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May 19 09 09:10a Southeastern 4078309602 p.2 <br /> 813 -780 -0020 City of Zephyrhills Fire. • Fax- 813.780.0021 ! <br /> Permit Application - <br /> e - <br /> Date Received . , • IIM' r , Phone Contact for Pemilt D. ; s • 1 7 - <br /> Owners Name - I q 1.(.1�. 619-0 0 `*e o 6a-/l l Dawes Phone Number 1 7/3 + EMI j 058 / <br /> Owners Address 1 13 a 6 4 / / 46/ t / / 6 Q 2er,i yy h I Il S P1 • 33 Sq j <br /> Fee Simple Ttli eholder Name I A, / M I Titleholder Phone Number 1 1 ` ft/A 1 I <br /> Fee Simple"Titleholder Address J A.,1 A I <br /> ��'..... -_. _.. +•;... =r:Y:.iLC.ti.'t..:�_..::' . :'.:.el'- _..:: :._.,. u .:.:::1...::. ^.� .�. —. ....�,.._.. _ ... `F:G i. as.w _.. _. .. 1.� ,.. . <.. ..+....�..�_ ,..- i�..a�( '.�tiu.. —' . ,:il. <br /> Job Address 1 13 1 3 &la 11 8) v D .. I Lot# I A <br /> • Sub Division I 1 Parcel # I / _ I <br /> r - :x.:.x.:__:_.�.�.: >:...ti:.a _. .... ..,;. r.:�. _•.h_..:.....::.. �_ s::- aair. ..,..,_.,_�'- '��+....�_..'.T._ se;...:..-i_.. _s ;:.�.v m_,_._,_.r_. <br /> D Bic - Hazard Waste Storage - ANNUAL D Fumigation Tent <br /> ri Comm Exhaust Kitchen HoodlDuct D Hazardous Malarial (Tier 11 or RQ Facility) ANNUAL <br /> D Controlled Bum D Hood Installation <br /> D Emergency Generator < 30 kw D LP/Nat rai C- lnstotlation <br /> D Emergency Generator> 30 kw D LP/ Natural Gas - ANNUAL Sale <br /> a Rim Protection Mainlenamoe - ANNUAL D Places of DUAL <br /> L=0 11 22.1 Le-4111 Sprinkler ..D D D D D u <br /> Reaeatlonal Burn //, J Iu <br /> Fire A1ann p 0 0 CI I D Spedders / ;fi 9/ I <br /> Hood Cleaning 12 Ie • 0 D 1 I n Spinkier System InstallabcE <br /> Hood Suppression 0 ❑ ❑ D 1 1 D Standpipes (Spireder Sys) <br /> D Fire Alarm installation D Torch Rooting/Ter Kettle <br /> Fire Pumps Q Waste Tire Storage ANNUAL . <br /> Fire Works <br /> Flammable Application- ANNUAL ( I Valuation of Project <br /> Fuel Tanks <br /> D Other. 1 I <br /> Contractor Scw-er S. rep "T iv—. S city o Cars •Compan• T C14576 " � ti - /dye ^ 7. Tic)--... 545 J <br /> Signature Registered. I u e N ( Fee Cunent ' Y / N I <br /> Address I L a O 43 EYtyr ieer#e'•• lAr '1'8) 1 _. License* ) I <br /> Signature Lao q 4 o0 d gl. 3" r7 S C7 I . Y / N Fee a.rant J Y / N , I <br /> Address J 1 License # J I <br /> PLUMBER Company <br /> Signature Registered Y / N j Fee Current 1 Y/ N f <br /> Address J 1 License # J I <br /> MECHANICAL Company I <br /> Signature Registered I Y/ N I Fee Current 1 Y 1 N <br /> Address j • I License # . I <br /> OTHER Company I <br /> Signature Registered Y/ N j Fee Current 1 Y/ N <br /> Address . License* <br /> Directions: •- -- <br /> Fill out application completely. <br /> Owner 8 Contractor sign bade of application. notarized (Or, copy of signed contract with owner) <br /> If over 52500. a Notice of Commencement is required.(Mechardcal work over $5000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Panel #- obtained from Property Tax Notice (htlp://appraiser.pescogov.com) <br /> • <br /> • <br />