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813-780 -0020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application -7 / - <br /> Date Received Phone Contact for Permit p (> aZj I L 1 1 <br /> Owner's Name I fiDiekbfA YtleQ0 tcrtc. /.. % C I Owners Phone Number I 8 13 1 1 - "M ci c) <br /> Owners Address , SS t 3S I`i lr7 lz v.6:1 <br /> ' E T seaujeW ' <br /> Fee Simple Titleholder Name 1 I Titleholder Phone Number I 1 <br /> Fee Simple Titleholder Address z =e - <br /> Job Address IAtS <br /> 135 ( IA— F-ri 1 5auf� b .. 1 Lot# I <br /> Sub Division 1 1 Parcel # <br /> El Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier I1 or RQ Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> El Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> mai mai mal utner I <br /> Sprinkler = ❑ ❑ I Recreational Bum <br /> Fire Alarm 0 ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ( 1 n Sprinkler System installations <br /> Hood Suppression 0 ❑ ❑ ❑ 1 ( n Standpipes (Sprinkler Sys) <br /> Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works 1 <br /> Flammable Application- ANNUAL Valuation of Project <br /> Fuel Tanks I <br /> Q Oth - <br /> z + => . YM. F, N.., rrrrr r�ir�rirrrrrry: - <br /> Contractor ,llw" Company <br /> Signature '' Registered Fee Current Y / N <br /> Address lif e yt. • 1.11.'1, r • Ai. • 0 License # L Iffilw Tr IN:111•111 <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I, I <br /> PLUMBER Company I <br /> Signature ' , ' . Registered L Y/ N I Fee Current I Y / N I <br /> Address I I License # 1 . I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current L Y/ N I <br /> Address I t I License # I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <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 (httpJ /appraiser.pascogov.com) <br />