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813-780-0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received 1 Phone Contact for Permit I I I <br /> Owner's Name / /AS / Clek ° ocA �,+f ef}/Q Owner's Phone Number <br /> Owner's Address !` / s'/ /.40 ps/ <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 6/S/ /Atk 6 / Lot # <br /> Sub Division Parcel # <br /> • %„;=:; W.f, `.n : T0 ,M5'.. , t..,. .. 4401 01 LMA4M P;a A'AdiNue'. +AiM €.''#MWHIZ OR,Z". ^1% M-w, ,.,... V.a e ..w ;4?'4 •44W. ,.'„ = , ......., c ,. - ..., _,. Ys L.b- <br /> I Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier it or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> nl Fire Protection Maintenance - ANNUAL l5t Places of Assembly- ANNUAL <br /> !Carly' iSemII FAFTI 1 tither <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning I ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ 0 I I 1 Standpipes (Sprinkler Sys) <br /> F - 7 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I I Flammable Application- ANNUAL ( I Valuation of Project <br /> I I Fuel Tanks <br /> [ Other: 1 <br /> .k.-.a ..ZI_I.M .r' E : ii = "W"r a : ».,z1:sgtd - M Sim .dlE4''aECI � `€" - ti �:'�v'� .. w _ ..,...long ..:P: im ,._ ,.;r..w. ,. Q ..o a ,_:t:.� m, r_ ..,....a in.,. ::k: <br /> Contractor / Company I <br /> Signature / 4 iC14.,xi • p Registered Y / N 1 Fee Current I Y / N I <br /> Address I 1 License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N 1 <br /> Address I 1 License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N I <br /> Address I 1 License # ( <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current Y / N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current 1 Y / N j <br /> Address ] License # I <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 />