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813- 780 -0020 City of.Zephyrhills Fire. Fax -813- 780 -0021 <br /> 7v A {` Permit Application <br /> (Z Date Received /42 C ( - Phone Contact for Permit <br /> Owner's Name 1.1. .2_1_0 AVM 7--/- Owners Phone Number R/ 3 57es • I 9357 <br /> Owner's Address f !L 9738 8 /J/ 7P4 f FL 33674g <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> - <br /> Fee Simple Titleholder Address <br /> c,-a 4., ...A: •,pr« x. , -. >.. x».,, h..x :.-. * - ..xrrw .' ,wo-;'5. r F...r , . ,^� .... r.. K " „..:".: a:e;a,..xr °r:s4E - -- .. <br /> �"`Niti. <.;, ;3.Y:'£- '^`a'�ru.�'F✓A 'x%�YU r'1�iss., ( �kfaS4 � / `J' ` /'' / � <br /> Job Address g4R ,6 Rt S /" r SO/ 7 671L/L ZLVD Lot# <br /> Sub Division <br /> Parcel <br /> Bio- Hazard Waste Storage - ANNUAL Ti Fumigation Tent <br /> ri Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL ,v <br /> I <br /> Controlled Bum i Hood Installation AA , <br /> I I LP /Natural Gas - Installation Vi <br /> I Emergency Generator < 30 kw � KKK��� „� <br /> I I Emergency Generator > 30 kw ri LP /Natural Gas - ANNUAL Sale (L� <br /> I Fire Protection Maintenance - ANNUAL f Places of Assembly - ANNUAL , .. - VP <br /> Iutnyl ISemiI tither <br /> Sprinkler ❑ ❑ ❑ 99999 <br /> n Recreational Bum �t j a i, <br /> ► �� <br /> Fire Alarm I I ❑ ❑ ❑ I . I 9 <br /> 4 / / 7 I Sparklers - <br /> Hood Cleaning VI ❑ ,cal ❑ I L I Sprinkler System Installations , - / /400 <br /> I I Stand p p es (Sprinkler S y) ,' s D i . 1 <br /> Hood Suppression I ❑ ❑ ❑ ( © W <br /> n Fire Alarrn Installation 1 Torch Roofing/Tar Kettle r; � L5R <br /> I I Fire Pumps I Waste Tire Storage ANNUAL / /� <br /> I I Fire Works <br /> Flammable Application - ANNUAL f ( Valuation of Project <br /> Fuel Tanks <br /> ri Other: IE <br /> Contractor Company <br /> Signature /op Registered Y / N Fee Current Y / N <br /> Address I I License # I I <br /> ELECTRICIAN Company _ <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I 1 License # I I <br /> MECHANICAL' Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address <br /> License <br /> s, ti's � w ,-.. �,. - - - �; �.x . •.�.ea� ., �. , . <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 clays for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />