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813-780-0020 City of Zephyrhills Fire ,k....gittt Fax- 813-780 -0021 Permit Application Date Received 1 ID l aC1 I °q 1 Phone Contact for Permit 1 -7g.7 I I (-1 1 I I (]g(pC) 1 Owner's Name 14cceru1 1 Owner's Phone Number I 1 I 1 1 I Owners Address IS 3/ N. C7 4i.4. r3 W D 7 vQIiY 2 thus P L 335%17 I Fee Simple Titleholder Name 1 ( Titleholder Phone Skmber 1 1 1 1 1 ` Fee Simple Titleholder Address I Job Address 1 5531 nl . G/-1A_ RwD Z0Pt4Y2N ILLS Pi 33.-C I Lot # I I Sub Division I 1 Parcel# 1 /D -7 `( 5 - 2' 002-o - 00 000- I 0 Bio- Hazard Waste Storage - ANNUAL n Hazardous Material (Tier I1 or RC Facility) ANNUAL D Comm Exhaust Kitchen Hood/Duct LJ Hood lrrstaliation Ej Controlled Bum El LP /Natural Gas - Installation 0 Emergency Generator < 30 kw n LP/Natural Gas - ANNUAL Sale 0 Emergency Generator > 30 kw [:=1 Places of Assembly- ANNUAL I o L ps-7.r,� � 1 S El Fire Protection Maintenance - ANNUAL n Re creational Bum / ® r-I Other l PI uv -'f vrst ( er ain r L / 6 Sprinkler LJ , ❑ ❑ ❑ I I 0 Sparklers n Fire Alarm 0 ❑ ❑ ❑ I I D Sprinkler System Installations q C r k T � 4 , Hood Cleaning 0 ❑ ❑ ❑ I I D Standpipes (Sprinkler Sys) 4doe •Suppression LJ ❑ i l< ❑ I 1 D Torch Roofing/Tar Kettle Q Fire Alarm Installation n Waste Tire Storage ANNUAL Fire Pumps Fire Works Flammable Application- ANNUAL ( Valuation of Project Fuel Tanks ® Other: I fE -.25 3 uPPRe7SioN S `f 5?'C - ry - Sem 1 i N3oPtL- I Contractor Company • L3 • 2L.1t3..t . n1 . Signature Registered "WM Fee Current rum" Address ( I 1 31st (iwQT t4. ST. W71Anol3ok. rL. 33)11, I License 1 I I ELECTRICIAN f Company Signature 1 Registered I Y/ N I Fee Current I Y/ N I Address I I Licence # I I PLUMBER I Company I Signature Registered I Y/ N I Fee Current I Y/ N I Address I I License # I I MECHANICAL 1 Company I Signature Registered 1 Y/ N 1 Fee Current I Y / N I Address ( I License # I I OTHER I Company I Signature Registered 1 Y/ N I Fee Current I Y/ N Address I I License # I I 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 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpJ /appraiser.pascogov.com)