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813 -780 -0020 City of Zephyrhills "Fire. Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received ^ ,S P ' Pho ne Contact for Permit 4 2 8' <br /> Owner's Name I 'Y hn- Mary »Z`er,(j I Owner's Phone Number I $'/3 1 I7P5 I 1°?‘ /7 <br /> ,rners Address 10' C / d 61- ecD AA (Box /, 7a hi FZ 3310S g yoya <br /> Fee Simple Titleholder Name I Titleholder Phone Number I 1 I I <br /> Fee Simple Titleholder Address <br /> Job Address 16 6 Gall f3/ v d, Ac C en r Ma Ke r/ o Lot # <br /> Sub Division Parcel # I <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent (7 <br /> n Comm Exhaust Kitchen Hood/Duct n Lf - - Hazardous Material (Tier II or RQ Facili ) ANNUA( 0 -/ <br /> n Controlled Bum n Hood Installation <br /> 5 <br /> n 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 /> Itlin371 'Semi, WA Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm / M ❑ ❑ ›It i J n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ n 9 n 7 <br /> I I n Sprinkler System Install 'ons 7 iJ <br /> Hood Suppression ❑ ❑ ❑ I I n Standpipes (SprinklerS s) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle / <br /> n Fire Pumps n Waste Tire Storage ANNUAL ) ''! <br /> n Fire Works <br /> I Flammable Application- ANNUAL <br /> I .4 I Valuation o roject <br /> Fuel Tanks <br /> 0 Other: I <br /> Contractor <br /> Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I I <br /> ELECTRICIAN Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address ( I License # I <br /> PLUMBER I I Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature I Registered Y/ N j Fee Current 1 Y/ N I <br /> Address I I License # <br /> OTHER Q Company 1 y` e L U Signature L_ ll/le _ I v /G�3 C <br /> Registered IoI� Fee Current Vaal <br /> Address I 5701 Al 14 re rS j/p. my A, rt.. 3 34 3 a License # 1 4: eD OV /a 3 I <br /> Directions: �" <br /> i <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 /> • <br />