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813 -780 -0020 / � / City of Zephyrhills Fire Fax -813- 780 -0021 <br /> / Permit Application <br /> Date Received ( Phone Contact for Permit <br /> Owners Name r i ra C SUL p pl y l f i n" p4 ( Owner's Phone Number I ( V 7 1 1 990 1 1 y b00 <br /> Owner's Address 1 0 PQk /-QLI. P 1 c C-e., t (-e/ I-kA) Doc) , 3M)- <br /> )--) <br /> Fee Simple Titleholder Name 70rv-1a `i.onn ( nQ)Gr .r` 1 Titleholder Phone Number I (n I J - t 4-14.10 .777 <br /> 7 <br /> Fee Simple Titleholder Address 156,' -e as RI- t y € I <br /> ------ ,r� ` ` s`'s,..ki <br /> Job Address (� I� � l`l0 7 .e ph1 r hols 1 FL• -- 53 s -4-1 / <br /> Lot <br /> Sub Division 1 Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Comm Exhaust Kitchen Hood /Duct = Hood Installation <br /> Controlled Bum n LP /Natural Gas - Installation p4 4' <br /> Emergency Generator < 30 kw MI LP /Natural Gas - ANNUAL Sale 40 /` ` g d q, c / ai <br /> n Emergency Generator > 30 kw n Places of Assembly- ANNUAL 7 l ` w <br /> Fire Protection Maintenance - ANNUAL i Recreational Burn �/J1 �F ^ N //� I <br /> rafl Ty y I Semi l (� Other / <br /> Sprinkler ❑ ❑ ❑ n Sparklers eg - • <br /> Fire Alarm n ❑ ❑ ❑ I I 1= Sprinkler System Installations <br /> Hood Cleaning D ❑ ❑ ❑ I 1 J Standpipes (Sprinkler Sys) ,Y,,, <br /> Hood Suppression In ❑ ❑ ❑ I 1 n Torch Roofing/Tar Kettle 9 <br /> 5 �� <br /> n Fire Alarm Installation = Waste Tire Storage ANNU —" � <br /> Fire Pumps <br /> El Fire Works <br /> E l Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> 0 Other: I I <br /> ;?t's.;CB} ;& b',;4iv P- ,+ .•>s;;.:y?t- ..,.ew...PY s's: :.;rssl�f.�kh&A.S.�A'',x >w Y>.*R 0::: 9'.'+„s s t <v::'A, r w Hsu , y:.,..w ,`,.53ro.� ` <ss; > s'rs y.. s.'.�t. c ,s +t •',+F tx, .. # <br /> Contractor Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I I License # ( I <br /> PLUMBER Company I <br /> Signature Registered Y/ N ] Fee Current 1 Y/ N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 3 Fee Current 1 Y/ N <br /> Address I 1 License # I I <br /> [ OTHER Company I <br /> Signature Registered Y / N 1 Fee Current I Y/ N <br /> Address License # <br /> F ¢ <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 />