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<br />. <br />813-7ao-D02[} <br /> <br />Date Received <br />~ -v- <br /> <br />Owners Name <br /> <br />Owner's Address <br /> <br />City ofZephyrh UIs 'Am; , <br />Permit Application <br /> <br />1-- <br />{.AJAL I'nI9Il.T <br />7~31 c;, f9L.L <br />I <br />-I <br /> <br />rl~ ",--_.. , <br /> <br />i%1q,~1 <br /> <br />Fax-813-780-0021 ,I; <br />C/l4I,J..J 6Jc./J;.,- ~r ~llh 1I&,'r <br />Pl1lJM COnl&ctfcr PenM --L.!~ .~ll- z &{ ~_lJ I (~_:..J, <br />aw.... Phone Number ] B/3 n 78 2 l'l/~i57 I <br /> <br />: <br />~ <br />I <br />I <br /> <br />.. <br /> <br />sf 70 Co <br />BLLJ{) <br /> <br />Fee Simple Tftiei10lder Name <br /> <br />t=ee Simple Titleholder Address <br />V <br /> <br />Job Address <br /> <br />SUb Division <br /> <br />~ <br /> <br />~~ <br /> <br />Signature <br /> <br />Address I <br /> <br />ELECTRIClANl <br />Signature , <br /> <br />Add~1 <br /> <br />PLUMBER I <br />Signature , <br /> <br />Address I <br /> <br />MECHANlCALI <br />Signature , <br /> <br />Address I <br /> <br />r <br />I <br /> <br />7lt,31 <br /> <br />Co Al..L <br /> <br />[?LUD <br />I <br /> <br />o <br />o <br />D <br />D <br />D <br />D <br /> <br />BicHiazard Waste Storage --ANNUAL <br />COmm Exhau5tKItchen HoodJOuct <br />COntrolled Burn <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Fire Protec1lon Malnte/1l!lnce "ANNUAL <br />'D~~~~ <br />o 0 0 L-..J <br />B ~ ~ ~B <br />Do ooc::J <br /> <br />Sprinkler <br /> <br />Fire Alarm <br /> <br />~ <br /> <br />o <br /> <br />Hood Gleaning <br />Hood S~pression <br />Fire Alarrn'lnstallation <br /> <br />Fire Pumps <br />Ere Works <br />Flarrvna~ Appllcation- ANNUAL <br /> <br />Fuel Tanks <br /> <br />Other. <br /> <br />'11tI&holder Phone Number <br /> <br />II <br /> <br />II <br /> <br />- <br /> <br />-/ <br /> <br />Lot # <br /> <br />Parcel '# <br /> <br />y- <br />O <br />o <br />D <br />o <br />o <br />D <br /> <br />o Recnatloll8l Bum <br /> <br />~ <br />D <br />o <br />o <br />) <br /> <br />Fumigation T!mt <br />HazardoUll Material (T/&r II or RQ Facility) ANNUAL <br />Hood ImrtaUalion <br />LPlNatural Gas-lnstallatlon <br />LPJNaturaI Gall-ANNUA1. Sale <br />P~aces of Assernbly-ANNUAL <br /> <br />~./- <br /> <br />P~.}e.;/ <br /> <br />54tc <br /> <br />Sparklers ~ <br /> <br />Sprinkler-System Installations - <br /> <br />Standpipes {Sprinkler SVIl} <br /> <br />Torch RoaflngfTrarKetlle <br />Waste Tire storage AI!INUAL <br /> <br />Stl4k Apfio..;ecJ. \ <br />5" fCl.lLck/) r(l.5,d~ <br />Wti f h1t4rl- -# 7D ~ <br /> <br />I Valuation of Project <br /> <br /> <br />7.911, <br /> <br />:1',1 <br /> <br />tJC4/C, ,..~ i"~~ <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />...J <br /> <br />OTHER <br />Signature <br /> <br />Address I <br />Directions: ~ _..- <br />FiI! out appJlcallDn complataly. <br />Owner & Contractor-sign back of application, notarl.%ed (Or, copy of signed contract with owner) <br />If over $2500, a Notice of Commencement Is reqLJred ,(Mechanlc:al work DY8I' $5000) <br />Supply two (2) sets of drawings with applicable ckJcLIllentation <br />Allow 10-14 days forrevlew aftersl.4lmtttaf date. Parcel #- obtBIRlld from Prcpe1ly Tax NotIcs {h1ip:fJappreiser.pascogc:w.com) <br /> <br />~2~5' <br /> <br />se, <br /> <br />- ~. <br /> <br />- ~/rE P'-/l.lfl AT .sr()R~ <br />r} 77 /l~ lieD <br /> <br />-- <br /> <br />5rl'1'fF: I-IC€rVSI? <br /> <br />/l-rrA CHE.D <br /> <br />- <br /> <br />J>(/i)j){)C 1 t- L.:51 <br /> <br />Company <br />Registered <br /> <br />'Ucense # <br /> <br />TtVT Fi~cc..JQ,#C-' <br />I Fell Current J Y / N I <br />I <br /> <br />J <br />-,I <br /> <br />I Y/N <br />I <br /> <br />I Y I N I FlMl Current <br />I <br /> <br />I Y/N <br />I <br /> <br />I Y IN I <br />I <br /> <br />I Y/N <br />t- <br /> <br />" -- <br />I <br /> <br />Company <br />Reglstel"8d <br /> <br />License I: - <br /> <br />Y/N <br /> <br />Company <br />Regist&red <br /> <br />Fee Cwrent Y/N <br /> I YfN I I <br />Fee Current <br /> I <br /> <br />License # <br /> <br />Company <br />Regi&tered <br /> <br />'licel'l5Eltf <br /> <br />Company <br />Registered <br /> <br />I Y/N I <br />I <br /> <br />Fee Current <br /> <br />LicBnlIlI # <br />