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4.q X 3 2 813- 780 -0020 City of Zephyrhills Fire Fax -813- 780 -0021 7 C ! � Permit Application / / Date Received 0 ` - 0 Phone Contact for Permit (3 ragni 3 s7 Owner's Name I Z e pas . 7 t3 �7/�70ti s I Owner's Phone Number I 1 I 1 1 I Owner's Address 13 to z /k 9 / , 4 4 ( ti 7;14 1 4 7 334 /8 Fee Simple Titleholder Name 1 Titleholder Phone Number I I I Fee Simple Titleholder Address - 7 £t": Q / �,( � � �, ,, �." 'F,w<.�z4�'.,�aa,"�- �..... Job Address - / ! T b 64/// A /t /`] '- `'fV', /rTi-- Lot# Sub Division I Parcel # I El Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL Comm Exhaust Kitchen Hood /Duct n Hood Installation Controlled Bum El LP /Natural Gas - Installation Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale / n Emergency Generator > 30 kw Places of Assembly- ANNUAE Fire Protection Maintenance - ANNUAL = Recreational Bum $ L53° � / r y LIEU =I MEM Sprinkler 0 ❑ ❑ ❑ = Sparklers Fire Alarm 0 ❑ ❑ ❑ I I E Sprinkler System Installations Hood Cleaning ❑ ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) H90d f Q 0 —�� Torch Roofing/Tar Kettle Fire Alarm Installation I Waste Tire Storage ANNUAL Fire Pumps Fire Works R Flammable Application- ANNUAL Fuel Tanks I 2 OOO • I Valuation of Project Q Other: I I Contractor Company Signature Registered Y/ N I Fee Current I Y/ N 1 Address I I License # I I ELECTRICIAN Company I Signature Registered Y/ N I Fee Current I Y/ N I Address I I License # I I PLUMBER Company I Signature Registered Y/ N I Fee Current 1 Y/ N I Address I I License # I MECHANICAL Company I Signature Registered Y/ N 1 Fee Current I Y/ N 1 Address I I License # I OTHER C /1-e 14/ F�a L'�Q CO- mpany I Signature ..�� P.1 R J iegistered �� C) N I Fee Current II Y / N I FL Address •A ' � �M 251 License # i7�si a1 51al • w l Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 - days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)