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813-780-0020 City of Zephyrhills -Fire Fax -813- 780 -0021 <br /> Permit Application 2 <br /> Date Received 60 01 Phone Contact for P rmit <br /> 1/1)/..3 3 I asst <br /> Owner's Name 5 i t h p\ {k 6(1 ' v e !1 ^ Owners Phone Number <br /> Owners Address 4 7 0 1 Oak f l ' r e I 1 To ni pc ( ] ' L. &3S/( <br /> Fee Simple Titleholder Name Titleholder Phone Number i <br /> Fee Simple Titleholder Address • 6 ,, : .= , 6 --3 , ,c r ,, jai> ' , - ;,- z-, �. , . //�� 11 2- , F=r c ,a � =,„a,w,� : =., , ,,, .:= ' <br /> Job Address 3 1 (3'34 Me chlca t 4'f4.3 C3 2e ph Li y t' )l i �FL. 3-/I Lot # <br /> Sub Division Parcel # <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> [ Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I Controlled Bum I I Hood Installation <br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I 1 Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> ILtrlyl !Semi' Mum <br /> Sprinkler E ❑ ❑ 011.111111 I I Recreational Burn <br /> Fire Alarm 1 ---1 ❑ ❑ i I ( n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ J I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> F Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> n Flammable Application- ANNUAL f I Valuation of Project <br /> n Fuel Tanks <br /> avauximuffir <br /> n Other: J <br /> Contractor ( <br /> Company .� !Yri' � `� !%�►v�t, tV I <br /> Signature Registered Y / N 1 Fee Current I Y/ N j <br /> Address s <br /> I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N j Fee Current I Y / N <br /> Address ( I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 I License # . <br /> MECHANICAL Company <br /> Signature Registered Y / N I Fee Current I Y/ N <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> i5± ..i ::•'n. .w..... raF: T' Rf! �R' A9m'; Y. N.z. ?icins,'e?.�..:..4`::1T- Sa`-.. <br /> Directions. -�^ � � - -•- 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 (httpJ /appraiser.pascogov.com) <br />