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OCT/28/2009/WED 10:45 AM ZEPHYRHILLS BUILDING FAX No, 813 P. 001/001 <br /> siFao-Gozo City of.ZophyrhIllsflre '# / 0 7 Fax-810-780-0021 <br /> •Perrrilt Application <br /> . , . . .• . . . • ' • <br /> Oats Received • • . • . • Phone Contact for Permit glitella IMPIII AsWir <br /> Owner's Name - Ike rtikL5 . •• Ovirter's Phone Number _ • 1 1,,c 1 1 1 / D <br /> J 1 <br /> Owner's Address • • <br /> 1 <br /> I I <br /> • <br /> Fee Simple Titleholder Name . 1 Titleholder Phone Number • 1 • <br /> I ' I '• <br /> Fee Simple Address <br /> Job Addres s ' 5130 a L L 81v• , ._ <br /> . , <br /> Sub Division ' <br /> ' •• , = Blo-Hazard Waste Storage - ANNUAL . , • '. .. • ' ' ''. . . = , Fumigation Tent . ,, ' • , <br /> = Comm Xilaust Kitchen Hood/Ouct • - . . ' i 1 Ma terial.ffier II or IRO' Facillty)ANNUAL , _ • <br /> In ", Controlled Bum . Li Hood Installation • • . ' • • <br /> • El • Emergency Generator < 30 kw ' ' • ' • . • 1 . LP/Natural Gas-installation <br /> • 7 Emergency Generator > 30 It ' • .. • .., • • n' . LP/Natural Gas-ANNUAL Sate i• • • • ' . <br /> • 1::: . Fire Protection Maintenance -ANNUAL " • • - El Places of Aassembly-ANNUAL • . ". ' <br /> Sprinkler . 7. Cl , .0 • - in EMI ReCrestional Bum •, • • ' • • <br /> . , <br /> , • <br /> Fire Alarm • • , El in: in 0 110111 • , ni Sparklers <br /> ...Hood Cleanin3) • 0 0 1 1 7. Sprinkler Sys Installations . • . . ' . <br /> • Hood Suppreastan LI 0 • 0 0 ----- 7 StandpIpai (Sprinkler Sys) • ' <br /> • <br /> = Fire Alarm Installation ' . , ' -, ' • El 'Torch Roofing/Mr Keittli . . • • . <br /> = Fire Pumps - ' • • = Waste The Storage ANNUAL * . . • • <br /> 1 ...... Flammable Application- ANNUAL • . ' • . ' • . . 111.11.1111.1.1 • Valuation of Project <br /> Fuel Tanks . <br /> ' , = <br /> Other • • • . <br /> . , <br /> ' • ' • Cony / 04) zd'I3-9`7" 2 5 v <br /> 1 Contractor A 6,6 c7e _....4 ..._.___ 3 ",. e....at • . . . <br /> Signature Ragiotarsel Y-/ N • 1 Fee Current 1 Y/ N j <br /> Addms ri Me ir Xei&W i lAWer ill° Hiiii a rja vam ilini - License # • - - I • • , <br /> .. . <br /> LEGsiTtICIAN 4 • . <br /> . Company ' <br /> Signature 1 , Registered Y / N 1 Fee Current J Y / N <br /> Address 1- - ,- License #. . . • • I . , , <br /> . - - <br /> PLUMB R . . . Company • ' • <br /> Signature . . .. . ‘ Registered ' Y / N 1 Fee Current I Y / N 1 <br /> Address r . <br /> 1 . , License # • ' . 1 • • . <br /> , .. <br /> " <br /> MECHANICAL <br /> • • Company <br /> Signature . • . <br /> Registered 'Y / N 1 Fee Current I Y/N I <br /> Address 1 __ <br /> • • • - , license # LL...„.. • _1 <br /> OTHER - T , <br /> - • <br /> • <br /> Signature ' Registered Y / N 1. . Fee Current 1 Y / N 1 , <br /> — <br /> Address , License # <br /> Directions: <br /> Fill autapplicatIon completely. . • • <br /> • <br /> Owner & Convector sign hack of application, notarized (Or, copy of signed contract with owner) <br /> , <br /> If over $2500, a Notice of Commencement Is required (Mechani ®1 Work over ;5000) - • <br /> Supply.two (2) sets of drawings with applicable documentation' • . • <br /> Allow 10-14 days for review after submittal date. . - Parcel # - obtained from Property Tax Notice (fittp://appralser.pascogcei.com) . . <br /> • . <br /> I , .• , <br /> • <br /> I . . . <br /> I ' ' • . . . . <br /> . . <br /> . . <br /> ' . • <br /> • • . <br /> • <br />