|
813.780-0020 Gty of Zephyrhi(Is Fire Far-813-780-002'
<br /> Permit Application
<br /> Date Received � ' �
<br /> -_.. .,._.�.:.. ._._ -�_..._.._-�-_- - - - _- -- -- -- - - -- -- ---
<br /> :.,......z_- ...... .�..
<br /> __�„=:s-sr--. --- -. ....;,� - z a - -- -
<br /> --.,.�,rn=._...,._,._„�
<br /> Phon�Contact fo ertnit I q
<br /> ._,,- __. ......_._..____..._ . -- -- ---
<br /> -,..-...=�r _ . . xs.rs_. r�P�_ � _
<br /> _..,,_-�.�,,,�___-�. ....__ _.��,__ --
<br /> -.- __a_z__�:.�.
<br /> -�:_�.-:_-.-.-..��...z::_.�._..:�.�, _:. 3
<br /> Owner's Name �/�gjCT(�/�7i/b `K.- /'I/r/�(�i � QyynePS PhOr12 Number d�'f� 7�0 .-` ?��
<br /> Owner'sAddress 3��ao �Qy J/Qi �� �� Z"/�/�(is r(i ?j T�,
<br /> Fee S�mple Titieholder Name Trtleholder Phone Number �� � �
<br /> �:.-S�mpie TdleholderAddress
<br /> � __,�_....__,_,,�_.�_, ... ..�_---_---'- -..,, ,�;.__ �..:�—
<br /> -�_:.:;�.c��.::...:-a'a.R<�.�_. . � - •a�. �_. .,.�_._,..�,a,.tm.,�:.=-�.� _��...___.
<br /> •-'-- �r:-.,._....
<br /> �� i �';".p��,:__�-;_.:_._�. ._
<br /> Job Address ��d)� �/�� , /e� � !o�� ��/���S 335�� Lot# ��
<br /> Sub Diwsion �,��
<br /> .- :.-�.- ---�. ,=v......,,,
<br /> '- _---__...�,.�,-�:--w..-��.,,..,,�. -����,��rd:;��,r..�x��. _
<br /> �:.-,_-: . _ .��,..._.,......_u..._;_�,x�,.�°���:�_�-_=__'_:.
<br /> � Bio-Hazard Waste Storage-ANNUAL � Hazardous Material{Tier II w RQ FaciJity)ANNUAL
<br /> � Comr*Exhaust Kitchen Hood/Duct � Hood InstailaUOn
<br /> � Conuolled Bum , a LP/Netural Gas-Installation
<br /> � Emergency�enerator<30 kw � LP/Natural GasANNUAL Sale •
<br /> � Emergency Generator>30 kw � Places of Assembly-ANNUAL
<br /> aPire Protection Maintenance•ANNUAL a Recreatlonal Bum
<br /> �� em� �ril� er ❑ � c) ;
<br /> Sprinkler ❑ Q ❑ Sparklers /,� �
<br /> Fire Alarm � ❑ � O � � Sprinkler System InstaAations � l
<br /> Hood Cleaning � ❑ p ❑ � � Standpipes(Sprinkier Sys)
<br /> Hooc Suppression � O ❑ ❑ � � Torch Roofing/Tar Kettle
<br /> � Fire Alarrn Instaliation Q iMaste Tire Storage ANNUAI
<br /> � Fire Pumps
<br /> Fire Works
<br /> � Flammable Application-ANNUAL �� Valuation of Project
<br /> � Fuel Tanks
<br /> �] Other:
<br /> �,...__:.. _..�,....: _._
<br /> . _:_>.. v___t_.s...__.�;� ,...
<br /> . .,__-- -_-.�.��:�. � �- ��..��:�*�:�---�-� - - �
<br /> �-�--� - �. � -
<br /> Contractor - -___ - -
<br /> Signature ���y T� y �u�'1'O
<br /> Re9�sterod Y/N Fee Cunent Y/N
<br /> Address 35 31 1�¢ 3},�rtG Rd. License# �F'000��l�!1
<br /> GLECTRICIAN � Company
<br /> Signature
<br /> Registered Y/N Fee Current Y/N
<br /> Atldress
<br /> Lic:ense#
<br /> NLUMBER � �mpany
<br /> Signature � Registered Y/N Fee Curcent Y/N
<br /> Adtlress
<br /> ucense# "'—�
<br /> MECHANICAL
<br /> S�gnature
<br /> Company
<br /> Registered Y./N Fee Curcent Y/N
<br /> Address ��# �_,_„�_�
<br /> OTHER
<br /> Signature
<br /> Company
<br /> Registered Y/N Fee Current Y/N
<br /> Address _
<br /> _... -•--.�. LiCen
<br /> - -,__•,____ - --- __....
<br /> ..�--.�=_,.-=�_ _.�-�:x;x;.-a=:. ...,_._
<br /> se
<br /> __�__-�-�_,.__�-_:ri.�:n::=-,_.:;�--�::�..�-����'�:��� � �
<br /> uecUons . °` .�.*_�.�^_}_ _
<br /> F�II out appiiCation completefy . - -
<br /> Owner 8 Contractor sign badc of appiication,notarized(Or,cepy of signed contract with ownerj
<br /> ff over 52500,a Notice of Commenoement is required(MechaniCal work pver g5000)
<br /> SuPP�Y two(2)sets oi drawingS with aAWieable dxumentatlon
<br /> Atlow 10-14 days for review after submitta!date. Parcei#-obtained from Properiy Tax Notice(http://appraiser.pascogov com)
<br />
|