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<br />813-780-0020 <br /> <br />Date R8ceMd <br /> <br />Owner's tame . <br /> <br />Owner's Adchss <br /> <br />CIty ofZephyrhUls~~ <br />Permit Application <br /> <br />-:{t~ '30~ <br /> <br />F_~13-780-0021 <br /> <br /> <br />; ~. ContaCt for PermIt <br /> <br />~:; -- <br /> <br />Fee SIn1H TIlIehaIdIr NlIrae <br />Fee SImple""""" Adena <br /> <br />Job Address <br /> <br />Sub DMsIon <br /> <br />gA/~E <br /> <br />I Lot. <br /> <br />1 <br /> <br />.1 <br /> <br />P.n:eI # <br /> <br />D <br />D <br />D <br />D <br />,&it <br /> <br /> <br />ConInIcIllr <br />SignMIn <br />Address <br /> <br />ELE <br />SignMIn <br />Adchss I <br />PlUMBER I <br />Slgnatln . <br />Address I <br /> <br />~ <br />Address I <br />OllER I <br />SIgnRn <br />Address I <br />Diredions: <br /> <br />o <br /> <br />8Io-Huard W.... StIlnge - ANNUAL 0 FurnIpIIon Tn <br />Comm EllhaIIlICIchwi HoodIDuct 0 tIlIDrdous........ (TIer U or RQ F8CIIty) ANNUAL <br />ConInllIed 81m 0 Hood ......... <br />~_lil8lrr.;y~<30kw D LPJNanI~ <br />Emergelrr.;y GeIwaaDr > 30 kw D LPINatIniI Gas ~.... <br />FnPl.Alodlol...........ICa-ANNUAL D P'-sol~AL <br /> <br />~_ BTTT'~ 8::-,:.._".. <br /> <br />..........- --, 6a 0 J( 0 E3 "'__"'1 <br />Fn AIIrm ..11l1l1111n E3 TORlh RaaIrvIT- K.aIe <br />Fn Pumps . - - - - . -- w....,.... SIanIge ANNUAL <br />Fn Wortca <br />FIMlm8bIe AppIIcdoI... ANNUAL ~ .1 VaIu8Iion of Project <br />full T'" <br />, <br /> <br /> <br /> <br />Compq <br />~.-I <br /> <br />LaMe . <br /> <br />Company <br />R8gIstIInd <br /> <br />L.IcIne . <br /> <br />CompMy <br />R8gIstIInd <br /> <br />LIcense . <br /> <br />Company . <br />~ <br /> <br />LIcense . <br /> <br />Y I N Fee CUrNrt <br /> <br />Y/N l FeeCUrNrt I Y/N <br /> <br />Y/N l FeeCUrNrt J Y/N I <br />j <br /> <br />Y/N', FeeCUrNrt l Y/N, <br />I <br /> <br />Company <br />~ <br />LIcense" . <br /> <br />FII out IiIlflIc IlII "" 4lClI.1ll11111y. <br />o.n. & CormIctDr aIgn '** 01 ~atb.. r~ (Or. copy 01.... c:annct wIth-> <br />If _ S25OO. . NoIce 01 coo....anwnt Is raq&*-I ~1Ii::aI work - S5OOO) <br />Supply two (2)... 0I1hw1ngs wIlh 8IlflIeable documelllatlon . <br />AIt:Nt 1~1" ct.ys for IWVIew after submittal ct.ta. ParceI#-oblaIned from Property T_ NoIce (hIIp:l/appnllser~.c:om) <br />