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81q- 7e0-802,0 City of ZephyrhUlslzire,: Fax -813 -780 -0021 t: .4 0 Permit Application I L'hn.rF) bia /' ii P/4 llkq- <br /> DateReceived i- Phone Contactfor Permit 8m Z'(3 / / .0 - <br /> Owner's Name LAAL /riFier 4f 70 (p Owner's Phone Number ..l I [ 782 1 1 / 457 1 <br /> Owners Address 1 7(03/ 6 ALL- 20 <br /> 1 Fee Simple Titleholder Name 1 Titleholder Phone Number <br /> ber I L _ f <br /> Fee Simple 'Titleholder Address <br /> MOE <br /> Job Address ( 7 X03 I Go A L C. IJ L O Lot# 1 I <br /> Sub CNvision Parcel # <br /> ED Hio-Hazard Waste Storage -ANNUAL n Fumigation Tent <br /> 0 Comm ExheustK lien Hood/Duct Q Hazardous Material (Tierit orRQ FaciMty)ANNUAL <br /> E il Controlled Bum n Hood Installation <br /> n Emergency Generator a 30 kw n LP /Natural Gas - installation <br /> n Emergency Generator> 30 kw El LP/Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance -ANN paryi L.111 ®t El Pl of Assembly- ANNUAL � <br /> _ 1 Sc. 1 64 <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm El ❑ Q ❑ 1 1 El Sparklers ...--- -- 5'its le + (� �PPIOJPU <br /> t <br /> HoodCIearrtng ❑ 0 i SprinklerSystemInstallations ep ,k /3 � hs l � Q <br /> Hood Suppression D ❑ ❑ ❑ r 1 a Standpipes (Sprinkler Sys) J <br /> n Fire Alarm installation EJ Torch Roofing/Ter Kettle Wet 1 h1 e r f -tf 70 i <br /> RI <br /> Fire Pumps n Waste Tiro Storage ANNUAL • Fire Works <br /> FlernmableApplication- ANNUAL ! , Valuation Of Project <br /> Fuel Tanks <br /> CI Other A / ' 4I f <br /> 0 r .I..> �i Co rn r& PiaE.P -3 - <br /> Signature A _ Registered [ wo <br /> Y/ N Fee Cunent j Y/ N 1 <br /> Address 1 s 2i5 SE . 79/ Sf Qado fL re.$. License # 1 __ <br /> ELECTRICIAN Company 1 <br /> Signature . . . Registered Y/ N I Fee Current Y/ N 1 <br /> Address I license # j <br /> PLUMBER Cony I <br /> Signature , Registered Y/ N J Fee Current I Y/ N 1 <br /> Address) 1 License* <br /> MECHANICAL Company J <br /> Signature Registered , Y 1 N ( Fee Current E Y / N ! <br /> Address L • ( , • License # ( 1 <br /> OTHER Company I <br /> Signature Registered Y / N 1 Fee t ii ' Y/ N I <br /> Address • Licence # 11111111111111110KanailIVAIIIIIIII <br /> • <br /> Directions: S )L h� % <br /> Fill our application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract w " 4 tth owner) 1 <br /> If over $2500, a Notice of Commencement le required.(Mechanlc l work over $5000) / <br /> Supply two (2) nets of drawings with applicable documentation BLS . /,�/ <br /> Allow 10-14 days for review after submittal date. Parcel #- obtained thorn Pro yT , 1 I� - , � • = iser paseogov corn) <br /> -- e Pc SIN AT S7o�'� • 4 0,151- /� <br /> ., ,�,4 <br /> Srt9 ?E Lic ,vSF 6 ri - AtttED V' •go <br /> f ec,i) 7 z_ L 5 r grrQ ewe D <br />