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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received tact for Con r Pe <br /> rmtt <br /> Owner's Name "vl 4„..7-t--7:S7 c_ L 1< 5 ) L L (_, Owner's Phone Number . <br /> Owner's Address 3 751 J ft L r e C A - - L., j 2L u /' <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> .. a r = ce>.',. 1,.,7M ,. M. IO.. ...M .VANA 3 $s t.d`.ui�$b� "9 fR{IDtW'!' .,.*ARDtm.s P,�n�Y' f kcn'. _... sem ain,,w2'`.m wwfr�` .3 q.g ,., n .. „;.., =. t.'.. ..,,, .,;,....a <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL 1 Places of Assembly- ANNUAL <br /> ry ISemi1 JAn� other - <br /> Sprinkler n ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ 1 1 I Sparklers <br /> Hood Cleaning 70 0 ❑ I I ( I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> El Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I I Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I I Flammable Application- ANNUAL I Valuation of Project <br /> I 1 Fuel Tanks <br /> n Other: I <br /> Contractor 7 Company <br /> Signature L. , ; -c... 6.6 :-1 ... ' t/11_ 4 Registered Y / N Fee Current I Y / N I <br /> Address ( I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N I Fee Current I Y / N 1 <br /> Address I I License # <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N , Fee Current I Y/ N I <br /> Address ( I License # <br /> ..s0"4'&,,.a._m:, °s �.__..�,., ...�..:..._...,.a.....:.: N.w..,.,��.,.:.,... a.�.,b..�, _ •"� ;mac <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 />