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Mar 31 04:44 PM Dunnwell 9196611900 2/5
<br /> DEC7'06/2007/TEU 04:22 PM ZEPHYRHILLS BUILDING FAX No. 813 P. 003
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<br /> - City of2ephyrhills Fire . • 1 Feg-a13-780-0021
<br /> 013-70P-0020 . - -
<br /> • . , Perri* APPlicaliOn . • i
<br /> / Phone.Contact for Fern* Mil ME . .
<br /> Date Received . • .... _
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<br /> Owners Name . e,.AN ; A" ■ .•• • ' . - : „I Owner's Phone Number 1 q13 1 l•'7R%11 oSiS
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<br /> Owdere Addteee I - 77 & 4 / . OPri I jai. , .
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<br /> • • ... ..._,Li. Titleholder Phone Nlmiber • I . • 1 ' ' • i I ..
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<br /> paa Simple Titleholder, Name • - 1 :
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<br /> Fee SimpleTWebolder Address • 1 - •
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<br /> . • Job Address • - . 7 69 GA tt 1LV D i.ot#
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<br /> submtsion - 17 7-7 7 -77.- . .1 .: Parcel # -..L ..
<br /> . • No innic.1) t rfeturci'vumessimiejtosiLl I lU esu g assesn AA
<br /> fearamse • . NIsimmitinallelataltlainemiallogillisomil
<br /> • D Bio Waste Storage - ANNUAL - • Fumigation ent •
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<br /> Comm Exhaust Kitchen Nliod/liuct - ' • .. - E:D liamtutlous Mateddl Ciler II or RQ rat,/ ANNUAL -
<br /> • . [ . Controllod Bum • . = Hood Installation , ' ■
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<br /> ' El . Emergency Genemtor< ao kw • ED ' LP/Natural Gas-Inslan .
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<br /> D Emergency Generator' 30 lei" ; • .. 1:::: LP/Natural Gas.ANNUAL Sale • .1 ,
<br /> • E:i Fire Protection - ANNUAL • .. , • • LI Places of AssernblyANNUAL • 1 • . •
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<br /> Sprinkler 0 ' . El Recreational Bum
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<br /> Fire A , lapi t ED Sparklers - - . • ; . - ,
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<br /> • • '" Hood tlianiSimpression ED ........- E:1 Sprinkler System Instailadons
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<br /> .0 Fire Alarm Installation • ' .-; ' • , . =1 StendpIpee (SarInkler Sys) . i . . . ..
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<br /> ED Fire Pumps • ' . • . . -• •• • - • , , • El Torch Roaring •
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<br /> . . : 0 Fire Works •• .. .. . . , - • ED Waste Ylre Storage ANNIVU, , r . 0. . ), 1 4 ,,,,x.e...., •
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<br /> Flemmable Application- ANNUAL • . . . .
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<br /> • .17 Fuel Tanks .
<br /> . . . . . • - ValUatlep of Prof t • -
<br /> • - . El Other: - i 10 1111P 1— . •
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<br /> • . Contractor • • Company its (.....y; ,,,,. I
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<br /> sIgnaiim s - -. - - . . ... . Roateroa . gum Fee curr4nt Num •
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<br /> Address . 5o2 - • - I 6 e.... .,„ ( L . % License* ' ' • • ' ; • •• • 1 " • .
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<br /> Pl - - • , , •. Company • . I • -.
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<br /> Signature - . l • • • . Registered Y / N 1 Pee Currant l • Y / N 1 . • . 1 •
<br /> •Address I •_. ' • • . .•• • , . • • ' 'Joann,* •
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<br /> PLUMBER -- • , . . , Company • . _ :'
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<br /> • SlonatUre • • • 'Registered . Y/N 1 • Fee Cu : t [ . Y/N 1 •
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<br /> -•, Address-) '
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<br /> - • . - . Unse # L . . ,
<br /> • MECHANICAL .
<br /> . . ; ' . Company - • • • " • ' 1 • .•
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<br /> 'SIgnatUre • ' • • • Reglateral. Iffirgill - Fee Currint I Y / N 1
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<br /> Address 1 . "
<br /> • License# 1 , . . ,
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<br /> OTHER - . '
<br /> Company ,
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<br /> . . Signature . ' • • Registered [ Y/ N j Fee Currdnt I Y 1 N I .
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<br /> address " ' ' • • License rA
<br /> . PIII out application completely.. ... • • • . • , ' . . • ;
<br /> Owner & contractor sign back•of applicationenotorized (Or, copy °feigned contact with owner)
<br /> If over OK .Notice of Commencement Is required (bAechanIcal work over 415000) ,
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<br /> . ' Supply two (2) sets of drawings AM applicable degumentallon •
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<br /> Allow 10.14 days for review after submits] date. - • • !
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