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. 1f9&/3. <br /> 813-7804020 City of Zephyrhilis filrllticfn Fax-813-780-0021 <br /> Permit Application • <br /> Date Received = ` 1 1 ____I • ' Phone Contact for permit 1 H I t J <br /> Owners Name ... - Domes Phone Number 1 1 I ' 1 <br /> owners Address • # 5 • = r i F ' 2' ' l — ' •41 - AY � <br /> Fee Simple Titleholder Name 1 I Titleholder Phan Number 1 i I <br /> Fee Sl npW flhi olderAddress I I <br /> Job Address 5.49/1C4' <br /> .49/ 1 .�- -- lot 0 <br /> Sub Division Parcel <br /> ❑ Rio-Hazard Waste Storage - ANNUAL ❑ Fumigation Tent • <br /> ❑ Corm Exhaust Kitchen Hood/Duct ❑ Hazardous Material (Tier 11 or RO Facility) ANNUAL <br /> ❑ Controlled Bum ❑ Hood trnteflabon <br /> Emergency Generator < 30 kw LPnr twit Gas -Iron <br /> Emergency Generator > 30 kw LP/Natural c3as -i�a UAL sale <br /> Fire Protection M nc. - ANNUAL ❑ Places of Assembly NNUAL r� <br /> 13EM ES Eff.1 0.-zall R Sprirdd.r 0 0 0 wa.ation Bum 0 (� i 9 <br /> Fire Airm 0 0 0 _ Spulders 1 <br /> Hood Clearing 0 0 0 SprinldsrSwim Installations • . <br /> Hood Suppression 0 0 A Stadpipes (SprM+ der Sys) • <br /> Roo Al <br /> Aarm YrteNation _ _ Ei . <br /> Are Rooting/Tar Kettle , <br /> e Pumps - ' Was Thre Storage ANNUM. <br /> Fin Woks <br /> Rem** Application- ANNUAL 1 I Valuation of Project <br /> Fuel Tanks <br /> rc a 1 " K b r W4 I'DIFEA § 1 q E I III I II II II I I I I I II III _ _ ftellillil OEN <br /> Addle** Vap? ,r,, ' ci4�®F ®.�r -! ' :air All Mom* r A "1 e.T.01 ",9 s:: n ; <br /> Sig Signature Sig Y/ N F« Current I Y/ N 1 - <br /> _ <br /> Address [ ; r <br /> License * I I <br /> ..:.. .:.. Company <br /> PLUMBER Registered I Y/N I Fee Commit I Y /N I <br /> Address I License e I I <br /> mEcHAtecA Company I <br /> RegbNrsd l Y/ N I Fee Cun.nt L Y / N 1 <br /> Address I 1 <br /> License F I [ <br /> OTHER <br /> Signeture [ N <br /> Registered Y / N • Fee Comet Y <br /> Fhti,outi,p o Mon ., <br /> O.nsri'C j #' 04'41004 s60 �) <br /> If ow $2800, a Notice ,� 4 work ) <br /> Supply two (2) sob of , <br /> Alba 10-14 days for aMrss i date. . 4`. 0 - obtained from Property Tax Notice (httpd/appealwr-ascogov-com) Parcel <br />