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813 -780 -0020 City of Zephyrhills Fire Fax - 813-780 -0021 <br /> • Permit 'Application <br /> Date Received 7 to • I Phone Contact for Permit 3 /3. <br /> AFC 1 813 117 t't 1.3 <br /> Owner's Name I 1 O wner's Phone Number <br /> Owner's Address 5 LP f ) &1 I 6 e..-eh yr 1 S, hl Ft_ 3 44:149 <br /> Fee Simple Titleholder Name <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> Job Address 55b( lV ( t .6)06 2 eph rh'►I ls, FL 3 4-7 -' _1 Lot # <br /> Sub Division ' Parcel # <br /> (Uti I AINtU 1 1'K0I I Y 1 AX NU 1 IUt) ,n <br /> F Bio- Hazard Waste Storage - ANNUAL I n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum 1==I Hood Installation <br /> Emergency Generator < 30 kw LP /Natural Gas - Installation \ <br /> Emergency Generator > 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> ,,n/ - Fire Protection Maintenance - ANNUAL Q Places of Assembly- ANNUAL l <br /> 361 et '�°� Sprinkler n Recreational Bum "--) <br /> mofth <br /> Frit Fire Alarm a n Sparklers <br /> ® 9!poem Hood Clean /Suppression Q� jJ Sprinkler System Installations <br /> r Fire Alarm Installation FT Standpipes (Sprinkler Sys) <br /> Ej Fire Pumps n Torch Roofing <br /> El Fire Works n Waste Tire Storage ANNUAL ti <br /> El Flammable Application- ANNUAL - <br /> n Fuel Tanks ' I Valuation of Project <br /> in Other: 1 <br /> bx ,,i - �_fli'LY�T °49t ,, TtJn.13EkP -,.;i .3h?., .,;.4,N . —z _, .... >.., ,. ,. x.�._,-'r,,._ -_. -• W. < „et >x, v.,. 5�5d. <br /> Contractor , Company <br /> Signature G , 7 p /L r C (7 , f ( y ir Registered Y / N 1 Fee Current ! Y / KI -- <br /> Address WI I / Z <br /> i 1 — < c .0._ L 33W tense # <br /> ELECTRICIAN I Company <br /> I Registered L <br /> Signature Y / N I Fee Current I, Y/ N I Address I 1 I License # I <br /> PLUMBER I I Company <br /> L I Registered Y l N 1 Fee Current I, Y/ N 1 <br /> Signature I <br /> Address I I I License # I <br /> MECHANICAL I Company 1 <br /> Signature I Registered . Y/ N I Fee Current L Y/ N <br /> Address I <br /> I I License # I I <br /> , <br /> OTHER Company Signature Registered Y/ N ( Fee Current L Y J N <br /> Address I License <br /> ,,, eas,nsrma ,,,xsa, . «.,x as..., ...u�_,°zr.x_.*. mad <- e •.•. .a <br /> ce # I <br /> Directions: <br /> Fill out application completely. I <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 II <br /> Allow 10 -14 days for review after submittal date. <br />