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<br />JUN/25/2007/MCN I I: 12 AM <br /> <br />81,3:180.0020 <br /> <br />Date ~eceived <br /> <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />City of Zephyrhills 'FIFe <br />Permit Application <br /> <br />FAX No. 813-780-0021 <br /># ro{)t~ <br /> <br />P. 002 <br /> <br />FBl<-813-780-0021 <br /> <br />:1. <br /> <br />Phone Conlacl for Permll <br /> <br />~.e Simple Titleholder Name <br />Fee Simple Tllleholder Addro:i~ <br />::b A:::' - ," <br />1_ <br /> <br />Owner's N8me <br /> <br />Owner's AddresS <br /> <br />Sub Division <br />~- <br /> <br />""$' <br /> <br />Contractor <br />SIgnature <br /> <br />Addl1lss <br /> <br />ELECTRICIAN <br />Signature <br /> <br />Addreee I <br /> <br />PLUMBER <br />Signature <br />Adclre:ss I <br /> <br />MECHANICALI <br />Sienature <br />Add~S3 I <br /> <br />OTHER <br />Slgnelure <br />Addtwss L <br />* ,... <br />Diractions: <br /> <br />Central Station Serv; "eR om l,llrlrO; rln I <br /> <br /> <br />is <br />same as <br />. '~_.""W <br /> <br />1I.1Ulilllll.....--..-.'U<f <br /> <br />"1 <br /> <br />.L ""' - <br /> <br />rl.1' <br /> <br />I <br />:;--:~ <br />I <br />I <br /> <br />*-"" <br /> <br />1 <br /> <br />'IICI <br /> <br />1 <br /> <br />6151 12th Str~t <br /> <br />Zephyrhills,'FL 33540 <br />j <br /> <br />Lot'" <br /> <br />Parcel # . L <br />'1 - '"""'\t'" <br /> <br />o FumlglltionTent , <br /> <br />D Ha'lluuoUS Mlllerial (TIer" or RQ Facility) ANNUAL <br /> <br />D Hood Installlllil;Jr1 <br /> <br />D LP/Ne\UrBl Gal;.lnstllllallon <br />D lP/NlltuflIl Glls.ANNUAL. Sele <br /> <br />D Places 01 Assembly-ANNUAL <br /> <br />D Recraatlonel Bum <br /> <br />D <br />D <br />D <br />B <br /> <br />II <br /> <br />D <br />D <br />D <br />B <br />Cd <br /> <br />. """'VT <br />Blo-Hazerd Waste storage .'.ANNUAL. <br /> <br />Comm Exhaust Kitchan Hood/Duct <br /> <br />'T P." <br /> <br />SPl!rklers <br /> <br />Sprinkler Syslam Installations <br /> <br />Standpipes (Sprinkler Sy,) <br /> <br />Torch ROoflngrrar Kellle <br />Wa,leTI", StolllQe ANNUAL <br /> <br />J <br /> <br />Valuation of Project <br /> <br />Contro!ltld BLm <br /> <br />Emergency Generator < 30.kw <br />Emll'gency Oenllnltor> SO kw <br />Fire Protecllon Maintenance - ANNUAL <br />~.~.~~ <br />Spr1nkler D Cl 0 0 ~ <br />Fire Alllrm [2J Cl 0 rz( C:=J <br />Do DOc.::J <br />DoooCJ <br /> <br />Hood CleanIng <br />Hood Suppression <br /> <br />~ <br /> <br />D <br /> <br />Firs Alllrm Inslallallon <br /> <br />Fire Pumps <br />Fire Works <br />Flammable Appllcation- AN~UAL. <br /> <br />Fuel'rank:s <br />Other~ <br /> <br />'-~- <br /> <br />Company <br />Registered <br /> <br />6 Q9 L.icense'. <br /> <br />Company <br />RsglStered <br /> <br />license # <br /> <br />_., . ~J <br /> <br />~~~~:~.., ~r. ei., .I.. <br /> <br /> <br />I Y I N I Fee cUlTsnll <br />I <br /> <br /> <br />L..r.lt!.J Fee Cu,",nt <br /> <br />C' <br /> <br />1- Y I N I Fae CLJl'l'ent I <br />I <br /> <br />I Y IN <br /> <br /> <br />L..~~I" r <br /> <br /> <br />L <br /> <br />I <br />I <br /> <br />I <br /> <br />~ <br />l <br />I <br />I <br /> <br />Y/N! <br />I <br /> <br />Company <br /> <br />Registered <br /> <br />license # <br /> <br />Y/N <br /> <br />--'("'vr r <br /> <br />III "'\]7 T <br /> <br />Company <br />Registll....d <br /> <br />. L1cenea #' <br /> <br />Y/N I <br />I <br /> <br />...... <br /> <br />..~~...., IT <br /> <br />Fe& Current <br /> <br />Y IN I <br /> <br /> <br />,.~._~.~- <br /> <br />-...-...... <br /> <br />Fill out eppUcatlon completsly. <br />awner & COntractor &151'1 baol< of epplicatlon. nolarized (Or, copy of signed contract YIllh ownsr) <br />If over 52500, a Notice of Commencement Is requlred.(Machanlclll WQrk ovsr $5000) <br />Supply two (2) sets of drawings with applicable documenlallon <br />Allow 10-14 deyr; for review after submlltel dale. Parcel # - obtained from Property Tal{ Notice (http://appralser.peBcogov.com) <br />