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813-780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received <br /> Phone Contact for Permit Q27 <br /> 1 o <br /> Contact <br /> Cl/ <br /> Owner's Name I S /5T #Z..� Owner's Phone Number I 3 7 g'2- 's 7 I) <br /> Owner's Address / ? 23 / S 70 re. <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> «....,.. S ,, ,. ",..a?°...aaa , s ,r e,.a iiii a . tea> g m r i- I:: ! alizr g <.. „', a <br /> Job Address 3g 2,'31 A 11`c -- Lot # <br /> Sub Division Parcel # <br /> f <br /> Z_ <br /> . .). ... .;_ - ..h. ,... '„,Ueh41�N Ur selb , R "a�, �,�.x,w.m..aPZa,. ';c.. d ;W, :::.,; 5'...< a« kG«,,, a ._ as._ea;;t:.,saa,....r,_. -tee, ha A..fkaza;*..dd�._. . a ":.;.c <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 n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtnyl !semi' FM Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ )( 1 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> 0 Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> .... `t ._.._° „.s,. ,,:e . :5. Rbag:.iaxoxgafs"_?';v� a�""°s':n.:�x: "eera5 moat .:i:�'�.�.,,�.w^emag. z ,�;. .�.,i..��'€�fi' a....'4.4wa - .�. , .�orge'�. ngesmaive aim _.. tt:�'A�.. zavaa,, <br /> Contractor /`� Company 6 -, �� Y 1 (2 � Signature U b l Registered � N I Fee Current 1 Y / N I <br /> Address V C1 ` crA 808 131 r c 0 �a kCeS f-' L I License # � d 1 3So Snoo 11 <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address I <br /> I License # <br /> PLUMBER Company <br /> Signature Registered Y / N Fee Current I Y / N I <br /> Address I I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N , Fee Current I Y / N <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N Fee Current I Y/ N I <br /> Address 1 1 License # J <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 />