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813- 780-0020 n City of Zephyrhills <br /> Fax - 813 -780 -0021 <br /> (d <br /> `") Permit Application <br /> )are Received i Phone Contact for Permit � Z I 5 i 1 1 5 7 " � 1 <br /> � <br /> - �....�..�._ <br /> owners Name `-- 1 A 5 4 C 'r h C . Owner's Phone Number 1 ¥/3 �K � c , F7Uo� Y <br /> owner's Address r7 g 5 30 e � � - - Z - e r (\ i t ` 5 i 3 3 6 <br /> / , <br /> :se Simple Titleholder Name Title older Phone Number <br /> :ee Simple Titleholder Address I <br /> Job Address 3 P aroel # <br /> 5 qn 5 1 2. •p�q I 1(1 S Fl <br /> 3 3 S Y Lot# <br /> Sub Division i L{ 0 2 1' 4 lb I/1 - J6 - J.,/ 'ik a �VX� QH v <br /> ri Bio-Hazard Waste Storage - ANNUAL Q Fumigation Tent <br /> Ei Comm Exhaust Kitchen Hood/Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Ti Controlled Bum 1 Hood Installation <br /> I — I Emergency Generator < 30 kw n LP /Natural Gas - Installation :' / / <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Se Lf f <br /> R'Fire Protection Maintenance - ANNUAL n Places of Assembly - ANNUAL 1 f <br /> t.u;m (semi Utner <br /> I f ❑ ❑ ❑ <br /> Sprinkler [-I Recreational Bum (e) i <br /> Fire Alarm lEr ❑ ❑ <br /> Sparklers &I& <br /> Hood Cleaning u ID ❑ I n Sprinkler System installations <br /> Hood Suppression LI ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation F Torch Roofing/Tar Kettle <br /> Fire Pumps I Waste lire Storage ANNUAL <br /> I Fire Works • <br /> Ej Flammable Application- ANNUAL i Valuation of Project <br /> Fuel Tanks <br /> Q Other I <br /> .. ..� a. ;,.. ..«am ..,:_Wr. . �._ -wa= _ . .....:..:.. .a �a ,,..,;. :.. �- ,;;..:. ;..r;..:. _ - _- ._..�.� . ... ,,. ..,..._ .N� •_...,:.h _. t�X..�«> ._._ -, ,.�tr��' �"..,e'7.:�,_�, <br /> Contractor . Company 5,e / / J44ur C .. SvS r 5 <br /> Signature ^ Registered _ Y/ N I Pee Current I Y/ N l <br /> Address 1 — 2 5/ y re. r /1- j /ma 7 4 I License # l e' Ft e) /p 7 `P I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 1 License # I <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N j <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current Y / N j <br /> Address I I License # I <br /> OTHER Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 ` License # I <br /> - <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 />