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<br />F EB/~0/200YTUE 11: lOAM <br /> <br />ZEPHYRHILLS BUILDING <br /> <br />FAX No. 813-780-0021 <br /> <br />~ ~3 \~.Fax-:~3~:8~021 <br /> <br />. .....:4:,-: <br />. ...;::.,\;~ <br /> <br />'813::?6~~0020 <br /> <br />City ofZephyrhiIJ$jf.j~~-o~2~' <br />Permit Application -.-. -... . <br />...:.l:.r:'! o:'~ ".'=:. :.i- _--0. . <br />.:.'.;:~.. .pl'jone ContacHor- Pormlt <br /> <br /> <br />..~ .~~;t:.', ..-. <br />_Date Received '_ <br /> <br />Owner's Nams . <br /> <br /> <br />~ 'srJ <br /> <br />fee SimpleliUetiolder Name I .' <br /> <br />Fee Slmplelltleholder Address 'L- <br /> <br />::::..~ F;;~~ <br /> <br /> <br />.,~~l M-~ JllMr;~ --1 W- ~- <br /> <br />o <br />D <br /> <br />D Conlrolled Bum <br /> <br />o <br />..D <br />D <br /> <br />Owner'S Address <br /> <br />r-'''~_. '. <br /> <br />:I ~CJ 'L Il( y;i -' 1.1 ~otJ:.._ <br />J:J.,2.t/ ~ <br />II <br /> <br />Q~n~r's f?hone Number <br /> <br /> <br />l <br />--1 ~ <br />~i"V~'~ ,: ~l <br /> <br />rl <br /> <br />. ' J. 1ltleholder Phone Number <br /> <br />.' . - ~~ <br />~~z': ~1~Y~~~~ <br />..D <br />'0 <br />.D <br />D LP/N~1Ural Gas~~nstallilllon <br />. D I-P!Natuml Ga$-ANN.';lAL 8alo <br />.. 0 ' places of A>;,sembly.ANNUAL <br /> <br />.Bio-Hazard 'iNast~ Stolllge ..ANNUAL <br />Comm Exhllu~t Kil.chtn Hood/Duct ' <br /> <br />. Emergency GerJBra~r " 30 kw <br />, EmeryerJCy Gfilnerator ;> ilO kw <br />Fire Protfilclioh Maintenance - ANNUAL <br />'. ~I~em"~~ <br />o D. 0 0 L.J <br />: 0 0 O. 0 c:=J <br />gjg~OCJ <br />D. D [] .0 c=J <br /> <br />Sprinkler . <br /> <br />Fi"" Alarm .. <br /> <br />Hood Cleenlng <br />Hood SLlPl'resslon <br /> <br />~"'-'fV'"-- <br /> <br />.D <br />.~ <br />D <br />D <br />'Yll_ <br /> <br />.\ <br /> <br />Dr <br /> <br />1-"" <br /> <br />Fire Alarri'llrJlltllllatlon <br /> <br />F=lre Pumpe <br />Fire Works <br />Rammable AppllcaUon- ANNUAl, <br /> <br />,Fuel Tanks <br /> <br />C. <br />IJ ~.~~v <br /> <br />Contractor <br />Signature <br /> <br />:u._.~ <br />.1. <br />..' .1 <br />.1 <br /> <br />Other: <br />- <br /> <br />~ <br /> <br />A~dr:~ll I. <br /> <br />ELECTRICIANI <br />Signature . <br /> <br />Addrnss I <br /> <br />PLUMBE;R <br />Signature <br /> <br />Addres5 I <br /> <br />MECHANICAlI <br />Signature . <br /> <br />Addreas I <br /> <br />O'THER I <br />SIgnature <br /> <br />~_ ~d~"J= _ <br />Dlrec1loffil: <br /> <br />w.........-......... ~";~ <br /> <br />.._~-_._.._- .-.:...-:.. <br /> <br />: . .'. P" <br /> <br />I'"umlglllion Tent <br />Hez.ardouv Material (Tier II or RQ Faclllty) ANNUAL <br /> <br />Hood Instellallon <br /> <br />Recreatiol12lI.Bum. . <br />Sparklers , <br />Sprinkler SYliltem Installlluons . <br />S~pIPfilS (SprInkler Sys) <br />tOrch RootlngfTar Kettle. <br />Wallie llre Storage ANNUAl <br /> <br />J <br /> <br />Valuation of Project <br /> <br />_ __ _-"-'....;110... <br /> <br />~ <br />I <br /> <br />IS <br /> <br />r <br /> <br />J <br />.1 <br />~ I <br /> <br />Company [ <br />Regililtered' I Y I Nl Fee Current <br /> <br />License # J <br /> <br />Company E <br />Registered Y I N <br /> <br />License # I <br /> <br /> <br />I Y/N <br /> <br />I <br /> <br />company I <br />Registered . Y I N <br /> <br />-License #. f. <br /> <br />compllr)Y E <br />Regi81a~ ~ IN: I. Fee Current I Y I N I <br /> <br />Ucenee# J ~.~__..,.._ _"....._~'" .~.,.._. ~ <br /> <br />- <br /> <br />Y/N <br /> <br />Fee Currerrt .1 <br /> <br />Y/N <br /> <br />Company <br />Registered <br /> <br />L1ceMe # <br /> <br />Y/N <br /> <br />Fee Current <br /> <br />Fefil Current <br /> <br />YI N I <br />I. <br /> <br />Fill out appllcaUon completely. <br />Owner & Contractor lllgn beck of appllcaUon, notariZed (Or. copy of signed contract wHh owner) <br />It over $2500, a Nollce of ColJ1lJlencement Is required .(Mechanlcal work over $5000) . <br />Sl.lpply two (2) seta of drawings whh applicable documenllltion . <br />Allow 10-14 day>; for review aftlilr submittal date. Parcel #- oblllined from Property Tax Notice (http://appfBiser.pascogov.com) <br />