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h $TZi <br /> 813-780-0020 City of.Zephyrhills Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Ow .. er Name � +'12 L, ! I � .� / o s Phone �.. <br /> - .....M.w. <br /> Owner's Name C' � Owner' Number S-1 3 Wr---2_ y / <br /> Owner's Address S 2__ S.- 14 b ( Z14 ! 1 ( S <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 3 Z- S 1 --t 6 i h S n - Lot # <br /> Sub Division Parcel # <br /> Bio-Hazard Waste Storage - ANNUAL 1 1 Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtrlyl )SemiI I""' l Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ J 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> I I Flammable Application- ANNUAL J /' ..'V. Fl v.911-5 ( Valuation of Project <br /> n Fuel Tanks <br /> n Other: <br /> sot:mm agirw . F:s r *LA ... .. ,+;..;H; z •= : a , :.,z, s.m = :z?�3 °,.. nr -•::. :ors =;te a-. .a%' ... "" :. .;f'�� � =.x �.z. " "''"5, :y2; .;$..a.;6.�.&tUasz >r wc::.: <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address ( License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current [ Y/ N j <br /> Address License # <br /> ,.. ,:.. ,.. «. ,,,.,. .,w max.,s�.a...,ors. ,u,•. �. .ww,ua_:: _____.. , . .:+.:i�,.,:.�.: ... ;.+ e •, <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 />