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10/26/2010 10: 58 7275310596 COMMERCIAL FIRE <br /> 4 ' � �� PAGE 02 <br /> air City ofZephyrhIllsFlre, Fax-8•13-7/10-0021 <br /> Permit Application <br /> Dote Received UJE /O . - •P�horie ContactforPermit �� , f� 7r <br /> - ....__.._..-, //�3 Ili o f <br /> Owner's Name I� 1 °(�l .((1 01 Y �`C I Owner's Phone Number ,�2WZ <br /> Owners Address r 3j(5 CY1ntI[e1 i uofe 7.Q f h l r Jk F 1 5'55'46 <br /> Fee Simple Ttleholder Name l Titleholder Phone Number I If I l <br /> Fee Simple Titleholder Address <br /> VaNdiMIWEN.... own, 2 �/�. 1- pQ rsn.. ........ �......__...._........�. _ .��..��...... <br /> Job Address s f t hf � et �p v4ti 7 p e f rh 1 I k El 333`10 1 Lot# f <br /> Sub Division ` "I parcel # j <br /> Bio Waste Storage - , ANNUAI. • Q Fumigation Tent <br /> Q Comm Exhaust Kitchen Hood/Duet = Hazardous Material (Tier 11 or RIO Facility) ANNUAL <br /> n Controlled Bum [] Hood Installation <br /> n Emergency Generator a 30 kw LP/Naturei Ges- Installation <br /> •Emergency Generator> 30 kw n LP/Natural Gas- ANNUAL Sale �1 <br /> Fire Protection Maintenance . ANNUAL Q Places of Aseembiy•ANNUAL a C_ ff <br /> Sprinkler D 13 D D = Recreetlonel Bum 01 9-Z15/71) <br /> Fire Alenn ellg O O X I I = sparklers <br /> Hood Cleaning III 0 ❑ 0 f I Q Sp„nklerSystem installations 6J cr- <br /> Hood Suppression D L--) D L. 1 a Standpipes (Sprinkler Sys) T <br /> E l Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Pumps Waste The Storage ANNUAL <br /> Fire Works <br /> Flammable Application. ANNUAL ( Valuation of Project <br /> Fuel Tanks <br /> p Othe I • — I <br /> Contractor Company s <br /> S- wi�I!% TiZT,r . 073n Malta" <br /> signature Registered Y / N Fee Gums EaLl s t ,• <br /> Address ( 1 • license # I �. <br /> ELECTRICIANI 1 Company Signature Signature Registered Y/ N I Fee Current 1 Y/ N J <br /> Address a J License* r I <br /> PLUMBER Company I <br /> signature Registered J Y/ N f Fee current t Y / N <br /> Address I <br /> License* <br /> MECHANICALI Company J <br /> Signature . f Registered Y . / N T Fee Current ( Y / N • 1 <br /> Address I • License# J <br /> OTHER <br /> Signature ( CDnY <br /> I Registered Y/ N T Fee Current 1 Y/ N <br /> Address <br /> Directions: License* <br /> Fill out application completely_ <br /> Owner & Contractor sign back of application. notarized (Or, copy of signed contract with owner) <br /> if over moo. a Notice of Commencement Is required. (Mechanical work over $5000) <br /> SuPPIy two (2) sets of drawings with applicable documentedon <br /> Allow 10 -14 days for review after submittal date. Parcel #- obtained from Property Tax Notice (hgpl /apprelser.paecogov.com) <br /> • <br />