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813 -780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> Permit Application L , <br /> Date Received —/ 5'"-e, 5'"-e, / c Phone Contact for Permit �7 Z8 IMMO <br /> Owner's Name 1 �C pi.i.vr 1-1Ci...," — I Owner's Phone Number I <br /> Owner's Address I <br /> Fee Simple Titleholder Name I 1 Titleholder Phone Number 1 1 I <br /> Fee Simple Titleholder Address <br /> Gc P- X£`.«mn';H•"a� � / .v`� <br /> Job Address 3O.2 ✓ 0 4 Ave. Lot # <br /> Sub Division I Parcel # I <br /> ED Bio-Hazard Waste Storage - ANNUAL = Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> E Comm Exhaust Kitchen Hood /Duct El Hood Installation <br /> Controlled Bum n LP /Natural Gas - Installation <br /> n Emergency Generator < 30 kw = LP /Natural Gas - ANNUAL Sale <br /> n Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> Fire Protection Maintenance - ANNUAL = Recreational Bum <br /> InTail EMI) (j Other <br /> Sprinkler E ❑ ❑ ❑ n Sparklers <br /> Fire Alarm n ❑ ❑ ❑ I I CI Sprinkler System Installations <br /> Hood Cleaning Ei ❑ ❑ ❑ 1 1 0 Standpipes (Sprinkler Sys) <br /> Hood Suppression Et ❑ er ❑ I 1 n Torch Roofing/Tar Kettle <br /> El Fire Alarm Installation El Waste Tire Storage ANNUAL <br /> n Fire Pumps <br /> Fire Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> Contractor Company Fire 0X 71 - 11 /� cvl ot: C�` l <br /> Signature 7/116/ \ Registered Y / N I Fee Curren I Y / N <br /> Address I I License# 1 7AlSy8"6 la-ex I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I 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 I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> �.3 >'.. cs,�{.. 3.v <::s.., n..�, `a:..�..•a•. ... c,uu .,...�. -- 'ran „ .s,a. ,. huxn+ sr�;.. aw '.=- .u .;m:w?.'r,:;iurssa2:xa ✓,- . °,., _,aiaar:.tassa.'.; .. <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 />