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. 4 ii <br /> 813 - 78040020 City of ZBphyfhiIIS Flit0hT24.1 Fax- 813 - 780.0021 <br /> Permit Application - <br /> Date .. C for a 1 1 I 1 1 <br /> Owners Name .... g /� � Owner Phone one Number 1 11 ' I 1 I <br /> Owners Addrus J 6 e2! -�/ O 7/ 7 �r// / Yr /� `n / // /Z i I <br /> Fee Simple TIlleholderName J J Titleholder P hone Number J 1 1 1 1 1 <br /> Fee S1mplelllIsholderAddress . am —a— <br /> . <br /> Job Address Lot 1 <br /> Sub Division Parcel e <br /> E Bio•ezard Waste Storage - ANNUAL Q Fumigation Tent ' <br /> El Comm 6dheust Kitchen Hood/Duct El Hazardous Material (Pier II or RO Facility) ANNUAL <br /> Q Ca eclied Bum Q Hood Installation <br /> Enhugency Generator < 30 kw LPMttimal Gas-Installation <br /> Emergency Generator > 30 kw LPnrsamd Ges-41INUAL Bale <br /> Are Protection Maintenance - ANNUAL paces of Assembly-ANNUAL <br /> EN <br /> Sprkdder i 0 0 0 _ waeatlond Bum <br /> FMs Alenn 0 0 0 Spedders <br /> Hood Cleenktg 0 0 0 Sprtnldsr System Instillations . <br /> Hood Suppression 0 X 0 Standpipes (Sprinkler Sys) Ayer - - <br /> R Ay Installation _ Torch RootiniRar Kettl , <br /> Kettle <br /> Pis Pumps -- - - R l Waste Tire Storage ANNUAL . <br /> FYnnnble App$atlon- ANNUAL ' • 1 Valuation of Project <br /> Fall Tanks <br /> SWOON* , % L A a�—�®T Rsgiklswd Ede :: <br /> Address / -C14 L+ G..: V rAirA _ ®z F stir1/4 A • . * NS - 1'4, f.7.4 ,' ✓ .Y"..; .u4 ..i , <br /> air .i�eooaix.s. �ecaee+w'wic-a•cztmvm ®v ... — ��...� - aa.�emsw:w.n.a�a®wr+'.�m+ <br /> ELE <br /> Signature IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIM Regiebnd Y/N Fee Ctarent J Y/ N 1 - <br /> Address " x : �. _ •; License # ! <br /> PLUMBER <br /> Signature Registered Y N . Fee Current I, Y / N 1 <br /> Address 1 1 Licensed ( I <br /> meampae Cornpeny <br /> Registered [ Y/ N j Fee Comet J Y/ N 1 1 <br /> I License A <br /> Address 1 1 1 <br /> OTHER <br /> Company 1 <br /> �,.. I I Y / N . 1Pas Comm 1 Y 1 <br /> A <br /> D <br /> f P8 t o - x _ 4 , <br /> Omer ft 4 ' - ; `. ..algNd'Oos* Gt WMh owner) <br /> If over 521400, a Notice 4 L 4 ... "- work aver 55000) <br /> Alm 10 days for t sfteosubridtteloste. 4 ,1-4,0''' parcel 0 - obtained from Property Tax Nolbe (h d phMar paecogov s ore) <br /> -4 ..,-;,;,,,,4;*, <br />