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3'13-7E0-Or�� C.I�/ Of Z ephyrhills f'IF rax-o � ri ov-�u_ i - <br /> Psrmit Application — _ <br /> D�`.s R�ceired � ' ZO ( � � Phone Conta� ior ?artnit � �OG. � , 7 7 <br /> : ��ss�=�.,ra.'-��:�K<..�_ �.w.���_,.._..-.>...... .. ---�-"� - " c ---- J" :.'x.,..:... . , ��-d:..�...-.�.. <br /> Owner's �fam� � L Owners Phone Number ��� <br /> Owner'sAddress ZS W �l�'�'�G� ! 5�� �� �. . /J1..� I.� R ��� <br /> rse Simpl=_ Titlsholder Name Titlahol�sr Phons Number ���� <br /> Fee SimpieTitl=fioldsrAddress <br /> � mt4}��^��i `-rt�".����i a '. "-n:.3t�:.`'�".'�.°'��:X�-'1�`��'�� ''��sxsa+�,,�':.�r ,. ^"t��'r�.�"� -r � . .� 'r.-y <br /> Job Address <br /> � 3`r'�� G Ii�.� LV hJ Lot � � <br /> Sub Division Paroel� 3S`25'Z �' ���' " 0 ��� <br /> � ��a�.y���-�-�, ���r�^R---°y. - . m ,°°, - <br /> t � Bio-Hazar� Wast= Storega - ANNUAL � Fumigation Tent <br /> Q Comm Exhaust Kitch=n Hood/Duct � Hazartious Ma;erial (Tier II or RQ racility) ANNUAL <br /> a Controifed Bum a Hood installation <br /> � Emsrgency Generator < 30 kw a LPlNatural Gas-Installation � <br /> Q Emergency G=nerator> 301cw � LP/Natural Gas-ANNUAL Sale �/� 2 <br /> � Fira Protection Main±enance - ANNUAL a Places of Assembly-ANNUAL � l <br /> ury J2fT11 On nar <br /> Sprinkfer d ❑ ❑ � Recraatioral Bum <br /> Fire Alarm � ❑ ❑ ❑ C� � Sparkl=rs <br /> Hood Cleaning � ❑ � O� a Sprinkler System (nstaltations <br /> Hood Suppression � ❑ ❑ O� a Standpipes (Sprinkler Sys) <br /> a Fre Alarm Installa6on � Tor�h RoofinglTar Kettle <br /> Fre Purnps � Waste Tire Storage ANNUAL <br /> Fre Works <br /> Flammable ApPlication- ANNUAL . VQ Vafuation of Project <br /> Fuel Tanks <br /> Q Other. <br /> -�� �°°��'-�.-.�.- - <br /> ConUactor � C� />> � 'j'�, ��(„� Company t� � �� <br /> Signature i��"�� Registered 1� Fee Current N <br /> Address �� /�,. • '7Q^ul '�. (� � Licertse # � � � �1 �l � <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License �? <br /> PLUM3ER Company <br /> Signature Registered Y/ N Fee Current Y/ N <br /> Address License � <br /> MECHANICAL Corrtpany <br /> Signature Registered Y/ l� ree Current Y�� <br /> Ad�ress License � <br /> OTH=r't Company <br /> Signature Regist=red Y/ N Fee Current � Y/ N <br /> Address License ;� _ <br /> �... - - .�_ - - - - - - - �_--°� - -- ..._...._.� r� .�._.. .._.._..� _�._��: <br /> + Dire�U�^s: <br /> Ftl out appii,:ation completely. <br /> Owner & Con:ractor si�n back of application, notarzsd (Or, co�y of signe� contrect �vi uh owner) <br /> tf ovar 52500, a Notice of Comm=n�em=nt fs required {M�chanicai work over S5000) <br /> Supply two (2) se:s of d2winys with appli�able documen,ation <br /> kflow 10.14 days for revisw a`t=_r subml:tal date. Parel r- obtained from Prope ,ry Tax No:i�a (h�pa'fap�:aiser.pasco�ov.co^�) <br />