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81..780 -0020 City of Zephyrhills-Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Recalled I 1. _ Phone Contact for Permit _- _ I 1.1 <br /> (� ..:.. `- (11 r-S ..... -.. ( o*ner's Phone Number r: ( 749 3 (1 7 7 <br /> Owners Name J A �• "S <br /> owners Address 1 7 v'6 c az C )86(,)0 z - ,sc C s A 1. <br /> Fee Simple Titleholder Name I I Titleholder Phone Number III 1 1 <br /> Fee Simple T Ieiolder Address <br /> T.�r. <br /> Job Address 1 -7 41• •)6Z -V6 z. • /7.-t2 CC - L«# <br /> Sub Division I Parcel # <br /> Q Bio- Hazard Waste Storage ANNUAL n Fumigation Tent <br /> a Comm Ebrhaust Kitchen Hood/Duct = Hazardous Material (Tier II or RO F. ty) ANNUAL <br /> ED Controlled Bum Q Hood Installation <br /> ED Emerg � <br /> eecyGerr< 30 kw r LP/Natural Gas - Installation <br /> Li Ernerge cy Generator> 30 kw 1= LP/Natural Gas - ANNUAL Sale <br /> El Fire Pro =lion Maintenance - ANNUAL ED Places of Assembly- ANNUAL <br /> EMI (aem11 ® •'+ _.._...._ _._... <br /> Sprinkler o ❑ ❑ ❑ n Recreational B • <br /> Fire Alarn El ❑ ❑ ❑ I 1 a Sparklers <br /> Hood Cleaning M ❑ p( ❑ 1 1 (' r—i Sprinlder System Installation. <br /> Hood SI.ppassion ❑ ❑ ❑ 1 ! I i Steppes (Sprinlder Sys) <br /> Fire Alain Instalation . n Torch Rooting/Tar Kettle <br /> H Foe Pumps . = Waste Tire Storage ANNUAL <br /> Fire Woks <br /> Flammaote Applcation- ANNUAL EI Valu • • n of Project • <br /> lJ Fuel Tasks <br /> �.n..._T,_R__ a _ Other. .. i.,. - .: - -,,. _,._ .,crz: -_.. _._. .. -� ..._._ -. .. . - .- -.._._ 7 _ <br /> co ntractor .__�_: __.. <br /> '� G. _ . - c om p any r <br /> rr �J - �._..lrs .4, <br /> Si gnattrs (4 _ - u _ Registered Y / N Fee Cu Y / N <br /> Address `y 1 3 ,8L+owAtb Tat Rhl.E .117%- IftNE.✓ Pr- ( License it <br /> ELECTRICIAN) C <br /> Signature Registered YI N Fee - Y I N <br /> Address 1 1 License* <br /> PLUMBER I a <br /> Signature Registered Y / N Fee -nt Y / N <br /> Address 1 License # <br /> MECHANICAL! Company <br /> Signature ( Registered Y / N Fee . nt Y / N <br /> Address j � License* <br /> OTHER Company <br /> Signature Registered Y / N Fee Cu nt Y1 N <br /> Ademss� License <br /> Diections: <br /> F8l out appli catfoo completely. contract with owner) <br /> Owner & Contractor sign bads of application. notaraed (Or, copy signed <br /> If over $2500. a Votive 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 subnttialdate. Parcel #- obtained from Property Tax No6ce (htlpilapprais - .pascogov.com) <br /> •.. d-s! E/11 /— Q —c Q <br /> I 1A -1 i-III /n 4ff CIA )0 ,,S oto RC 2. 2,c 4- Ped-M;t <br /> j a.-Igo 9 PAy.tN4 App l, 'c...rsu i AAA 4 kiiVo Esc I 4 krPT <br /> 1, • d 061.Z - t' 8 err d b6 60 60 86 30d <br />