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813-780 -0020 City of Zephyrhills Fire ,ms Fax- 813 - 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit I 5 / L. SZ 2Z a7 <br /> Owner's Name Z' e1: H 1 L L 5 l N � E-?EN DST L, 1,,,, i Owner's Phone Number 5/ (,o 49 G / S O.S <br /> Owner's Addre 4 2o5SL i' r ' it --- `'J-( , ter /0° GT/LV DQiu2 / /() y / /79 7 <br /> `.10011N Iw i <br /> Fee Simple Titleholder l � M (. Titleholder Phone Number s/ G ' to /S <br /> Fee Simple Tighter •+.L•f -L . G I bM +r +IiaMe --- • <br /> ., : ..o 7 :,,77,,. ., w. ,tv. .s i '' .a, . .,, . ,,. <br /> Job Address ° 1 .-% T ?7 "--o b T dR i) ■ l'aTilYe µ lc L s, "F 3 Lot # <br /> Sub Division C 1 Ty OF ` Pi/YR LL S Parcel # 35-25- 21- 001 t' 07100 <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum I Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> FT Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL Ii Places of Assembly- ANNUAL <br /> )(Arty) ISemiI lather OGcU ?r9NG/ paem, <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm E ❑ ❑ ❑ I 1 I 1 Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 I n Sprinkler System Installations <br /> Hood Suppression Ei ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> El Fuel Tanks <br /> I 1 Other: 1 i <br /> CLI ill di..t�i Company <br /> Signature � en�^�`�`" - co 1 - Jo 9 Registered Y / N ,I Fee Current I Y / N <br /> Address 1.41 q C11.03 2 ✓-( /1,4)00350,y Ivy 1 ir) License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address ( I License # <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address 1 I License # I I <br /> MECHANICAL Company I <br /> Signature , Registered Y/ N I Fee Current I Y / N J <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address, <br /> License <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 />