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<br />Fee Simple mlano/def Name <br />fee Simple Titleholder Address <br /> <br />tJ13-78(}-@Q20 <br /> <br />Date Received <br />~ I_~~ <br /> <br />Owner's Name <br /> <br />Owners Address <br /> <br />Job Addl"!l6s <br /> <br />Sub OMalon <br /> <br />~"ll"..t.o.. <br />Sign~ure <br /> <br />Address 1 ~2 S .J <br /> <br />ELECTRIClANl <br />Signature , <br /> <br />Address I <br /> <br />PLUMBER I <br />SIgnature , <br /> <br />Address I <br /> <br />MECHANlCI\LI <br />Signature , <br /> <br />Address r <br /> <br />OTHER I <br />Signature <br /> <br />AddrellS L_~ <br />Direo1ions: <br /> <br />City ofZephyrhUIs'Flm, ' <br />Permit Application <br /> <br />1(1q33 <br /> <br />'!; <br /> <br />Phone Contfoctfor f>ermt <br /> <br /> <br />Ownet's Pha1e Number ] 8 ( 3 <br /> <br />1"17f31 <br /> <br />1"197&7 I <br />I <br />'-I I <br />I <br />pill <br />"I I <br />I <br /> <br />---v.. <br /> <br />PUBLIX 11 :Jqo <br />7J20 ~ ALL RLu J) <br />I <br />I <br /> <br />lltIeholder Phone Number <br /> <br />II <br /> <br />- <br /> <br />I Lotti <br /> <br />r <br /> <br />6 JCI LL <br /> <br />BLVD <br />I <br /> <br />7320 <br /> <br />"I <br /> <br />Parcel 'if <br /> <br />o <br />o <br />D <br />D <br />D <br />D <br /> <br />r <br />Bio-Hazard Wasle StoraQe -,ANNUAL <br />,Comm ExhaustKIk:tJen HoodlDuct <br />Controlled BOOl <br />Emergency Generator < 30 kw <br />Emergency Generator> SO kw <br />Are Protec1lon Mainteoance . ANNUAL <br />'D~~~~ <br />Sprinkler 0 0 0 L-.J <br />Fire Alarm 0 0 tl 0. c=J <br />Hood Gleaning 0 0. 0 0 c:::J <br />Hood S~pfilssion 0 0' Cl 0 c=J <br />Fire Alarm' ~nslallaliQn <br />Fire Pumps <br />Hre Works <br />Aarrmable AppUcallon- ANNUAL <br />Fuel Tanks <br />other: <br /> <br />Fumigation Tent <br />Hazardous Material (T1&r II or RQ Facilty) ANNUAL <br /> <br />Hood Insta~alion <br /> <br />LP/NUJral G88-Installellon <br />LPJNatural Gall-ANNUAL Sal& <br /> <br />Places of Assembly-ANNUAL <br /> <br />SprinklerSystem ~nstallalions ' <br />Standpipes {Sprlnk!&r Sys} <br />Torch RooflngfTw: Kettle <br />Waste Tire Storage ANNUAL <br /> <br />Kefec: I S4/~ ().;. <br /> <br />5-1ak. Ilff'r() "0 <br />5 It:. / );/0'> I ;, ~ (CI ( <br />lbtJ,)( <br /> <br />~ <br /> <br />o <br /> <br />,~ Valuation of Project <br /> <br /> <br />LY~ /t; ri-.i"'" q?lll. <br /> <br />Ccmpany <br />Registered <br /> <br />'Ucense # <br /> <br />T7" j:;/{~HI' <br />Y I N Fee Current I Y I N <br /> <br />-.I <br /> <br />SE <br /> <br />:IS/I, s/. <br /> <br />........~... <br /> <br />,..J <br /> <br />Company <br />Reglstsml <br /> <br />Ucens& if " r <br /> <br />Company I <br />Reglstenld , Y I N <br /> <br />Ucense # I <br /> <br />Company I <br />RegI6t8recl Y I N <br />, License # I <br />Company I <br />Registered Y ! N <br />Licenlil8 # ~_ <br /> <br />- , <br /> <br />Y I N I Fee Current <br /> <br />Y/N <br /> <br />Fee CUrrent <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />I VfN I <br />I <br /> <br />I <br /> <br />Fe Curl1ll1t <br /> <br />Y/N I <br />_ J <br /> <br />Fjll out applicatlon completely. <br />Owner & Contfllctcr- sign back of appJlcatlcn, notarized (Or, copy d signEld contract with owner) <br />Ii owr $2500, a Notice of Commencement Is reqi.Jred. ,(Mechanical work over $5(00) <br />Supply two (2) sets of drawil'l9s with applicable dccl.l'l1entaUon <br />Allow 10-14 days for revfew after submltlal da.. Parcel #- obtained from Prope7ty TlIX Nollce Chtip:/JapprBIIl8l".pascogov.ccm) <br /> <br />____ 51TE pt1lJlV,$ II r .sTolZE - pLDC)l,)e ; t"~Ar/",;J OUTI1TEJ) 8'1 ;::ilt$ h1191t'.s1-f~'- <br />,... $TA rE LUEtf4JSe An-JUNe-:P <br />,/ fROAJct J-/~1 ,frr4CHE D <br />