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. A q ( i 7 <br /> 813 - 780 - 0020 City of Zephyrhills iF � ^?^ Fax-813-780 -0021 <br /> Permit Application - <br /> Date Received _ 1 1 _ Phone Contact for Pent* 1 U 11 <br /> Owners Name .... i /74 7N,A /)94'1 S .A 091% h I own Phone Number l 1 I / 1 •I <br /> Owners Address , " , / 4 _ ' .0 i i� Lam© <br /> Fee Simple Titleholder Name Titleholder Phone Number I I I I <br /> Fee SimpleTltlehwlderAddress I <br /> Job Address 76.7 .... <br /> .-7/4zi, ..• V 4J • Lot # 1---'— <br /> Sub Division . ! . : " Parcel # .I <br /> ❑ Bio- Hazard Waste Storage - ANNUAL ❑ Fumigation Tent • <br /> ❑ Comm Exhaust Kitchen Hood/Duct ❑ Hazardous Material (Tier I1 or RIO Facility) ANNUAL <br /> ❑ Controlled Bum n Hood Installation <br /> ❑ Emergency Generator < 30 kw ❑ LP/Natural Gas - installation <br /> ❑ Emergency Generator > 30 kw ❑ LP/Natural Gas- ANNUAL Sal* <br /> Mk Fire Protection Maintenance - ANNUAL ❑ Places of Assembly- ANNUAL <br /> Sprinkler ❑ ® ® ®- ❑ Recreational Bum <br /> Fire Alan 0 ❑ ❑ ❑ T1 ❑ Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ 11 ❑ Sprinkler System illation . <br /> Hood Suppression ❑ y ❑ 11 ❑ Standpipes (Spdn der Sys) • <br /> ❑ Fire Alarm Installation - - ❑ Tenth Roofing/Tar Kettle <br /> Fire Pumps ❑ Waste Tire Storage ANNUAL <br /> Are Works <br /> Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> Fuel Tanks _ <br /> ED eli <br /> -_ <br /> Contractor L /N FeeCrrrent Y/N Company <br /> Signature /�� . �,� — <br /> Address WAtat l f r/fil�?lit/ «�:IP5MYAL%(IYfj . License # I I <br /> f/ 7 4 141/-4 4 ' J. ,1.64 ' Registered I Y/N I Fee anent Y/N I <br /> Address I / License # I I <br /> PLUMBER Company <br /> Signature Registered I Y/N ( Fee CUnsnt I Y/N I <br /> Address I I License # I I <br /> MECHANICAL Company <br /> Signature I Registered I Y/N 1 Fee Current ( Y/N I <br /> Address I ( License # I I <br /> OTHER Company <br /> Signature Registered I ¥ / N• I Fee Current I Y/N I <br /> Address License # <br /> Directions: <br /> FIN out application completely. <br /> Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) <br /> If over 52500, 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 />