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813 - 780 -0020 City ofZephyrhills Fire. Fax - 813-780 -0021 <br /> /y p Permit Application <br /> Date Received I tV /R 0 10 1 P hone Contact for Permit S I S79-..r <br /> Owner's Name / L - / ,4Tr'7 Owner's Phone Number IgJ3 S 5'5 , 93S) <br /> Owner's Addresr ' q 3 7/ / fr/ ; "FL 3 36 74' <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address H1 A 6 G,4 /Z DeA 5/ 641j_ RZ„V,0 Lot# <br /> Sub Division Parcel # <br /> ? :-mg -44444 :n 44 444fz ✓_ 444441+- 44444r ,._ » 44* /+fc 4 .^fix' :. ,.x .l'-.� .r �..��4 2...4 .r.`.. _, 24•,4:5 n F.x - °4 44+44 <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Ti Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I Controlled Bum I I Hood Installation <br /> I I Emergency Generator < 30 kw h LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL D <br /> IUtnyl Semi1 Uther <br /> Sprinkler n ❑ ❑ ❑ I ] Recreational Bum <br /> Fire Alarm I 1 ❑ 0 ❑ I I I Sparklers <br /> Hood Cleaning F ❑ ❑ ❑ 1 I I Sprinkler System Installations <br /> Hood Suppression ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> II Fire Alarm Installation I Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> f I Flammable Application - ANNUAL I ( Valuation of Project <br /> I I Fuel Tanks <br /> I—I Other: I <br /> _wx Ku'4 14 44 44 _ .-iu_ .. ..:;m c lyx :h:" -_•K+ , s _ +1+144 ,. ! ,v, a. EfiY-- E �i -F.w w <br /> Contractor Company 1jr� ��4 ��EA, <br /> Signature 9 Registered Y / N Fee Current Y / N <br /> Address I <br /> 1 License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current Y / N <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N . 1 Fee Current I Y / N 1 <br /> Address 1 I License # I <br /> MECHANICAL Company <br /> Signature <br /> Registered Y/ N J Fee Current I Y / N j <br /> Address I <br /> I License* <br /> 1 <br /> I <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address <br /> 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 />