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813-780-0020 City of Zephyrhills Fire Fax-813-780-01021 <br /> Permit Application <br /> Date Received MAVPhone Contact for Permit <br /> Owner's Name A )57t S ty J vh b� �H Owner's Phone Numb er /3 `� Q /f <br /> �. <br /> Owners Address `76Sp <br /> Fee Simple Titleholder Name Titleholder Phone Nt)Mbbr . <br /> Fee Simple Titleholder Add�ss <br /> -re .. <br /> Job Address /6SQ 29Pa111R 1lZ'_1s . . <br /> Lot# <br /> Sub Division Parcel# 35' c��7 07/ QO/Q ;l6S� &LILJ <br /> Bla)iaz$rdNaste Storage-ANNUAL Fumigation Tent. <br /> Comm Exhaust Kitcheh HoodlDuct Hazardous Material(Tier it or RQ Facility)ANNUAL <br /> Controlled Bum R Hood Installation <br /> ❑ Emergency Generator<30 kw LR/Natural Gas-Iristallatior <br /> Emergency Generator>30 K*w ❑ LP/Natural Gas-ANNUAL Sale <br /> ❑ Fire Protection Maintenance-ANNUAL ❑ Places of Assembly-ANNUAL <br /> ® WeR man] <br /> Sprinkler ❑ ❑ ❑ ❑ ❑ Recreational oum 910 <br /> Fire Alarm ❑ ❑ ❑. ❑ ❑ ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ Sprinkler System Installations �� <br /> H ' ��/ <br /> Hood ression ❑ ❑ ❑ ❑ Standpipes(Sprinkler,Sys) ) <br /> I& <br /> Mrs Alarm Installation ❑ Torch Roofingrrar Kettle <br /> ❑ Fire u ❑ Waste Tire Storage.ANNUAL <br /> Flammable Application-ANNUAL CY,G Valuation Of Project <br /> Fuel Tanks <br /> Other: <br /> Contractor Company <br /> Signature Registered Y,/N . Fee Current aY IN <br /> Address License# <br /> ELECTRICIAN Company /�. <br /> Signature Registered N _ Fee Current > IN- <br /> Address 9v75 / w, G it FL-- Y$76j. . License# I �. <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 Y/N <br /> Address License# <br /> OTHER Company <br /> Signature Registered Y/N Fee Current <br /> Address License# <br /> Directions: • <br /> Fill out application corePletely. <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$50001, <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.pascagov.com) <br />