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813-7804120 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received 7 L a Q 2 Phone Contact for Permit 1 <br /> .. `�>`t�.w�t""' fi$% &',:�::. .. ntN�;+,Y'"T(�''f:�FS'rE d4F v°�Mn ,.;,£:r$n. ........,�:.ie:• -xu 8s l...s Ts;» <br /> Owner's Name (/f/ 4L G"j - j Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> ' <br /> d , � : # ..Ec? n �C N..;'.. �a� `, u`', ",r::�`3„` .,!d.ffi.mat.'".,,'..« a.,. ,.<,: ,_,. <br /> Job Address 76 3/ t✓ f/ C L 4 (. V / v 2 EY // Z (I Fi 33 3 7/ Lot # <br /> Sub Division Parcel # <br /> ,P-.u _ _ .' m MI;ZZOea i'- a... ''_' 4Tia rr. a. Ws: nSVMAK, . U C .as.x- 4;s,c su;, .,It' .: <br /> I Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct IT Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I I Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> r---1 Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> 17 Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> l dtriyI !bemmI rAN1 Other <br /> Sprinkler X ❑ ❑ ( Recreational Bum <br /> Fire Alarm I ❑ ❑ ❑ I ( ( I Sparklers <br /> Hood Cleaning 7 ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> 7 Fire Alarm Installation I I Torch Roofing/Tar Kettle , <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Are Works <br /> I Flammable Application- ANNUAL ( ( Valuation of Project <br /> Fuel Tanks <br /> I I Other: I <br /> ., <br /> ....,:Aa °F a,.:.us:�. Kax�:.•af x'w�'a'E4t[.�.u. G�P�aw' ' ae� ss+�:ss'✓arsa�' r � m, . s.. z4u2441M1a"' UL-MIMARif8€ a, rxl. ;qttkaU�J'.�Saaere �sZ.S€szu: +u� whlgglIratiu.,: <br /> Contractor Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N j <br /> Address 1 I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N _I Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N I <br /> Address I 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 I Y/ N <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 />