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\ <br /> �' <br /> 813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> ' Permit Application <br /> Date Received Phone Contact for Permit�� (y� _� <br /> r-�--�--�`=�-_--��--_.n_ __� ____a___._�_..__-��=�=--�__---,�_-�_-�"Y—�-�-_-�.��____._'r_—�-___._ __---�----------�-------_�_..- <br /> Owner's Name �' MUI.� s � s l/ Owner's Phone Number � � � <br /> Owner's Address � ��X p`J�� �'Ql`I�(l�f I �1'� � �S-1 � ' l"'� 3� � <br /> Fee Simple Ti2leholder Name Titleholder Phone Number � � � <br /> Fee Simple Titleholder Address <br /> - - -----f---------------�---- _--- ---- -- ----_-a------ ------------- --- ----------, <br /> ------------- ---------- ------ -�.._ ------- ------------------ y.____._._--------- _�,_. _.—-- ----------»_____. <br /> JobAddress ��3` �a�l 3rv�� �t? h` ��1'S ��.. ?^� 1 Lot# � <br /> SubDivision Parcel# �j�'Z�J�z�- ��11?'" (�(7oa17-" �� �� <br /> L� � ' � Bio-HazardWasteStorage-AIVNUAL " �` � �KFumigationTent z �_�_____�___e__.______..__�—.____._, <br /> � Comm Exhaust Kitchen HoodlDuct � Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> � Controlled Bum � Hood Installation <br /> � Emergency Generator<30 kw � LPlNatural Gas-Installation <br /> � Emergency Generator>30 kw � LP/Natural Gas-ANNUAL Sale (� ��I <br /> � X� <br /> I � Fire Protection Maintenance-ANNUAL � Places of Assembly-ANNUAL � (J <br /> try Semi �n Ot er <br /> I Sprinkler � ❑ ❑ ❑ � � Recreational Burn <br /> Fire Alarm � ❑ ❑ ❑ � � Sparklers <br /> Hood Cleaning � ❑ ❑ ❑ � � Sprinkler System Installations <br /> � Hood Suppression � ❑ ❑ ❑ � � Standpipes(Sprinkler Sys) <br /> I � Fire Alartn Installation � Torch Roofing/Tar Kettle <br /> � � Fire Pumps � Waste Tire Storage ANNUAL <br /> � Flammable Application-ANNUAL <br /> � � Valuation of Project <br /> Fuel Tanks <br /> Q Other: <br /> Contracton Company T e f�O(1-Z � Y ' G �C� L J <br /> Signature �� ' Registered Y/�1 Fee Current Y/N <br /> Address ��� ' �GLM�(.� ��(n'� License# (..12- ab0 <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> I <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Addrl ss License# <br /> MECHANICAL Company <br /> Signature I Registered Y/N Fee Current Y/N <br /> Addrl ss License# <br /> OTHER Company <br /> Signature I Registered Y/N Fee Current Y/N <br /> Address License# <br /> .______.__^-- - _____�---- �_ <br /> Directionsr �.._ __..__ �__. ______...._T_�_e---�._...______�.._____._._.��_.�_ ____.____---�___�._�_---s�___--__-_-_--------- ---�___-;� <br /> I Fill out application completely. <br /> Owner&Contractor sign back of application,notarized(Or,copy of signed contract with owner) <br /> � If over$2500,a Notice of Commencement is required(Mechanical work over$5000) <br /> � Supply two(2)sets of drawings with applicable documentation <br /> ; Allow 10-14 days for review after submittal date. Parcel#-obtained from Property Tax Notice(http://appraiser.pascogov.com) <br /> � <br /> � <br /> i , <br /> , / <br /> / <br /> � <br />