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813 City of Zephyrhills Woo- 4q (,) - 7,- <br /> Fax-813-780-0021 <br /> Permit Application <br /> ... <br /> Date Receive() I I Phone Contactior Permft 1 1 1 1 F .-- <br /> Owner's Name Ly, .....e. Phone Number 1 VS 1 IMP II <br /> Owner's Address . 440 4 ,/, Li ; 4 .!, A. 1 , ie . A/ - A A I <br /> ..- t 1 .. 1 r -- 1 r .-- <br /> Fee Simple Titleholder Herne I /49 1 - filleboklerPhonet Number 1 1 I - I I._____ <br /> Fee Simoie Titleholder Address <br /> frill Arlehx, 1 hid/5 0 41 , 731 , l e 4/142 1 de M r.s..( <br /> Sub <br /> Elvision Parcel If 1 <br /> ED Biro-Hazard Waste Stowage - ANNUAL r fumigation Tent <br /> I Comm Exhaust Kachort Hood(Duct ED Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> ri Controlled Burn 1= Hood inetallallion <br /> ED Emergency Genenner <30 k ED LPINekral Gas-installation <br /> ED EmergenLy Generakir> 30 kw 1:=1 LP/Pa al Gas-ANNUAL Sabi <br /> ED Fire Protection Maintenance -ANNUAL D Places of _ <br /> 1 --- 1 13MI 1 il 'h <br /> Sprinkler LI 0 0 C n Recreational Burn <br /> Fee Alarm 0 0 0 1 1 10 Sp:alders <br /> Hood Chinning Pie 0 pi i ED Sprinkler System Installations <br /> Hood Suppression 0 0 0 0 1 1 0 SteridPiPes CaPrinkler SP) <br /> El Fire Alarm Installafton ED Torch FloolingfTer Kettle <br /> H <br /> Are Pumps fl Waite Tie Storage ANNUAL <br /> Fire Works <br /> Flammable Appication- ANNUAL <br /> I 1 Vakailion of Project <br /> Fuel Tanks <br /> ED Other: 1 <br /> ccsntracbx i <br /> 1 4/1146,4 gife:eW "Ael/ff-M4 Sfre <br /> S i g n a t u r e 1 1 R e g i s t a t e d Y 1 14 i Fee Current 1 Y / N I <br /> Address E:EirzgEv7;ezig4iFE5: License* 1 I <br /> BECTRICIAN Sicjnature JA/401,C, Company <br /> Registered 1 Y/N 1 Fee Current 1 Y/N 1 <br /> , <br /> Address 1 1 License ft 1 I <br /> PLUMBER Company <br /> Signature Registered I Y / N 1 Re current 1 YIN . 1 <br /> Address 1 I License * 1 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N1 Fee Current 1 Y / N 1 <br /> Address 1 1 License* 1 I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Curlers I Y / N <br /> Addres Licarie <br /> Directions: <br /> Alt out application completely. ' <br /> Owner & Contractor sign back of awry:Mon noted:sad (Or, copy of signed contract with owner) <br /> If over $2500. a Notice of Commencement is required (Mechanical wort over $5000) <br /> Supply two (2) sets of drawings with appicabie documentation <br /> Allow 10-14 days for review after submittal date. Parcel ft- obtained from Property Tax Norm (htipliappraiser.pascogov.com) <br />