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813-780 -0020 City of Zephyrhills Fire Fax -813 -780 -0021 <br /> p Permit Application <br /> Date Received ✓ — 1 Phone Contact for Permit $' 3 3 $` a$' <br /> _..�u ���, s,:. =�r;` �..E.a .tiu,.�.. .m�s: r. _ �, r -- - -.:w,r .. •x,c...,�.:z -,a^ :.e.', _ _ _ . �_. h <br /> Owner's Name P b f i 1C S'-be v /'1t. r Ket Owner's Phone Number 1 7/3 1 7g`,� I 16 Syl <br /> wner's Address <br /> Fee Simple Titleholder Name Titleholder Phone Number f <br /> Fee Simple Titleholder Address I I <br /> n "� /`_ >.a< / �;A;a��. - .. °ter / / -= �.�r,�;a�..�c�� <br /> Job Address 73 all ITR// 1j/V4 .Z4 ), r hig.� p 3 3 . �y/' i.3',0 Lot # <br /> Sub Division Parcel # •41.,5 /— 0 AO -- 01rgG0- -c900!' <br /> k'£ '. %i', a:. :Ga�"t,a*a`.ffi. *a;;,�.: r':•ra'sn:u> , ::..ET`a• ?,w;w`.s�«^'..a''� .. ''.acb'.... "C. <br /> El Bio- Hazard Waste Storage - ANNUAL 1 Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct Ii Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation j j ' 27 <br /> 4dik <br /> El Emergency Generator < 30 kw In LP /Natural Gas - Installation (� <br /> n Emergency Generator> 30 kw I 7 LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> ILItnyl ISemil (J Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm � ❑ ❑ I I n Sparklers 90 l 5 <br /> Hood Cleaning I I ❑ ❑ ❑ I I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n] Torch Roofing/Tar Kettle <br /> F Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> Other: I I <br /> d" :`i'::6:?R- �,..2....i2*Ym'd!:r as" ie3:' c✓ AR: at`:- ?,:' Z ?<2'%.'6$::w:�'9H.:kSk..�+Sr;, �"s�'rz xw ^:a4 „ #.,zlri?e:4i'''Y �t4. tl”; e 2C .z&".L',?'..': +:: `a'i ., _ ,_ ...:,.. ;.. <br /> Contractor Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # ( I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N <br /> Address I I License # I I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N I <br /> Address I I License # J <br /> OTHER Company ■ e/ I2 TiZ V/Ces i. <br /> Signature % 10-14 - 10 10 . <br /> Registered ruU Fee Current WOM <br /> Address Y '/ k/ , re 'f;.$ g / • a L Z2 Al License # I /'F DD O // ? 3 <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 />