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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received �2 Phone Contact for Permit �L3 <br /> _:..�...._,._,_,......<—•:�.__...ri_�...�-___-me,µ. ....zr�-..___.__.��_...._,.......,�__.�_...__.,.,. _._..__� .-.M,..< ....�,....... - <br /> Owners N2me lb�lCl Urn �,1a�r1[Q�C Owner's Phone Number V� <br /> Owner's Address 600 LJt:>u t,S V[We <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ��_:�.._.e���.,�::.._/:.__�..._�.-ram... <br /> Job Address //"1Z� -C(.�� -bkvd- 2-� 6 �ra;l` �5 ��, j54� Lot# <br /> Sub Division Parcel# <br /> Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier II or RQ Facility)ANNUAL <br /> Controlled Burn Hood Installation <br /> Emergency Generator<30 kw LP/Natural Gas-Installation <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> try emi r77q ter <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ 0 Sparklers Q Q <br /> Hood Cleaning ❑ ❑ ❑ F;�] Sprinkler System Installations ` <br /> Hood Suppression El ❑ ❑ ❑ = Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Other: [Ck GwkC,[ aY— [rep P_ t- t &oCLVI <br /> Contractor Company UyLkveT �e S w-s <br /> Signature Registered Registered N I Fee Current I Y/N <br /> Address 1 -3 4- W!i _ License# c S Cj oo 1 Kai Z <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> - _ t <br /> Directions: <br /> 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(hftp://appraiser.pascogov.com) <br />