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11/24/2009 16:12 8133671607 SIEMENS PAGE 01 <br /> A q6( <br /> Fax - 813 -T80 -0 <br /> City Of Zephyrhills'Fir••e �7 H(, <br /> P Application <br /> B13-780-0020 r—• <br /> Phone Contact rtnl <br /> for Pat Ma Jiiii <br /> Tats Received M - ............ .- - Owner's Phone Number <br /> Dwnaes Name . r :. k (kilt.) f- '13 54 <br /> �- <br /> Owner's. ^titleholder Phone Number ��_ _ <br /> Fee SImPleilth holder Name n , <br /> `tee Simple -3 -3��( Lot# <br /> J am" 3SD 1111 �a �1�z 1g ,..,5'. p010 0 6900 0010 <br /> Job Addroas <br /> Parcel # �� <br /> Sub plvislon ,� I= Fumigation Tent <br /> 610-Hazard Waeb9 Storage - ANNUAL Hazardous Material (Tier II or RQ Faculty) ANNUAL <br /> Comm Exhaust Kitchen Hood/Duct 1 7 <br /> iHood installation n 73 ��roiled Bum LP/Nature' <br /> ? /Nsbnai Gas -Installation <br /> Generator < 30 kw (� LP/Natural Gas - ANNUAL Sale <br /> Ei Emergency --' <br /> > 3 0 kW • Places of Assembiy- ANNUAL <br /> Emergency <br /> ir Protection e Gorr mete ANNUAL <br /> Fire protBetlon Maintenance - in ,•,,;rte Ojai n Recreational Bum NM El <br /> Sprinkler • D 0 n E:=1 spar* <br /> Firo Alarm Sprinkler System Instailetlons <br /> 0 p s ood Gleaning El (Sprinkler Sys) <br /> ( p <br /> Hood Suppression Torch RaoflnglTar Kettle El <br /> Fire Alarm Installation Q Waste live Storage ANNUAL <br /> Fire Pumps Valuation of Project <br /> Fire work; <br /> Flammable Appiieatlon- ANNUAL <br /> Fuel Tanks <br /> :3 Other <br /> . ,. ,.. . • _ , .. _. Company YI Fee Current Y / N <br /> Registered <br /> • <br /> GorRreCter <br /> Signature .... License # . <br /> Address; Company ELECTRICIAN . <br /> Company Fee fitment MEM <br /> Signature License */ Address Company <br /> PLUM re <br /> Registered y / N Fee current <br /> Signature License # Mai <br /> Add Company <br /> MECHANICAL <br /> Registered / Fee Cum3nt MOM <br /> Sipnawre • License # <br /> Addreas Company S i tNwS h/ ��^'t"� �/'� Fee Current / N <br /> OTHER ' / Regist°red �e1, <br /> Sipnaturo `� Cleanse# .'.^ <br /> Address; ���� -�- r -- •- ^- � <br /> • Irectlons: <br /> FIIl out application completely. notarized IOr, copy signed cvntraet'�Ith owner) <br /> Ow^or B Contractor clan back of application, r,leell warn ever 55000) <br /> If over 52000, a Notice or Commencement is reatgr°d •(Maerrt+ <br /> Supply MO (2) acts of drawings with applicable doe mren1tI0 Parcel #- attained " from Property Tax Notice (httPJlspPm�er pascopov.com) <br /> Allow 10 -1a days fC r review attar submittal date. . <br /> • N In *e di i oh . <br /> \ / c /c' • <br />