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MAR728/2007/WED G7:20 AM ZEPHYRHILLS BUILDING EAX No.813 P.001 <br /> 8137$0-�0 Cfly Of28p�lYif11116Fd9: Fax-813-780-0021 k <br /> permit Applicetion . _. <br /> Data Recelved •Phone Co �r PBrmR P�� I ZO ( <br /> Owner'e Name • Owner', Phone Number .� �� <br /> Ownera Addresa <br /> Fee Simple T1Ueholder Name � ' Titleholdar Phone Numbar ��� <br /> Kee SlmpleTltlehaldtfAddreas ' ' <br /> � �L . � � <br /> Job Address Lot # <br /> 5ub DivEslon Parael # <br /> � Blo-Hazard Waste Storaes —ANNUAL Q Fumlga0on 7ent , <br /> � Comm Exhaust i(itchen Hood/ouct : •�• Hamrdous Metedal �er II or RQ Faclliry) /WNUAL . <br /> � Conlrolled Bum � Noul Inslaltetlon <br /> � �mergency Generator < 30 kw � � LP%Naturel Gas-Inatallatlon ' <br /> •.� '�mBrgency Generator> 3a kw � LPMatural Gas-ANNUAL Sele . <br /> {� Flre Protec6on Mahttenence = ANNUAL . � Places vf Assembly-ANNUAL • <br /> ` y � emi e <br /> ��� � <br /> Sprinkler � � � ' � � � ReoreaUonal Bum • . �^�� <br /> � Fre Alartn � . ❑ l7' ❑ � � SpwWew . `� '� <br /> Hood Cleaning �[] � ❑ fJ � � 3Arinlder'3ystam Installa6ons <br /> Haod 5uppresslon � {7 O ❑ �� _ � Stendpipes (Sprinlcler5ys) � � `' �1 � 1 <br /> � Fre Alartn Inetalls6on . � TotcFl Ronfingffar KeB1e . . <br /> �� p� -' � Weste Tire Storage ANNUAL <br /> Flro Worlte ' • <br /> Flammable Appfica0on-ANNUAL • • •� Valuation of Pfoject . <br /> Fuel Tankb ' <br /> Q • Other. ' ' <br /> Contraclor � � " � ' Comparry �— <br /> Signawre � ' Reg�st�red Fee Cuirent N� <br /> Address License # <br /> �LEGTRICIA � d Comp�rry <br /> Signature � Reglsierarl Y/ N• Fee Curtent Y/ N <br /> Addre�e license # ' � <br /> PIUMeER Company �� <br /> Slgnalure Reglstered Y/N Fee Current Y/ N <br /> Addross ' Llcenaa # � <br /> MECHANICA� Company �� <br /> sienature Ftegistared Y/ N Fae current ,Y / N <br /> Address � Licepse � <br /> OTH�R , Compeny � ' <br /> signature ' Registered Y! N Fee Curtent Y/ N <br /> Addreea • Llcenes # <br /> Oirection&: <br /> Flll oU[ applica0on tomplataly. <br /> Ovmer & Coniractor sign baok of application, nolatized (Or, copy of eigned contract wlth otimet) , <br /> It over 425D0. a Notice of Commancemant ia required.(Mechanical work over $6000) <br /> Supply two (2) aets of drawinge wilh appllcab�e documentatlan <br /> AlloW 10-14 daye for revloW afler submittal date. Percel #- obtainsd irom Property Tax NoUce (h[tpJ/apprsieer_paSCOgov.com) <br />