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�6 2.. <br /> 813 -780 -0020 City ofZephyrhillsFirs• Fax - 813-780 -0021 <br /> Permit Application <br /> Phone Contact for <br /> Permit <br /> Date Received I 1 � � = .vE.•� .........r, . ....,.� ,�...�....,..,_...... � ....,.. �...._.. <br /> ,: <br /> i <br /> 1 f r r s4- C/ c", C I U ,� - 2 1 ":1 ' °� - P(/ G^2 fi d e s Phone Number rJ �--3 7erZ 7 Z <br /> Owner's Name /� /� � �j�' � � <br /> ( '-^ Owner's Address 2 XS / - / 2-t- �� �e /r Y/ r1 r % `/ 33 -r-c <br /> Fee Simple Titleholder Name 1 I Titleholder Phone Number 1 , <br /> Fee Simple Titleholder Address �� M -f ,: „ � µ <br /> � -� M s4j„r .. r._ _ _. ..• <br /> (CJbb Address <br /> / /-5 / / Z 7 —� 6?-- <br /> . t,/. / y L J4 /' , - C � : S Lot# <br /> Parcel # <br /> Sub Division - su <br /> I Bio-Hazard Waste Storage - ANNUAL I Fumigation Tent <br /> I ( Comm Exhaust Kitchen Hood /Duct I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I I - Controlled Bum Hood installation <br /> Emergency Generator < 30 kw I 1 LP /Natural Gas - Installation <br /> 1 1 Emergency Generator> 30 kw 1T LP /Natural Gas- ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> - (utriyi 'I semi 1 Erb' <br /> Sprinkler n ❑ ❑ ❑ 1 1 Recreational Burn <br /> Fire Alarm 1 I ❑ ❑ ❑ 1 1 1 , Sparklers <br /> ' Hood Cleaning 17 ❑ ❑ x' I 1 1 1 Sprinkler System Installations <br /> Hood Suppression 7 ❑ ❑ ❑ 1 1 1 1 Standpipes (Sprinkler Sys) <br /> I Fire Alarm installation • J Torch Roofing/Tar Kettle <br /> 1 Fire Pumps I 1 Waste Tire Storage ANNUAL <br /> n Fire Works I <br /> Flammable Application- ANNUAL D Valuation of Project <br /> Fuel Tanks <br /> 1 1 Other: 1». <br /> Contractor , / �� /� /�--- Company <br /> Signature Registered Y / N Fee Current Y / N <br /> - <br /> Address L J / (.),C. I/.✓7 , Tr1 4.} ej e-` - 33 License # <br /> ELECTRICIAN Company • Signature Registered Y / N Fee Current Y / N <br /> Address : 1 License* <br /> PLUMBER Company <br /> Signature Registered ` Y / N Fee Current Y / N <br /> Address License # 1 <br /> MECHANICAL Company <br /> Signature Registered Y / N Fee Current Y / N <br /> Address 1 -License# <br /> OTHER Company <br /> Signature Registered Y / N Fee Current I Y / N i <br /> Address License <br /> ?'! . x.JLri,:wasWaa . uu 4 •. _.:`_• •w.,Yn'ullmuu4vuu w.•.^• .. ... .. ,. '..F n. wR IM. .wr'^., .>... .. <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 />