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813-780 -0020 City of Zephyrhills -Fire. * 5 Fax -813- 780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit S3 EMI > 02 ; <br /> Owners Name I F/o r / Pt d Se i' TS PrProp e_Y 1 es J7,c . I per's Phone Number g 1 17 2'02 I / '/7 <br /> /ner's Address ' 3'.2 . 9' EQ $t VD'd. r, J G e l ie 7 ) Co So 5 / — ? / 97 <br /> Fee Simple Titleholder Name Titleholder Phone Number I <br /> Fee Simple Titleholder Address I <br /> Job Address 6 , o'/ Dairy Rd 9 Z ejo h y r4/ //s PL _1,2_6 ('I/4:- sti no D K Alec/001) <br /> Sub Division Parcel # 0,1-026 -4 /-©O /P 6,3 fee - -©t' <br /> . <br /> Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> FT Comm Exhaust Kitchen Hood/Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum In Hood Installation <br /> In Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> IUtny) !bem1I LEI Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm la ❑ ❑ .( I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I I 1 Sprinkler System Installations <br /> Hood Suppression 0 ❑ ❑ ❑ I 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 /> n Fire Works <br /> FR Flammable Application- ANNUAL ` r/f I Valuation of Project <br /> Fuel Tanks <br /> Q Other: I <br /> r AVIV <br /> Contractor Company <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I • I License # I f I <br /> OTHER � Company j f <br /> Signature �A� Registered Kam Fee Current VJE <br /> Address 1-6 / W W 2 e lt5' AVe, ,Ta n�a, -Y - 6 34 I License # I E"F "t O f /o't 3 I <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 (httpi /appraiser.pascogov.com) <br />