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813 - 780 -0020 City of Zephyrhills Fire Fax - 813 - 780 -0021 <br /> Permit Application 0 ° <br /> Date RPP".eived • Phone Contact for Permit <br /> Owner's Name 5f m p l eC 6r /I ne 11 Owner's Phone Number I I I I I <br /> Owner's Address 'I7 01 O f 0. Cr 'Slue , 7_' pth !fins , R, 33(01 3 <br /> Fee Simple Titleholder Name i Titleholder Phone Number I 1 1 <br /> Fee Simple Titleholder Address I <br /> . n%✓<.tx.: �% .- ., 'r:.t'�+'+%. t_. :::.,. re „ ' t v$ S ?E' 4° 4' 3fi �. 7 w: 2'. �7 T 3 ”. 4em" 11,' a:' c. b" r � '° .4, ', „ f!+4 °.....z W%L+'��2° Mi'd��SUz . 144, k4:1"s� <br /> Job Address 7 °SO Gall Blvd- 2 ephyr1-1 ills � FL 3 Lot# I <br /> Sub Division Parcel # <br /> l=•.,r..„„�:s:,.vs* ?s.? , :.: -`'a. N ...;;u r., ?,........ xc�..,-; r�« I«, s�:;. v- s” ,...o- m`?r,:-w.s,.-a:P"^�"a, =z .. <br /> 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 I I Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I I <br /> LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtrlyl JSemiI Other <br /> Sprinkler ❑ ❑ ❑ Recreational Bum <br /> Fire Alarm ["p v" ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 I 1 I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> Pi Fire Pumps I I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> n Flammable Application- ANNUAL I ( Valuation of Project <br /> n Fuel Tanks <br /> I -I Other: I <br /> AMISSECOMOSSIMIth <br /> Contractor / Company . ? Cr"• fig,$, t( <br /> Signature ,! Registered Y/ N j Fee Current Y/ N I <br /> Address I <br /> I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N j Fee Current I Y/ N J <br /> Address ( <br /> 1 License # I I <br /> PLUMBER <br /> Company <br /> Signature Registered Y/ N 1 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, <br /> Address I I License # 1 <br /> OTHER <br /> Company <br /> Signature Registered Y / N I Fee Current I Y/ N j <br /> Address 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 />