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SEP/28/2009/110N 03:02 PM 2EPAYRAILLS BUILDING FAX No. 813-780-0021 P. 001 /001 <br /> ;• 813750-0020 City ofZephyrhIlle•Fke Fror•813- 760-0021 <br /> • ;Petra Application . - • <br /> .. ... .,.. ' -: —.r' -..► -- PhorwGunaoliorPemllt ' Z� -+ 7 r • Owners NORM ., Z' �,� Owrele Phone Number 11 <br /> F e e simple T i t l e h o l d e r Name 1 . • ' • ' , , Yeleholder Pbone'Number I • 1 1 I . • <br /> Fie 6bnple'Reeholder Address <br /> Jab Addles r3�a5 a g An vim. ` L et$ . ( • <br /> sub ONIston �...._,T„T .. = 1___ .Par�l # : ' _ �.. ._::_,.�,.�. <br /> D ' 010- HazOtdWate Storaue- AN NUAL ' ' • =I • FumigaionTent • • D Comm Exhauet Kitchen Hood,Diict ' .. MOeetdoes Materiel (Tier 0 or R0 Facility) ANNUAL • • <br /> E Centralia: 00m . t .: . , •• . D Hood InstaMatlon • <br /> Emergency Generator < 30 kW: , . LPINeEwar 4erHneteMa6on <br /> ® emeryency.Generator> 30 Mar : • UNNalural oaEE- ANNUAL dale , 7 j� <br /> Tire Proeecdori Malfltenance - ANNUAL • • Ptaces Of • Assembly,ANNUAL � /999y) � / 0 C <br /> Sot¢iWer O •O .. ❑ �' Rscre Bur i • ' I:tre Al ann . • • O O •9paddsrs • . . <br /> Mood . R.• <br /> phoning :. G . O O Eprkrlder Syetri b,etaueso,re . <br /> Hood Slip reesion ' a • a . In • El 8tarldplpas (Whiff SYS . • • •. <br /> Re Atanw Yrs&aIa11or . . ' • •• . ' Q Tamil R soinefrar Ksab . <br /> • Fee Pumps :. . Waste Tae StoraOw ANNU • • . . • <br /> Fes works • <br /> Flammable Application- itinuAL . ) n . 1 • Vaivaflon of Pvujeat " <br /> 0, Fue Tanks . <br /> Q '.Other.. I . <br /> C nteotor con,pary Ir► 3 ' a� : a .. _. ).. <br /> • Signaling RegiNtred • - `1 1 1 N , Pee Current `jjii <br /> Address'' . . . . • " ;, �'' ;Amos* , 1 <br /> p.h'QrRIG1AN Cp ny ' : , • <br /> • Striatum I _ Registered I Y / N 1• nee Current I Y/ N 1 . <br /> Address .I • • • • License*. 1 ! • <br /> PWMMFR • _ - • Company <br /> Signature . • ' • • • ' • • Registered. ; l Y / N I Fee Current I YIN j - . • <br /> Address 1 . 1 • . Ligon.. 1 • . .. . 1 <br /> • MECHANI • Company <br /> Slpneiur! • Registered } Y/ N I fee Current I Y 1 N .1 <br /> Marna ( 1 Menge# • I, J • <br /> OTHER • I . Compares • • <br /> • Signature I • . , , . • Registered. Y / N 1 Fee Ounont [ Y / N I <br /> Address I License* <br /> Directlons: • • • • <br /> PIG out application completely. <br /> • j OWnr a Contractor son hook or eppecebon notarized (Or, Dopy or signed contract with owner) • . • <br /> . if over 32500, a Notice of Commencement Is rewired (Meohenlwl Wolfram 55000) . • - <br /> Supply two (2) sets of drewape wish applicable documentation - <br /> AGow 10-14 days for review alteraubreNtal deie, • . Pared *- obtained "ern Property Taos Notice (fder•Jlapprelser pascogovmm) <br /> • <br /> • <br /> ZO /Z0 39Cd W21t71V 31ti1S O8 LT :ST 0T0Z /8Z/60 <br />