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�, r o w- av-uuGu City of Zephyrhills Fire Fax-813-780-0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit C-913 <br /> _.� �� D <br /> Owner's Name I kt t-t7 0 QAJ 40�tf� IWu j 7?2 ( Owner's Phone Number �0 �--t <br /> Owner's Address It l`I�f /V h-/`� (�v C[1�CCr f''( - 7-�3 �4 J <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address Lot# <br /> Sub Division Parcel# ! 26 'Z2 ~Look com (} <br /> Bio-Hazard Waste Storage-ANNUAL Fumigation Tent <br /> Comm Exhaust Kitchen Hood/Duct Hazardous Material(Tier 11 or RQ Facility)ANNUAL <br /> Controlled Bum 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 Fn f er <br /> Sprinkler ❑ ❑ ❑ Recreational Burn <br /> Fire Alarm ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑ �<r Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ Standpipes(Sprinkler Sys) <br /> Fire Alarm Installation Torch Roofingrrar Kettle <br /> Fire Pumps Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application-ANNUAL f 2 j Valuation of Project <br /> Fuel Tanks <br /> Other: <br /> �rc.�.'.,..-.'1�._ :f,S...y^ `_ .,.y.{�-•-way»r �C-C:.:...... -•i•�. _ _ -" _ "':Y':->.;:+�_.��.-•:•;,.,,na7,•'�:•v...�-,.,-..,..�-r __-«...E..>•�-�,.,-...a..;,,men_.a�._.:.� <br /> Contractor Company <br /> Signature Registered Y!N' Fee Current Y/N <br /> Address License# <br /> ELECTRICIAN Company <br /> Signature Registered YIN Fee Current Y/N <br /> Address License# <br /> PLUMBER Company <br /> Signature Registered I Y/N Fee Current Y I N <br /> Address License# <br /> MECHANICAL Company <br /> Signature Registered YIN Fee Current Y J N <br /> Address License# <br /> OTHER n Company I IVIIWA-) r1?_C- 22b jc-r-7 <br /> Signature Registered Y/N Fee Current Y I N <br /> Address -7j1, -(j [. j S License# 1 I Z co <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 />