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tr q ( ( 5 <br /> . , <br /> 813- 780 -0020 City of Zephyrhills Fire Fax - 813 -780 -0021 <br /> Permit Application <br /> Date Received 20 " <br /> �` 0 Phone Contact for Permit ei 3 7S'a mod/ <br /> Owner's Name <br /> � ) _..���. / y/ � 1 Owner's Phone Number 1 ?�3 11997H/64/11 <br /> / <br /> I e l9' f 2f , ,o•A�"h /1(J- <br /> . y 0 <br /> Owner's Address 1P0 /30 / S'', 2-A,"5- - 6666 W// Jter ) (& s ,- J <br /> Fee Simple Titleholder Name I ( <br /> Titleholder Phone Number I I <br /> Fee Simple Titleholder Address I <br /> " a➢!.k�t 4 : '' '« ' .L -. <br /> p Fe, . / - 'O 1I� n ,�Q L / T/ . <br /> Job Address I 3 O / c1� # J� ,9ue . 2ephyrhdi F - 335 ., 1 s, Lot # <br /> Sub Division I AO SC c�i€ / f' Id Parcel # I �9 �p . -/ 46/ 5 Q /6eo QL OI <br /> ".:'2x'Ym�.��.i �-'u *s.�.'c�. ,.,3�.�:i';aw.� .... :, , +z „, '- '��S,±cY ^cf�+?? ... m,,: w,.. ., �:; a:: x' sA: �` :w°,�,4:= �>;Y�,,.�s..v'.;,..�a 3::�..,»�a:;su?'Nsx. ....ia,4:' >rxr.._sk �'Y;F �s.r°v.. '.`,.v!✓ �5f. cat=�?srre«±eF= w:�r.��_3n.: ;a'.w t;,�rr: <br /> 0 Bio-Hazard Waste Storage - ANNUAL ED Hazardous Material (Tier II or RQ Facility) ANNUAL . <br /> E Comm Exhaust Kitchen Hood /Duct 0 (9"/Natural Installation <br /> Controlled Bum ®(7 /Natural Gas - Installation <br /> El Emergency Generator < 30 kw El LP /Natural Gas - ANNUAL Sale <br /> El Emergency Generator > 30 kw n Places of Assembly- ANNUAL <br /> El Fire Protection Maintenance - ANNUAL El Recreational Bum <br /> Pr Mrli l MI L•i M <br /> Sprinkler Li ❑ ❑ ❑ in Sparklers <br /> Fire Alarm E ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Cleaning 0 ❑ ❑ ❑ I I = Standpipes (Sprinkler Sys) <br /> Hood Suppression LI ❑ ❑ ❑ I 1 El Torch Roofing/Tar Kettle <br /> LJ Fire Alarm Installation Waste Tire Storage ANNUAL <br /> R Fire Pumps <br /> Fire Works <br /> El Flammable Application- ANNUAL ( 15?' ( Valuation of Project <br /> Fuel Tanks <br /> 0 Other: I <br /> 'r�'�+➢:ti .: •. �v�. by d.+aek.:'�`v"r.. ., MY_�” :+£§L.. � m "AY..,e k�:'+3AFsrY a�F: "..�1rt,,.,1x. �, E,:..:t E&C. ;f3Ni.+.ro.�c}}3'3 ' <br /> Contractor Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address 1 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 <br /> Signature Registered ( Y / N I Fee Current I Y / N I <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> OTHER Company r /-'O -r7NP <br /> Signature Il a- "7 <br /> - / / am= ) Registered r Fee Current ram <br /> -- r <br /> Address License # ST/ re l7 l <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 /> • <br />