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-- 813- 780 -0020 D -91 City of Zephyrhills Fire Fax -813- 780 -0021 <br /> ( Permit Application <br /> Date ReceivetJ 07, Phone Contact for Permit 1 513 I I .:,...2‘41 I 1 <br /> Ii0 <br /> Owners Name • • ,'.. ',, • ! Vi , A Owner's Phone Number I al 3 1 1 5 1 Zp ( 1 <br /> Owner's Address 160l b a rptrt 28. ` p i- \ I IS , PL. S/ / 2_ <br /> Fee Simple Titleholder Name I Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> , • 1 I- <br /> Job Address 1 Sot (o J'T 1 C Pa t � . . �°1 r k �,t 1 S t R_ 33S4 2 Lot # I <br /> Sub Division I ` 0 ph ('rY\ i I Is ( Parcel # I <br /> n Bio- Hazard Waste Storage - ANNUAL Ei Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Comm Exhaust Kitchen Hood /Duct n Hood Installation <br /> El Controlled Bum Q LP /Natural Gas - Installation <br /> D Emergency Generator < 30 kw E=I LP /Natural Gas - ANNUAL Sale _,_, <br /> . ....... <br /> Emergency Generator > 30 kw n r Places of Assembly- ANNUAL ! <br /> Fire Protection Maintenance - ANNUAL a KM Recreational Bum <br /> r A <br /> rardil , i rt gC <br /> S6/1, r 1 nN Sprinkler ❑ ❑ ® 0 Sparklers <br /> i' <br /> log Fire Alarm ❑ ❑ P. I 1 n Sprinkler System Installations <br /> 24 <br /> II 'IDC\ Hood Cleaning ❑ ❑ ❑ Ej Standpipes (Sprinkler Sys) <br /> Hood Suppression 0 ❑ ❑ ❑ I 1 E Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation n Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> n Fire Works <br /> 0 Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> El Fuel Tanks <br /> Other: i it'i`. . » it! i <br /> P� <br /> Contractor � y � / Company <br /> Signature �1 6'k Registered roi , Fee Current /"U(J/� nt MUM <br /> Address In/3 r- l /// n <br /> - to Q� cakk twi id064 a �r l License# (Q1 (OQ 2i G.00C) 1 11 ,PS I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N J Fee Current I Y / N j <br /> Address ( I License # I 1 <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I <br /> I License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I <br /> 1 License # I <br /> OTHER Company <br /> Signature Registered Y / N 1 Fee Current I Y/ N I <br /> Address ( I License # <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 />