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eiaac�-oozo CdY ot 2eW�YAuts�re car8i 3rBOaozi <br /> , q PotmitAppFt6tton <br /> Date ReCClved 3/13l2013 Phone CanEecl for Perm[t 813 313 1811 <br /> ... ....... . . .. .. <br /> --- - -°,..:.....:... . . . <br /> Owners Name Fbrida Hoa ltal Ze h ils Owner's ahone t�umtxr ��[_]C� <br /> Owners Addreas 7050 GallBtvd ZEPHYRHILL FL 33541-1399 <br /> Fee Simpte TWehoider Neme Titleholder Phone Number ��� <br /> Fee Simple TlUehddar qddress <br /> - `---- ---......-•--- -,_..,,.,.. _::.....,... .. - . . - .... ..........__...-_-,_-, ._-.. <br /> Job Address --- --- ---Lot H .� <br /> Sub Dlvieion pe���� � <br /> __ .,,.._.....n-,-�----_:.�,..._�,.;_._...,-...,_..._._ ..- _ - --:_ . <br /> ❑ Bto-Hazard Wasfe SYorape-ANNUAL � Fumigetton Tent . - ---'- -1 - - <br /> ❑ Comm Exheust iQlciien Hood/Duct � Hazardoua Malerial(7ier 11 or RQ Faaliry)ANNUAL <br /> ❑ Conlro�ed Bum �� Hood InafepaUon <br /> ❑ Emergency Generator<30 kw � LPBJatural Qes-Instaaation <br /> DEmerpeney Generetor>30 kw � LP/Nalural Gas-ANNUAL Sale /���` /�/��,J <br /> Fire Protection Maintenance-ANNUAL ��� � p��g�Asaembly-ANNUAL �{�( y'(JI,� l <br /> s�nkter `1� <br /> � x � Reueatiortal Burn <br /> Flro Aiarm o � O Spa�ara <br /> Hood Cleaninp o 0 0 � Sprinkler Syetem inalallalfons <br /> Hood Suppresnlon [� o o ❑ � � Slandplpes(Sptinkiet Sys) <br /> [] Fire Alarm InstaNaGon <br /> � Torch Roofingfl'ar Ketlle <br /> Firo Pumps � Waste Tire Storage ANNUAt <br /> Fire Wotks <br /> Flammable Application-ANNUAI �--7 ValuaUon ot ProJect <br /> Fuei Tanks <br /> ❑ Other. <br /> Contrector Wende Paradie Comp Sim ex Grinnep ^ -� <br /> SignaWre Regist Y 1 N Fee Cu Y/t3 <br /> Address 4701 Oak Falr Blvd Tam Ft 33610 Liceose f� <br /> EI.ECTRICIAN Com an <br /> Signature � ReBf t Y!N FeeCu Y/N <br /> Address License# � <br /> PLUtiSBER <br /> Signaturo Compan -�'-, <br /> - Repist Y/N Fee Cu Y!N <br /> Addross Licensa# <br /> MECMANICAL Compa �-----� <br /> Slgnafure � Repis Y/N Fee Cu Y!N <br /> Address <br /> License# <br /> OTHER Com n <br /> Stpnature Regis�! Y/N Fee Cv Y/N <br /> Address <br /> - .::... . .: ... . ...._ ...,.._........,,. License p <br /> :...._..:...... .... .. . ... �__ ._ _:-.------- <br /> Directfons: .. . .. .. .. . ._... . -. , �-� - . ._. <br /> fiip out appUcatlon comptetely. <br /> Owner&ConEtactor al8n back of appficaQon,notarized(Or,copy of signail conlrac!wilh owner) <br /> lf over�2500,a MoUce o(Commencement is requlred(Mechenfcaf work over$5000} <br /> . Supply Mro{2)sets ot Arawings witl�appticebie dacumente0an <br /> PJlow t0-94 days tor revtew aftar submittal date. Parcel#-obtalned trom Properfy Tax Nottu(hup:/lappralaer.paaco8ov,com) <br />