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09/04/2009 10:47 FAX I) 002
<br /> 811780 -0020 City of Zephyrhills " ('7 Fax - 813 - 780 - 0021
<br /> Permit Application
<br /> Da te Received Phone Contact for Permit
<br /> Ov'ner'sName I STM'PT,FX(RTNNFT,L I Owner's Phone Number 1111. I 62 1 1 5482
<br /> Ov ners Address 4701 Oak Fair Blvd TAMPA FL 33610 .
<br /> Fe : Simple'iltiehoider Name - Titleholder Phone Number • I (
<br /> FeIsimple?ItleholderAddress I - Niallielial9
<br /> Jell Address - 1&3C ) G C Nit 1 k 2. tIlttS C -)*( ?)S Li 1 Lot#
<br /> Su) Division I Parcel #
<br /> n Blo- Hazard Waste Storage - ANNUAL jJ Fumigation Tent
<br /> Comm Exhaust Kitchen Hood/ Duct a Hazardous Material (Tier 11 or RQ Facility) ANNUAL ,
<br /> F • Controlled Bum n Hood Installation •
<br /> Emergency Generator 30 kw n . LP/Natural Gas - Installation
<br /> a Emergency Generator Fire I ?rotseUtinMairrtenartce- ANNUAL 304&w • In LP /Natural Gas - ANNUAL Sale
<br /> , n Places ofAssembly- ANNU
<br /> 'Lady ! ISrniTI Mr Ulner •
<br /> . Seri
<br /> prinkler. ❑ 0 ❑. fl Recreational Brun .
<br /> , •. Fire Alarm , ' • 2 0 le ❑, 1. , 1 Sparklers . • •
<br /> • ' " "" ' • Hood CleaNp9 Li d ❑ 0 f I [ Sprin dersystem installatlong
<br /> . Hood Suppression - _ , .] q„ . . ¢ . . . , • . ( Standpipes (Sprinkler S y s ) _ • .. _
<br /> , :0,7 - ';', � •FlrefUamil _ .. , Ikitlon ...,_.. .��.,...•..,,..� _ L. lorcKR.
<br /> _ - � Fire Pumps I • _ Waste The Storage ANNUAL •
<br /> - Fire Works , • , • .
<br /> N '
<br /> •,,. m a ble Application- ANNUAL
<br /> a ration o rode
<br /> • i. �" Fuel Tanks , . .
<br /> ,,..,. 0
<br /> reran a ®r ` H _ •
<br /> Cor tracto '. ` - Company '' C(
<br /> Sigr n a t u r e - Registered Y / N Fee Current Y / N I •
<br /> Addisas .,w_. •,, . Ucense # - . ...
<br /> Eu C7R(C m .-r. -, , ,:,,,:?:.:-.e...:•-..., . •• Company. ' . . y: •. .. • , ,
<br /> Si i 2atuie _ - ` - .. Registered �-.. Y /•N i I , ;; I;; .. Y / N..I,r.
<br /> g Address' . ,,. I License*
<br /> ,PEL MB �7�� spa ^Y r . , • ,
<br /> Sigr attire Registered . Y / N I Fee Cunene- I Y / N 1, •
<br /> •
<br /> Address 1 . . _ i Gcensp # - I - I
<br /> ME( :HANICAL Company • .
<br /> Sigr attre . - Registered Y / N 1 Fee Current I Y / N
<br /> Address 1, :..,, .. . . 1 License # — I
<br /> On ER Company -
<br /> Sigr slurs Registered Y / N 1 Fee Current I Y / N • ,I
<br /> Address . I License # .
<br /> VENN ..
<br /> Dire :lions •
<br /> Fill out eppncation completely-
<br /> _ Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) -
<br /> If over $2500, a Notice of Commencement is required.(Mechaniaal work over $6000) . .
<br /> Supply two (2) sets of drawings With applicable documentation
<br /> _ Allow 10.14_days for review after submittal date_ Parcel #- obtained from Property Tax Notice (httpJ /appraiser.pascogov.eom) •
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