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813 -780 -0020 City of Zephyrhills Fire i 9 653 Fax -813 -780 -0021 <br /> Permit Application <br /> s <br /> Date Received /2 ci J / i Phone Contact for Permit I t) 3 I FCM3 i ll 0 ki <br /> Owner's Name JJCA 131,0CJ4 nn Owner's Phone Number <br /> Owner's Address 70 GA CL Il. V j. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee SimpleTitlehold- - <br /> 3 `'. - i , . g SR A " :;a'"A,M e ,aew (ARKS. , � ugn ate ; REZ �,' .,. ,, <br /> ..:_. ?: �iRM.rr ,.., Y R , : , r- ?,e - <br /> Job Address S'S6 GALL- !bo / J Lot # <br /> Sub Division Parcel # <br /> . g:, ,..a:. _ . ;WS a &. m4 , ,,aee°+ iE. sue.€..? ><..u.:ASOKOZtilihW„ OM ... :.4Z- 12mJ+,a1 50;41MM e. .r.NMM , - ;;M. - am,Z a ..,�:..:sM . ;;;A .....ri .g �e `z Y...t .. 4,. ..�...�_ .,.t ", <br /> .. ,A .ddb -v. <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> I I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> IUthyl !Semi] WM Other <br /> Sprinkler El ❑ ❑ ❑ Recreational Bum i Pell-P/1;1— <br /> Fire Alarm n ❑ CI ID 1 I Sparklers v ��_ <br /> • • \� r ecr lA` <br /> Hood Cleaning n ❑ ❑ ❑ I I I Sprinkler System Installations <br /> 1-71 Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) . <br /> -- `.- <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle W/1 ' <br /> Fi Pumps n Waste Tire Storage ANNUAL r <br /> jr—i Fire Works l I <br /> n Flammable Application- ANNUAL I ( Valuation of roject <br /> n Fuel Tanks <br /> I Other: I <br /> Contractor Company f/Q.E. ,4 F ' riCil I <br /> Signature Registered Y/ N Fee Current I Y/ N <br /> Address c 4 0 , , r 1 e J SR .Sy SW 4- /47 ?1! Wfstcy AIPICL License# 1 EF 2dr■L'NO L)ga I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N ] Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current 1 Y/ N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I 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 />