />City of.Zephyrhills'FI~ei <br />PermIt Application <br /> <br />,~,~iiT~~~~~;permn J_!,~_~lll.r ~ :lJ.LftlJ <br />] I') I 'J _ I <br /> <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Simple TitletlOlder Address <br />~"!i!"I"'I'"'1 nmll'll!?"'" ._1 .Ilfilj'" 'I '-.In!l/II~"" n lIS. ..,lilIir- ~-- mTT~r- 1 i .' nnrnrnj ~1WlI <br /> <br />Job A<""" [6' 6 ~ 7I1e~ i: 111 ~i? vY. L II /It:.. ztp! !(kIJ, r / 33.5 yOL ! L... I I <br />SubDlvi9ion [ _ ,_ _ I PHrllel# .If)~'J..b-d-I-Od9(2~OOOQrJ-O/)d.-O I <br />~ i~:al1III1 ".lrx~_b ~.&l1 ~~ ..,~~ v- IT. rT~ _lXf .1l ~Wb ....-.~ _.A~~ <br />D Slo-Hazard Waste storage ",ANNUAL 'D Fumlgatlon Tent <br />D Comm !;xtlaust KItchen Hood/Duct D Haiardous Matarlal (Tier II or RO Facility) ANNUAl- <br />D Controlled Bum 0 Hood Instsllatlon <br />D Emergency Generator'" 30 kw D LP/Natural Gae-Installation <br />D Emergency Generator" 30 kw D LP/Natural Ga!il-ANNUAL Sala <br />D Fire Protection Maintenance - ANNUAL ,D !"Iaces of Assembly-ANNUAL <br />, L2!!2l'~ 1m:! ~ 0 <br />o 0 0 0 L.J Recreational Burn <br /> <br />~ ~ ~ ~ 'R B <br /> <br />Do 0 oc:=:J 0 <br />D <br />D <br /> <br />I t' f?6 (/.::J,.,/ .1 Valuation of Project <br /> <br />813-780-0D20 <br /> <br />Ownars Name <br /> <br />Owner'll Addres,!il <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Hood Suppression <br /> <br />Contraotor <br />Signatur'e <br /> <br />Address <br /> <br /> <br />I=lre Alarm InstallatIon <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Applicatlon- ANNUAL <br /> <br />Fuel Tanks <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Acldreee I <br /> <br />PLUMI3ER I: <br />Signature <br /> <br />Addreasl <br /> <br />MECHANICALI <br />Signatu1'9 . <br /> <br />Addre~e I <br /> <br />OTHER <br />Signature <br /> <br />Address L <br />J.! fT -.. IlTI!I <br />OlrecUone; <br /> <br />"iIrrY:...~- jq[_l!~~ <br /> <br />=._,~~ " - <br /> <br />--.n <br /> <br />Fax-S13-780-0021 <br /> <br />: i~ <br /> <br />J,." <br /> <br />II <br /> <br />,II <br /> <br />" <br /> <br />Sparklers <br />SprinklerSyetem Installations <br />Standplj)es (Sprinkler Sye) <br />Torch RooflngIT ar Kettle , <br />Waste Tire Storage ANNUAL <br /> <br />~ \)t-- <br /> <br />I <br />I <br />I <br />I <br />I <br />l <br /> <br />Company <br />Regi!iltered, <br /> <br />L1cen.... # <br /> <br />Company <br />Registered <br /> <br />License # <br /> <br />C2LI0ta! S.lv+.'cr" <br />L::YZ.RJ Fee Current I <br />[ <br /> <br />I Y/N <br />r <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y/N <br /> <br />II.............- <br /> <br />,JIll!lJ!!i <br /> <br />,I <br /> <br />Fee CUlTent <br /> <br />Company <br />Registered <br /> <br />Licensl!l # <br /> <br />Company <br />Registered <br /> <br />, L1ce",le # <br /> <br />Fee Current I <br /> <br />Fee CUrrent <br /> <br />Y/N <br /> <br />Fae Current I Y I N <br /> <br /> <br />-"~.-'-....m. "1,--,J.. <br /> <br />Fill out application completely. <br />Ownar & Contractor elgn back of application, notarized (Or, copy of signed contract wlth owner) <br />If over $2500, a Notic" of Commencement Is required ,{Mechanical work over $5000) , <br />Supply two (2) sels of drawlng$ with applicable documentation <br />Allow 10-14 days for review siler sUbmittal dat", parcel #- obtained from !"roperty Tax Notlce (tltlp:"appralser.pa~coQov.com) <br />