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R13a80 =0020 City of.Zephyrhills l ( Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit R /.3 -,ea-- 33/ . <br /> Owner's Name D fc-U ;h9 .TNC , Owner's Phone Number �/3 we 7 <br /> ,S- <br /> Owner's Address 6.( /Q 4Gtd ;u� A I' f/- 2 /1i / /l�' ff. 33 v2 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> rtrt;ttttYY e e .. <br /> ' { r ss�s ':. SF .�X�.i�:�a^�.k ? {.�:'.wd §J�dMtl'�&W��`�'.a.'' s��`..`4.J1 �.;. ...EI.Si� . . € . . . »... .. ..,... . ... m .,.'x4,ra.n... w. . . .. .... .:. . .. ... <br /> n <br /> Jo Add . ...,. Sym Lot# <br /> Job Address <br /> Sub Division Parcel* <br /> T >... .ti.. ,. ` :....:.�- re... .:l Ca.�t '. <br /> ^ Fed': a i ttt^. .. -. _ .. <br /> 7 - 1 Bio -Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I 1 Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum I Hood Installation <br /> I Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> X Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> ILitrlyl )bemil uther <br /> Sprinkler n ❑ ❑ ❑ Recreational Bum <br /> Fire Alann i I ❑ ❑ ❑ I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I' Torch Roofing/Tar Kettle <br /> I Fire Pumps Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I Flammable Application- ANNUAL <br /> r'' 1 Valuation of Project <br /> I I Fuel Tanks <br /> Other: 1� .— -- - � ��r — ,.a , <br /> - .'..�.... - 3 «. � , pangr ,ms'; ,, tfe .,�,,.,,■,, 'sk' t? ` ro"` , ,1 " s li:ii4Mita.. i51 - 2. :', Miaird�.._G, MOtt <.r ;,a aii t.,,: E <br /> Contractor Company <br /> Signature • Registered Y / N Fee Current Y / N <br /> Address 1 I License # <br /> ELECTRICIAN � � Company • / <br /> Signature i 1 �� Registered UP / N Fee Current I Y / N <br /> 7 I License # I OC GDO / Zb <br /> Address 13g „/ �Ge,�ies � Z ��,A�� � 1 c� 3 <br /> PLUMBER Company <br /> Signature Registered Y / N 1 Fee Current Y/ N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address' I License # I I <br /> OTHER Company I <br /> Signature Registered Y / N Fee Current I Y / N <br /> Address 1_ License* <br /> _ ....:::�::"''u <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 />