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813-780-0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application _ <br /> Date Received I I Phone Contact for Permit I I J l <br /> Owner's Name Ike--c- `Tw ; el T <br /> : : :: <br /> Owner's Phone Number ) I I <br /> Owner's Address ,313 S ?) S ;`=/"1 JC Zer 1. / y,r L :// 1- e- <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address Lot # <br /> Sub Division Parcel # <br /> ....a, =; „_f < ,..4 0," ,,'; , .' aW „.:-W ,R F 1 ') =.44 K RZ.Mig Rg. m„ ,;e .ZV , , T`., . a „ W,: s w .t . .., 4, ; .. ,, w.i.. s,. <br /> ,..� m_ <br /> .T_; ,e_ x. ,_ <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 I I Hood Installation <br /> Ti Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> PIII iier•ency Gen- - • s n LP /Natural Gas - ANNUAL Sale <br /> n/ ”' Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> lUtrlyl )semi) 6•Li1ai <br /> Sprinkler n ❑ ❑ ❑ _1 n Recreational Bum <br /> Fire Alarm ® ❑ ❑ n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> imm ire ' arm Insta a on n Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> 7 Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> ..P,a«.0 '.€S°_ _. i _ -,ealii3z..'r1? G . _ '- :t::£. ,..:rMV+aiSES Sz ..:6AE4aMlkfrAffg.,z�... al,T e.MS M:NNVR.v,. RWk "t ,.._Q:.:: a:.,1E,': ' r... « fi ;RaltM , ..... w .'.: Sii:ta � aat tlaaw...L_.• <br /> Contractor _ Company 7//e fy�i7� /?•-•0._ 1 lire. on C �/•L I <br /> Signature �,� /�-- Registered Y / N j Fee Current Y / N I <br /> Address I'ey Q. se er:c /1 /4 4 . 414/es,tZ I License# I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current 1 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 />