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• <br /> B13-7130-0020 City of Zephyrhills +' 906 Fax -813- 780 -0021 . <br /> Permit Application _ _ <br /> Date Received J Phone Contact for Permit j I I j7 19(.0 <br /> am <br /> Owners Name - )Ct. )1. f1_ ' 1i0 A.,t (_,Li .e-y CQl-OZ Owner's Phone Number g /3 � 1 -A <br /> Owners Address X133 @alt \ CA <br /> Fee Simple Titleholder Name o O Tt l r Titleholder Phone Number <br /> Fee Simple Titleholder Address I J <br /> : It:E,.,M,..sCMMIT: ,a T "IMMT , _ rEN . ` A ° v '.. .,, �� , . ' .;;la .,, ; . , k . ,Eg la g kit: , l "' MM:2 <br /> Job Address ek• Lot # <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I -I Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> I w Emergency Generator > 30 kw <br /> n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> tutnyl �Semi1 Other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm ❑ ❑ ,( I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ 1 1 El Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> I Fire Works <br /> 1 Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> I Other: I <br /> _. €'...,>._a" `":.'t4;,.c.;s±;; - *,... '"tom', u;. _ .e :a`..a"'a�'"�""::°""v a '... �.,'•.� vrs� ::' ts�?.:3 I <br /> Contractor (� (� Company !i a I., ,i , 1/ 'c- 5 .s ' ttl_► <br /> Signature 1 ZA i f: - I X I Registered magi Fee Current `ei <br /> Address ' 0 -ea 1_ L ' As , L F (- a c - - License # I EC - OCOtO<Ko <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N j <br /> Address I License # I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current 1 Y / N <br /> Address I I License # <br /> MECHANICAL Company J <br /> Signature Registered Y/ N - Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N J <br /> Address 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 />