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813-780-0020 City of Zephyrhills Fire Fax- 813780 -0021 <br /> /OR [,� • Permit Application <br /> Date Received 1 1 12 I -/ 0 9 Phone Contact for Permit �1 = 1 9 - <br /> Owner's Name / 4 Q 1( J - ,/119•0W14}77/4 Owners Phone Number R13 S - /• 1 <br /> Owner's Address PO 11� o/ �M� 4 ' / T2 336'79 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I g- <br /> r, �,,:. naa =s^�a a -,-,- X, . i „� .._.. ,.--: . --- ,,, ascA -.=-... ,,,e, - <br /> ,. :;fir <br /> Lot* <br /> Job Address <br /> Sub Division /- <br /> Y Parcel # <br /> E Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> I 1 Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL _— <br /> I(ttriyl I Semi I FM «thF e ," <br /> Sprinkler n a ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I Sparklers ��f � , t) <br /> Hood Cleaning 12' ❑ ❑ ( I Sprinkler System Instal tions <br /> Hood Suppression l ( ❑ ❑ ❑ I I I Standpipes (Sprinkler s) !'> <br /> F1 Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> I Flammable Application- ANNUAL 1 ( Valuation of Project <br /> Fuel Tanks <br /> 1 Other: / <br /> m^5 .+:�e"+F 4v.. .. Ha :., r._»m> d'r., ; a+ , ... T,:: -iY, ... M .-. _ ^f , dtt...�.u_ _ a . «x._ vim._ �... t ."^- ✓- flvT", c...F_�4 M.h. ,. _._'. _ s.'c'U6, « �. ,_ `/ <br /> Contractor / Company G1/U /I -t S ViC ,,S <br /> Signature / � Registered Y / N 1 Fee Current I Y / N <br /> Address ( I License # .. ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address 1 I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N I <br /> Address 1 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N 1 Fee Current I Y / N 1 <br /> Address 1 I License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address _ _ .. <br /> 'M`�aWd'3 .... ,.., „ :. „ a . ..- ,.: e rc =,:+ S ., e. _._.. .. ._.... .n ._, ✓ <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 />