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. 813 -780 -0020 City of.ZephyrhillsFire Fax- 813 -780 -0021 <br /> Permit Application ___ <br /> Date Received Phone Contact for Permit 7 o 7 <br /> Z O.& <br /> Owner's Name VJ I t f l H u a &e P--- Owner's Phone Number <br /> Owner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> szi � , r,U.Yi;a�', sr ,/ ez � +..r._:s - .c n - .. 1r a „ X.iae;; , ..sa...^b�nz";tiJ '...su` ^;'a =S);s .a..' -'.Ea :.:.snG..„",�.Xiri "✓ <br /> Job Address 7 8O (-,- LL QC_ V D ° Z ep I )/ 2 l it S / r t - 3 3540 Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> I I Comm Exhaust Kitchen Hood /Duct Ti Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum 1 1 Hood Installation <br /> I - 1 Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> El Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> (Cltrlyl !semll raj Other , <br /> Sprinkler _,- <br /> ❑ ❑ ❑ Recreational Bum O <br /> n n <br /> Recrea <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning d ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression E1 ❑ ❑ ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/far Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks <br /> Other: I I <br /> . <br /> Contractor Company I <br /> Signature Registered Y / N I Fee Current I Y/ N J <br /> Address I I License # I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # <br /> • <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 1 <br /> Address MINIIIIMMAIIIIIIIIIIIIMIIIIIIIII License # <br /> OTHER ° De ej� /�' —t Company V S V f Lfs • <br /> Signature Registered ,�i�,� <br /> Address _moo S +/ - gj / i ��ri q . 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 />