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813-780 -0020 City of Zephyrhills Fire Fax - 813-780 -0021 <br /> > I Permit Application <br /> Date Received (2 / 6o / O °` <br /> ,,$[[[ Phone Contact for Permit <br /> Owner's Name � .v .. -, <br /> ^�� � 1 t )e5 y r <br /> Owner's Phone Number 18 ( 1 ? (9 3 I I i 1 <br /> Owner's Address ` q 0c1 (4 LL `-) U j) <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> Job Address 7 9 C> `1 C-, A 3) J <br /> Lot # <br /> Sub Division Parcel # <br /> 5, -, n: .. a :m.,. r. .O+s , Kd :^POA,MVki ' ;MAM4W 3 ua - Ut" . . . C, . 3 .r3 .,..MILW:: <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> El Controlled Bum n Hood Installation <br /> I - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ❑ p ttriyl Semi) Uther <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I 1 Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ X 1 1 I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation Ti Torch Roofing/Tar Kettle <br /> Fire Pumps I I Waste Tire Storage ANNUAL <br /> 1 I Fire Works <br /> i �—� I Valuation of Project <br /> I Flammable Application- ANNUAL I t��j oc <br /> i l Fuel Tanks <br /> n Other: I <br /> „,al. R'.,..Scv.a.$ c .b&'i w. "`:r&IBIE,! .': s UCIEW Au S;.T, ,. pia.'.'." Es . na" i;' PUI23; alWar ` , ' $"r -`_ 10,I:,.,&M: a - iftz.... s ...:.......?Mur 0;441. W ,UM: s..... ' °a.a iiiiM _ WAT:iEMA::fZISx. ail <br /> Co ) <br /> Contractor • r . ) (\ Company 5 '}P. (1CF C 4- l 2e <br /> Signature ,� ! ► y l➢ <br /> Registered Y / N j Fee Current 1 Y / N I <br /> Address I y /n }/Oo De_ I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current 1 Y/ N j <br /> Address I I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address 1 I <br /> License # <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N, <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I <br /> I .; License # <br /> "Y,a`4•..:M ..._;,.au..<.,,a; .x., <:s..szv_. r,.,,..�a:,:« ,v,.z..:.,.�» �mw._...a ,�. '`"ia''.u.,r..x , v 3`..,.,.� <br /> Directions: .._,. .. �..a�. <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 />