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<br />OWner's NiUTlEI <br /> <br />-1 J <br />L5"te/R"/ 11,A-Jl 5t/f'~1t /1S1.1 <br />7~,) C,4u.- /JvYO 2~#yl2-#1U5 r-t 7Jsy/ <br /> <br />FAX No, 813-780-0021 <br /> <br />/l1)W Fax-81" '780-0021 .;,>>, ~, <br />City ofZephyrhills':F1lfet ,';':'.: k ~() ~ - <br />Permit Application - tr <br /> <br />m~'---f .~I [ '~I :\- r'~' <br />Owner's phone Number , ?I:J 7 F () / d j' ~ . <br /> <br />p, 001 <br /> <br />APR/09/2007/MON 02: 15 PM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />813-78l;l-0020 <br /> <br />o'ite Received <br />. <br /> <br />Owner's Address <br /> <br />Fee Simple Titleholder Name <br /> <br />Fee Slmple'litleholder'Address <br />f <br /> <br />Trtleholder Phone Number <br /> <br />n <br /> <br />-lL <br /> <br /> <br />-.-. <br /> <br />L <br /> <br />I <br />_ -J <br />'I <br />cJ <br /> <br />- <br /> <br />l <br /> <br />~ ' <br />2-6)OI#L#7U/~ p~ 7.7fy/ <br /> <br />'I ' Percell# ] <br /> <br />D Fumigation Tent <br />D Hazardous Meterial (iter II or RQ Feclllty) ANP4UAl. <br />',D Hood Inslllllation <br />D LP/Natural Gas-Installation <br />D LP/Natural Ges~ANNUAL Sale <br />D places of Assembly-AP4P4UAL <br /> <br />D Recreational Bum <br />o 'Spartders <br />D Sprinkler'System Installa6on:!; <br />D <br />D <br />D <br />I <br /> <br />Lot # <br /> <br />Job Address <br /> <br />SubDivisIon <br /> <br />= <br /> <br />D <br />D <br />'D <br />D <br />,D <br />o <br /> <br />Emergency Generator < 30 I<w <br />'~ency Genenitor> 30 kW <br />Fire Protectioll Maintenance - ANNUAL . <br />'D,~'I1;)e'ffi!],~~ <br />Sprinkler 0 0 [j LJ <br />D [:l 0 DC], <br />Do [] oc=J <br />Do Voc=t <br /> <br />l'ill3 Alarm <br /> <br />Hood Cleaning <br /> <br />Hood suppTMslon <br /> <br />Standpipes (Sprinkler Sys) <br /> <br />Torch RoollnglTarKettle <br />Waste Tire storage ANNUAL <br /> <br />~ ::~-- <br /> <br />D Other: 'I <br />_ ~ m <br /> <br />~~~:~~:~~~~ ,I <br /> <br />'" Addrees [{IIf') C(UtllPlIJudi'l.. #8, aI-?1~)rC.- i.f~ <br />J:LECTRlCIANI ' I <br />Signature <br />Add1'e$S I I <br /> <br />~~~~~: 1 I <br /> <br />~~I ] <br />MECHANICALI I <br />SIgnature , ' <br />Addressl I <br /> <br />OTHER I ] <br />Signature <br />Addrm;\-! _ ---, <br />Dlrectlonlil: ---' I <br /> <br />Fire P\.Impa <br />Fire Works <br />Flammable Application- ~NUAL <br /> <br />,~ Valuation of Project <br /> <br />: I <br />r -= I : r -r= <br />CompanY 1m CeI,."TUt.. Sj.J~r 0 CH1Ilt<<J(1f},vc.. <br />,Registered N I Fee Current L Y IN' <br />_~icen~_#_,.J / eJ tfr ~CX) l) /~ dO;} I <br /> <br />~;=~ ~Y/N I F\HJCurrent l Y/N I <br />L1cellge # L I <br />Company 1 <br />Registered , Y I N <br />Licen", # I <br />Compilny I <br />Registered , Y I N I, Fee Cwrent I Y I N <br />. LIcense # L <br /> <br />=:d ~ Y I N I. Fee Current <br />License" L <br /> <br />J <br /> <br />Fee Current <br /> <br />L Y7N I <br />I <br />I <br />I <br /> <br />Y/N J <br />I <br /> <br />Fill out application complelsly. <br />Owner & contradOr sign back of application, 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) ssts of dr.lWlngs with applicable documentatior'l ' <br />Allow 10-14 days for review after ,ubmitllll daw- Parcel # - obtained from Properly Tex Notice (hltp:l/appralsef,pascogov,corn) <br />