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813-780-0020 City of Zephyrhills -Fire Fax -813 -780 -0021 . <br /> / Permit Application <br /> Date Received - Phone Contact for Permit <br /> ,,,,aki,,eLl Owner's Name ` A yr, y C� t 1 / }•j 4 A NA2. t) r � � <br /> l - y „ 14.. l Owner's Phone Number Y/ 3 �(� <br /> Owner's Address t Q C ' ( 36 - • i 4 l j � ' 0 O, e pk ' f i 11 , T 1 3 3 5 `7 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 1 <br /> >6 ..., . t, - ms. °- ' , areor g rem oma - , i ` F A - � ,: M '. 1 U -gi g . ;. mk- ,r�� f' witwa ....... e44w: a a� it .. k zfga �� � � ;: <br /> Job Address 09,30 6—c, S d z Q,,p c. h is P[ Lot# <br /> Sub Division . 4 Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct 1 1 Hazardous Material (Tier II or RQ Facility) ANNUA - C J _ <br /> n Controlled Bum Ti Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale Vi Fi re Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL /1r IUtnyl semi ( (Anf1 Other <br /> 4 ET <br /> Sprinkler n ❑ ❑ ❑/ n Recreational Bum <br /> Fire Alarm ❑ ❑ l I 1 1 I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations %� <br /> Hood Suppression ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) t' <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I <br /> E L V : i d - M a & V ' : : " : . , , -.n .: 1 : Z ' 1 <br /> Contractor 11 ` r <br /> Signature � Registered Y N c1 Fee CBrrent Y / N ' r' <br /> J <br /> Address ligaMiMIIM,MA,IMMAP5 License # 1 J <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N ] Fee Current I Y / N j <br /> Address ( I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address I 1 License # I <br /> MECHANICAL Company 1 <br /> Signature Registered Y / N ] Fee Current 1 Y / N <br /> Address 1 1 License # <br /> OTHER Company 1 <br /> Signature Registered Y / N 1 Fee Current 1 Y/ N <br /> Address 1 License # 1 <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 />