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813-780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received -J „ / L g-cl / Phone Contact for Permit <br /> Owner's Name 4.4 A f) . 26 , 6 Owner's Phone Number I ,/ ? 1 ?k2. I > ,1-- 7 <br /> Owner's Address 76 3/ 6.4-(c 4 L ✓-✓J <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> R ,. + `' alr,' 0/ , , a: .y _mot. • ;'I ','' . 'i " 2,.Z r, m k0 ,_...,„�.a a.it:A, ,. xmit., .no?h.;=' <br /> Job Address /„ -t_ pt (T 07a6 <6 2/ G//if( /SL a Lot# <br /> Sub Division Parcel # <br /> -.w . . z,m--z... `_ .' ... .,,, . ...:•:;•a- o/a- -; € -ax Cara "sra, w maw-zw,,Arolm.. w.aw /.4k*, . ->,..weLm . .,. ", ».' a.t' .... ...,,r., m ».,,,, :^.i r me ,. .:. 4- ;:zt ., ,4 :,' li<.� k.,Ak. <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum 1 I Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw Ti LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Mal lSemil FiTi 1 Other <br /> Sprinkler /"`T' �:A ;1` ❑ ❑ Recreational Bum <br /> Fire Alarm r ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> n Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> Contractor Company <br /> Signature <br /> Registered Y / N 1 Fee Current Y / N <br /> Address ! t (e) Z /y.(X C 4 , , Q 2(- C% #C,f.^/ 42,` ,'( )T1 - g V License# <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address 1 <br /> I License # <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N ] Fee Current 1 Y / N <br /> Address I I License # <br /> OTHER <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I <br /> 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 />