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City of Zephyrhills rire• Fax -813 -780 -0021 <br /> s1 Tao -o02o p Application <br /> Phone Contact for Permit 1 0 3 <br /> D ate Received ar :swum . i•: s...._.- ..w x................•.,T... T ,.,.,._........ <br /> / N.. L OG e y ex Owners Phone Number <br /> Owner's Name <br /> Owner's Address <br /> 1 385/ C/1. S`i ZGtlf)S RL 335y 2 <br /> Titleholder Phone Number <br /> Fee Simple Titleholder Name <br /> Fee SimpleTitleholderAddress 1 t a "�M.t&_ . �' .. �`...w ...s` <br /> .. -. W x,... a :w.....,.,..w�»�..a6:�..�:,�x nip �z3'"v'�'.,,!,y„5{'.�.",�.Ar� . �a a <br /> Lot # <br /> Job Address <br /> Sub Division <br /> Parcel <br /> Fumigation Tent <br /> 1 1 BID- Hazard Waste Storage - ANNUAL J ANNUAL <br /> Hazardous Material (Tier II or RQ Facility) <br /> 1 Comm Exhaust Kitchen Hood /Duct <br /> Hood Installation <br /> - Controlled Burn <br /> LP /Natural Gas - Installation <br /> Emergency Generator < 30 kw <br /> I Emergency Generator > 30 kw LP/Natural Gas - ANNUAL Sale <br /> Places of Assembly - ANNUAL <br /> Fire Protection Maintenance - ANNUAL <br /> • <br /> lutnyl )bemrl JKnT] Utner <br /> Sprinkler <br /> 0 0 Recreational Burn <br /> Fire Alarm 1 i 0 0 0 1 Sparklers <br /> Hood Cleaning 1 � � ED C J Sprinkler System installations <br /> Ho <br /> C 0 ❑ 0 1 Standpipes (Sprinkler Sys) <br /> Hood Suppression <br /> n Fire Alarm Installation 1' 1 Torch Roofing/Tar Kettle <br /> 1 1 1 Waste Tire Storage ANNUAL <br /> Fire Pumps <br /> 1 Fire works Valuation of Project <br /> I Flammable Application- ANNUAL IIIIIIIIIIIIIIIIII <br /> I Fuel Tanks <br /> 1 Other: 1 <br /> Company <br /> Contractor / Registered } Y / N I Fee Current ( Y / N <br /> Signature <br /> Address 1 -. <br /> License # 1 <br /> • <br /> Company <br /> ELECTRICIAN nature <br /> Registered Y / N 1 Fee Current Y / N <br /> • <br /> Signature <br /> Address I 1 License # 1 <br /> 1 Company <br /> PLUMBER <br /> Registered Y / N I Fee Current 1 Y/ N <br /> Signature <br /> Address 1 1 License # 1 <br /> 1 Company l <br /> MECHANICAL <br /> ALI I L <br /> Registered Y / N I Fee Current L Y/ N <br /> Signature <br /> Address I 1 License # 1 <br /> OTHER Company <br /> Registered 1 Y / N 1 Fee Current I Y/ N <br /> Signature <br /> Address License # <br /> Directions: <br /> F81 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 55000) <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 />