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� s�saso-oo2o CiryofZephyrhiils�Firs• Fax-sisaso-oo2�
<br /> . , PeRnit Application _
<br /> Date Received Phone CorRact for Pertnit
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<br /> Owner's Name `ANDERSON4 P�SS Owners Phone Number � � ��R
<br /> Owner's Address 51�F M[JR�Y —
<br /> Fee Simple TiUeholder Name Titleholder Phone Number � � �
<br /> Fee Simple TiUehoider Address
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<br /> Job Address GOLDEAT CORRAI, 6855 GA�LI� BLVD. ZEPHYRH — �ot#
<br /> Sub Division Parcel#
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<br /> „� rn Bio-Hazard Waste Storage-ANNUAL � Fumigation Tent
<br /> � Comm Exhaust Kitchen Hood/Duct � Hazardous Materiai(fier II or RQ Facility)ANNUAL
<br /> � ConVolled Bum � Hood Installation
<br /> � Emergency Generator<30 kw � LPlNatural Gas-Instaliation
<br /> aEmergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale
<br /> � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL
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<br /> Sprinkler � ❑ ❑ ❑ � Recreational Bum �
<br /> Fire Alartn � ❑ ❑ ❑ � � Sparklers ��1
<br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations ��
<br /> Hood Suppression � ❑ ❑ ❑ � � Standpipes(Spri�kler Sys)
<br /> � Fire Alartn Installatlon � Torch Roofingrfar Kettle
<br /> � Fire Pumps � Waste Tire Storage ANNUAL
<br /> Fire Works
<br /> Flammable Application-ANNUAL , Valuation of Project
<br /> Fuel Tanks
<br /> Q Other:
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<br /> Contractor Company
<br /> Signature Registered Y/N Fee Curtent Y/N
<br /> Address License#
<br /> ELECTRICIAN Company
<br /> Signaiu2 Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> PLUNiBER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
<br /> MECHANICAL Company
<br /> Signature Registered Y/(V Fee Cument Y/N
<br /> Address License#
<br /> OTHER Company
<br /> Signature Registered Y/N Fee Current Y/N
<br /> Address License#
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<br /> Directions:
<br /> FII out application completely.
<br /> Owner 8 Gontractor sign back of appiication,notarized(Or,copy of sigr�ed contract with owner)
<br /> If over$250Q,a Notice of Commencemerrt is required(Mechanicai work over$5000)
<br /> Supply two(2)sets of drawings with applicable documentation
<br /> Allow 10-14 days for review after submittal date. Par�el#-obtained from Property Tax Notice(httpJlappraiser.pascogov.com)
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