Laserfiche WebLink
From: 07/13/2011 12:35 #430 P.002/002 <br /> B13-78M020 City of Zephyrhills Fire Fox-al3.780-0021 <br /> Permit Application <br /> Date Received µ,Y ' Phone Contact for Permit NEE 1�j , �b Date <br /> Phon Co Per , <br /> Owners Name P� S�1-11T1 E5 N L✓ _.+� owner's Phone Number ! �� <br /> Owner's address 1 O o G <br /> Fee Simple Titleholder Name � Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> nTTpT?�, (�S��S <br /> Job Address In-3 J�� � 'J — 2,I-P Ll.Li ELI» Lot# <br /> Sub Division Parcel# <br /> ® Blo-kfazard Waste Storage-ANNUAL � Fumigation Tont <br /> Comm Exhaust Kitchen Hcod/Duct Hazardous Materiel(Tier If or RQ Facility)ANNUAL. <br /> Controlled Bum Hood installation <br /> ® Emergency Generator<30!<w LP/Natural Gas-Installaton <br /> Emergency Generator>30!cw LP/Natural Gas ANNUAL Safe <br /> Fire Protection Malntenancs--ANNUAL o Ptaces of Assembly-ANNUAL "( <br /> PiTyl EEO�n ar <br /> Sprinkler ❑ 13 ❑ Recreations!Burn <br /> Fire Alarm ❑ o El Sparklers <br /> Hood Cleaning ❑ 0 ❑ ® Sprinkler System Installations <br /> Hood Suppression ® ❑ o ❑ ® Standpipes(Sprinkle,Sys) <br /> Fire Alarm Instailation Torch Rocifingl7ar Kettle <br /> ® Fire Pumps Waste Tire Storage ANNUAL <br /> r7 Fire Works <br /> ® Flammable Applicaltpn.ANNUAL Valuation of Project <br /> Fusi Tanks <br /> Other: <br /> p» S3�TGs.32u <br /> Contractor ompany it'i lKtrlS F'Ric <br /> Signature —� � �tJl�2G� Registered Y/N Fee Currant Y/N <br /> A619 Il D o$ 2- t1T �� '3 License# 22 r,)t S000(z a 1 1 — <br /> ELECTRICIAN Company <br /> Signature Registered Y/N Fee Currant Y/N <br /> Address License 9- <br /> PLUMBER Company <br /> Signature Registered Y/N Fee Current Y/N <br /> Address 1 License# <br /> MECHANICAL Company <br /> Signature Registered Y i N Fee Current Y/N <br /> Address License# <br /> OTHERF Company <br /> Signature �� Registered Y!N Fee Current Y/N <br /> Address License# <br /> Directions: <br /> Fill out application completely. <br /> Owner&Controotor sign back of application,notarized(Or,copy of signed contract with owner) <br /> if over$2500,a"ce of Commencement Is required(Mechanical work over$5030) <br /> Supply two(2)sets of drawings with applicable docurmntatlon <br /> Allow 10-14 days for review after submittal date. Parcel 4-obtained from Property Tax Notice(http:!lappralser.pascogov.com) <br />