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813 - 780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> ' ° Permit Application <br /> Date Received I q I 23 I Phone Contact for Permit I a l r 3 11 2 41 114 <br /> Owner's Name 1 L■4 0 E c (`� t t S ` - A, r pp ( f Atc k Owner's Phone Number I V 13 1`71L1 1 1 � f7q'7 <br /> Owner's Address 1 5335 8 S ,4-. Y\ (� C " k, t 11,$ , f L 3 35c12- <br /> Fee Simple Titleholder Name I Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 1 x AA Par- Qc t Q rh y t�L 3 SLI Z. Lot# OM <br /> Sub Division 1 t i P 1 Parcel # 13 — d- 10 — MOO — DO I co- ooao) <br /> 0 Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> II Controlled Burn = LP /Natural Gas - Installation <br /> E Emergency Generator < 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I - 1 Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL = Recreational Burn <br /> rainjr1 peril UM Other / <br /> SC-W { Sprinkler 0 ❑ ❑ ❑ = Sparklers ' <br /> parklers �f <br /> 46( C O 3 D1 Fire Alarm TI ❑ ❑ ❑ I I n Sprinkler System Installations r <br /> Hood Cleaning Pk ❑ ❑ E l I n Standpipes (Sprinkler Sys) <br /> Hood Suppression TI ❑ ❑ I l l I n Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> E Fire Works <br /> E Flammable Application- ANNUAL I I Valuation of Project <br /> Fuel Tanks <br /> 0 •1 -r: I <br /> Contractor x 41, Compa i Fi 1 � oh h � • SnC . <br /> Signature � Registered ream Fee Current rem <br /> Address I gg10 ProCtSSion«¢ ? 1 TemPQ , Fl _ 33b3e7 I License # IOC bgaaaoc) i( gj5 I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address License # <br /> PLUMBER Company I <br /> Signature Registered Y / N _I Fee Current I Y / N <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I 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 />