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813-780-0020 City of Zephyrhills Fir 09 Fax -813- 780 -0021 Permit Application Date Received Phone Contact for Permit Owner's Name I (i/,L -t_ f'19t2.2-T'A. I Owner's Phone Number I I I i Owner's Address I e' 3 1 G Q L-L, egp u Le CJc A P c f , 3 . 5 _' o Fee Simple Titleholder Name Titleholder Phone Number Fee Simple Titleholder Address I Job Address / 6 3 ( G4 gLvd - 2pJ a,, 33..5 o Lot# Sub Division I Parcel # Bio- Hazard, Waste Storage - ANNUAL n Fumigation Tent n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL n Controlled Bum n Hood Installation F - 1 Emergency Generator < 30 kw n LP /Natural Gas - Installation F Emergency Generator> 30 kw , n LP /Natural Gas - ANNUAL Sale EI Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL piny! (semi' 01 tither Sprinkler n ❑ ❑ ❑ n Recreational Bum Fire Alarm El ❑ ❑ ❑ I I n Sparklers Hood Cleaning n ❑ ❑ ❑ I I Sprinkler System Installations Hood Suppression ® ❑ ) ❑ I 1 n Standpipes (Sprinkler Sys) El Fire Alarm Installation n Torch Roofing/Tar Kettle In Fire Pumps n Waste Tire Storage ANNUAL Fire Works Flammable Application- ANNUAL I _35'0 `J ) Valuation of Project Fuel Tanks 7 Other: I Contractor i �� Company i ' G . .1.6..i t A. w 4 - Signature 4 �� O r " , , fi Registered w� Fee Current max Address I FAO, S oy4 GEt72- 3 c�M [.ten c2 „it-6 3 :7751 License # I ELECTRICIAN Company Signature Registered Y/ N Fee Current 1 Y/ N I Address I I License # PLUMBER Company Signature Registered Y / N . ,I Fee Current I Y / N I Address i I License # I I MECHANICAL Company Signature Registered Y/ N J Fee Current I Y/ N Address I I License # I OTHER Company Signature Registered Y/ N I Fee Current I Y/ N I Address License # Directions: Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over $2500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation Allow 10 -14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com)