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813-780-0020 City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application (/Avs n7�rce772,� <br /> Date Received / Phone Contact for Permit S? 7$ <br /> c= <br /> Owner's Name xce- e alymelle Owner's Phone Number <br /> Owner's Address 330 20AA ST• YVli 335 2 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address T !� ST. ,1 /]/ 7�L 335�Z Lot# <br /> Sub Division Parcel# <br /> Bt PA I N ED F_RO M P..R 0 PERT-7-.-;NOTIC a 7--- -3 <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-Installatior <br /> Emergency Generator>30 kw LP/Natural Gas-ANNUAL Sale <br /> Fire Protection Maintenance-ANNUAL Places of Assembly-ANNUAL <br /> tr Semi An Other <br /> Sprinkler El ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm El ❑ ❑ ❑ Sparklers Hood Cleaning El ❑ ❑ Sprinkler System Installations 4013 <br /> Hood Suppression El ❑ ❑ ❑ Stand (Sprinkler Sys) <br /> Fire Alarm Installation a Torch Roofing/Tar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> ® Flammable Application-ANNUAL gf00, 00 Valuation of Project <br /> Fuel Tanks <br /> 0 Other: <br /> Contractor Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <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 /Wa <br /> Signature `r+/J Pic.1`7 Registered Y/N e- Current I Y/N <br /> Address ltv License# (o $O-0L7� 2G19 <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(http://appraiser.pascogov.com) <br />