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<br />FAX No. 813-780-0021 J P.002 <br />City of-Zephyrhills Fire f' 1113 Fax-81H80-0021 <br />Permit Application <br />.l.~,tJ~".~J ... ~umM-~ _~~n.eco~~~LP~lt.J~~~.+!.Q1~ <br />r Jo.sedl Jasef)h, I owner'sPhoneNumb~r I, X' /3llC2Q5I.l t' ~7 I <br /> <br />i~J(,~05- /rd/~;7JQllnd Rd_ --Tamp:1... F~ 33W! l <br /> <br />Fee SImple Titleholder Name 'I .' _ ~ . Titleholder Phone Number ! II II I <br />Fee Simple Titleholder Address i: _ ,u , -, <br />__u -- (.'. ; "'.'/5 =!f'6 f ..::::r ~ -<' -'-~ · ,,--;- .........'.J ~ <br />JObAddress_--3igrs-- _-~ ftt~ ,-Cc;oh'fh1fLJ FL.. Il.ot#' I ] <br /> <br />I __ . I p-~__ lji,~~~~~~tI~ <br /> <br />__ ..oliloil I! I .w n II A~ r 11 i it <br />Contractor I I <br />Signature <br /> <br />Address I J <br /> <br />ELECTRICIAN ~ ' -I <br />SIgnature L " ' <br /> <br />Address r I <br /> <br />;~~~~~ I I <br /> <br />M~r J <br />M!:CHANICAYI <br />Signature ' I ' <br />Address I J <br /> <br />~~~~:re ,[-~ :- I <br />.qf1 td=~lrm;:~y~-~.- ~~,!,,~ _:~_. '''~~l''--------___~ <br />Directions: <br />FiJI out appilcatlon completely.' '. " ' <br />Owner & Contra~or sign back of appllcatlon, 'notarized (Or, COpy of signed contract with owner) <br />If over $2500. a Notice of Commencement Is required (Mechanical work over $5000) , <br />Supply two (2) sets of drawlngs wlth applicable documentation <br />AllOw 1 o~14 days for review after submittal date. ' <br /> <br />OCT/31/2007/WED 02: 18 PM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />813-780..0020 <br /> <br />Date ReceIved <br />....- tJ;~ rlt111 r <br /> <br />Owners Name <br /> <br />Owner's Address <br /> <br />sub Division <br /> <br />~~II;"'-,,'V <br />,D Blo-Hazard Waste Storage" ANNUAL <br />o Comm Exhaust Kitchen Hood/DUct <br />D controlled Bum <br />D . Emergency Generatpr < 30 kW <br />. D emergency Generator:> 30 kW <br />~ Fire ProtecUon Maintenance" ANNUA/... <br />sprinkler . ' ,r'!5lJ' <br />Rre A1ann, , U <br />Hood Clean/Suppression 0 <br /> <br />D <br />D <br />.D <br />o <br />D <br />D <br /> <br />Rre Alarm Installation <br />FII'9 Pumps <br />Fire Works <br />Flammable Application- ANNUAL <br />Fuel Tanks <br /> <br />Other: <br /> <br />r- <br /> <br />D Fumigation Tent <br />o Hazardous Material (Tier II or RQ Faclllty) ANNUAL <br />.D' Hood Installation <br />D LPlNatural Gas-Installation <br />o l...PlNatural Gas-ANNUAL Sale <br />D places of ASSembly-ANNUAL <br />D Recreational Bum <br />'0 Sparklers <br />D sprtnlder system Installations <br />D Standpipes (Sprinkler Sys) <br />o Torch Roofing <br />, D, Waste Tire Storage AN~UAi.. " <br /> <br />J~.a5D . Cf) 't <br />: <br /> <br />Valuation of Project <br /> <br /> <br />""'-.... t II ''ll'''':= ....m:"'1l' '-~ <br /> <br /> <br />Fee Current ~L Y I N I <br />I <br /> <br />Pee Current I Y I N I <br />I <br /> <br />Y IN I <br />I <br /> <br />.d:I"u <br /> <br />- <br /> <br />Company E <br />. Registered Y I N ~. <br /> <br />Ll~nse 1# ,[., <br /> <br />Company I <br />R~gisterad' Y I N I <br /> <br />L1cenSEl #: "I <br /> <br />Company I <br />RegIstered . Y 1 N <br /> <br />License # 'I <br /> <br />Company I <br />Registered . <br /> <br />License # ' I <br /> <br />l Y/N J <br /> <br />Fee Current <br /> <br />Y I N I~ Fee curr~nt L Y I N I <br />I <br /> <br />Company , <br />Registered <br /> <br />Y/N I <br />~::~~~ # ~~~-__.~'fr~_"'\ilc...___...~J-..;.., ~~~ <br /> <br />Fee CUlTent <br />