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09/04/2009 10:48 FAX ,J/�/� /� i ,) Z004 <br /> 813 -786 -0020 City ofZephyrhills'Fire (/(/ / 5' Fax - 813-780 -0021 <br /> Permit Application <br /> Da e Received phone Contact for Permit I <br /> O ner's Name L c T 14 PT,FX( T ti j $j ,L ry ` 1 Dwnees Phone Number 813 1 6 2 6 115482 <br /> Oµ,er'sAddress 4701 Oak Fair Blvd TAMPA FL 33610 , <br /> Fee Simple Titleholder Name I Titleholder Phone Number I <br /> Fee SimpleYltleholderAddress I • <br /> Jot Address -- 7e, `1.c) Gat" c&v.i. • 7._ QrvotI5 •c1 • 335 1 lot# <br /> silt Division 1 Parcel # 1 <br /> sass <br /> . Bio- Hazard Waste Storage - ANNUAL o Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> • Controlled Bum n Hood Installation <br /> ri Emergency Generator < 30 kw n . LP /Natural Gee- Installation • <br /> Errrergoncy Generator? 30 •kw • = LP/Natural Gas - ANNUAL Sate • <br /> Piro Protection Maintenance - ANNUAL a Places of•Assembly- ANNUAL <br /> MT ( O. timer _ Sprinkler ❑ a. Recreational Bum <br /> Piro Alarm. - n ❑ 0 0 • . 1 . Sparklers - <br /> • Hoed Cleaning n in 0 C1 I 1 n Sprinkler System installations . <br /> . - ', : '...:. •, . • oo ression d , 0 Standpipes (Sprinkl rSys), • <br /> 1'. -•' FIreAlartn kls tellation • 7oicfiRooflitITar Kittle M. <br /> •,, • Flre Pumps Waste Tire storage ANNUAL . • <br /> :.. • Fire Works - . • , • • , <br /> ••,;; Flammable Application - ANNUAL ` • :1 ' V aluation of Project , <br /> • ii'`; ,,.... Tanks i .., •• • ., _ <br /> • Other . <br /> Cont actor / <br /> Sign duns Company rH'' .',.,. (:( - <br /> - Registered Y / N Fee .Current I' Y /'N I ' <br /> , <br /> ELE';TRI.Ci R ,. , Co . . .. . 3.:' .. . , <br /> sign: rturl - y . ' Registered ' Y / N . 1, • Current• I:,; •: Y 1 N � • <br /> Ad License # I J <br /> •PLUt MIER Company a , <br /> Slgnr;tura . ' Registered Y / N » 1 Fee Current-• 1 Y I. It/ I - • <br /> ' Address I • . - 1 License* , j - . .. • 1 <br /> MEC WANICAL Company • <br /> Sign:; tuns . . . Registered Y / N I Fee Current l Y / N 1 <br /> Address 1, ;. • . ' • 1 License* ' 1 <br /> O71-IE R • Company - <br /> Signe tare Registered Y/ N I Fee Current 1 Y / N . _ 1 <br /> Wddrpss l.icenoe # <br /> Direct ions: <br /> Fib out application .complefely. - <br /> Owner & Contractor sign back of application. notarized (Or, copy of reigned contract with owner) ' <br /> tf over $2500, a Notice of Commencement Is iequtred,(Mectranicai work over $5000) , • <br /> - - Supply two (2) sets of drawings with applicable documentation <br /> , Alloy 10- 14, d deys for review after submittal date. Ran #- obtained from Property Tax Notice (httpl/appraiser.pascogov-com) <br /> • <br /> • <br /> • <br /> • <br />