Laserfiche WebLink
<br />813-7iio-D02U l <br /> <br />oats Received <br />=-- v- <br /> <br />Owner's Name <br /> <br />Owner's Address <br /> <br />City of Zephyrh Ills 'FIllS, " L.k /l1 q 0, 3// Fax-813-780-0021 ,I; <br />Permit Application ~ _ C H,:IeLe.s WAt~EL> ,r.ir#1J <br />, ......,f>hoM Conl&ctfor PerIM L~.:> -J.L z '( ~_lJ 116':",_J,m <br /> <br />Ow....sPhoneNuniler ) e/J 1'1 790 I'] It)"'~ I <br />I <br />I <br />I <br /> <br />r J-...r- -_.~ ~ <br /> <br />.-.1- <br />S vi EET Bllyl .# /752 <br />7J;6 CD Al.,t.. 01- L) D <br />I <br />'I <br /> <br />Fee Simple Tltlenolder Name <br /> <br />Fee Simple Titleholder Address <br />" 1 <br /> <br />Job Address <br /> <br />Sub Divilllon <br /> <br />~ <br /> <br />o <br />~r <br /> <br />, Si gn2lture <br />Address I <br /> <br />ELECTRIClAN[ <br />Signature _ <br /> <br />Address r <br /> <br />FLU~BER I <br />5Jgnat~re , <br /> <br />Address I <br /> <br />MECHANICAL! <br />Signature , <br /> <br />Address I <br /> <br />~j:=re I <br /> <br />732S <br /> <br />61lLL <br /> <br />.8L. I/D <br />I <br /> <br />'... <br /> <br />o <br />o <br />D <br />D <br />D <br />D <br /> <br />Bio-Hazard Waste Storage -,ANNUAL <br />,Camm ExhauslKllchen Hood/Duct <br />Controlled Burn <br /> <br />Emergency Generator < 30 kw <br />Emergency Generator> 30 kw <br />Are Protec1lon Mainternsnce "ANNUAL <br /> <br />SPrin~D ~ Ito;;"11 '70 <br /> <br />Do O'Qc=J <br />Do 0 Dr==! <br />o 0 0' 0 c=J <br /> <br />Fire Alarm <br /> <br />Hood Cleaning <br /> <br />Heod S~pression <br /> <br />Fire Alarm' ~nstallatlon <br /> <br />Fire Pumps <br />Flre Works <br />Aammable AppUcatlon- ANNUAL <br /> <br />Fuel Tanks <br /> <br /> <br />'.;5$ <br /> <br />tfJrok Fe. .?~?y <br /> <br />I <br />I <br />I <br />I <br />..-1 <br /> <br />Address! .""...... <br />Dlrectlol'Ul: <br /> <br />f~ <br /> <br />~ 9.;,st :>.F <br /> <br />"TItleholder Phone Number <br /> <br />II <br /> <br />1'1 <br /> <br />'-.,- <br /> <br />- <br /> <br />.- <br /> <br />-i <br />.1 <br />"IilF . <br /> <br />Parcel # <br /> <br />J <br /> <br />, Lot# <br /> <br />'/ <br /> <br />11 <br /> <br />o <br />o <br />D <br />o <br />D <br />D <br /> <br />o RecI1lational Bum <br />G3-Sparklers --- <br /> <br />o Sprinkler-System Installations ' <br />o Standpipes {Sprlnkll&r Sys} <br />o Torch RoofIngfTarKetlle <br />o Waste Tire Slatage ANNUAL <br /> <br />, <br /> <br />Fumigallon Tent <br />HazardoUll MlIteriat (TIer II or RQ Facilly) ANNUAL <br />Head Insta~ation <br />LP/Naf1Jral Gas-lnstallatlon <br />Lf'1Natura1 Gas-ANNUAl.. Sal& <br />P~aces of Assembly-ANNUAL <br /> <br />~/r;t;1 .5uk "I- <br />.5"7~ #f'f'I"OJld 51'4,fl,I" <br /> <br />in~d C .5 J-JUr 8~ 'I Hn 'Z <br /> <br />I Valuation of Project <br /> <br />Company <br />RegisteTed <br /> <br />'UcensB # <br /> <br />"T;I/ r F;" "'f .,M,de oJ <br />Y/N I FeeCUTTent L Y/N I <br />I <br /> <br />'.1 <br /> <br />Com,oany <br />RegIstered <br /> <br />Ucense #- ' I <br /> <br />Company l <br />RegIstered [ Y I N <br /> <br />Ucense # I <br /> <br />::~ I Y/N <br /> <br />'llcell88 tt I <br /> <br />Company I <br />Registered Y I N <br /> <br />License # t- <br /> <br />Y I N I Fee Cun'9nt <br /> <br />Y/N <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Fee Current <br /> <br />I YfN I <br />I <br /> <br />I <br /> <br />Fee Cumll1l. <br /> <br />Y/N I <br />--~ <br /> <br />FiJi out application c:ompletely. <br />Owner & Contractcr sign back of appllcallon. notarized (Q-, copy r:i signed contract with owner) <br />If o\lElr $2500, a Notice of Commel1C8lTlef1lls reqL,jred. ,(MechanIcal wtJrk DYeT $5000) <br />Supply two (2) sets of drawings with applicable dcolnent2lUon <br />Allow 10-14 days for review after submlUat date. Parcel #- obtaJnad tam Property TlIX Notice (htip:JJaPfllBillBl".pascogov.com) <br /> <br />- .$ ,.re ,/,111;;/ AT ~7D~~ - ;>J..,q~e,.,., GN"t f)IC TA lEi> 81' <br />_ ~"R7E LUC;>l5E' I9rT;1CHeO <br />I(ZD~I)~' ~15r IfrTIIICIfEl> <br /> <br />~~ E /")\ ,0 Is H-a" <br />