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• <br /> 813-780 -0020 City of Zephyrhills Fire 0 1 71 Y Fax -813- 780 -0021 <br /> Permit Application _ _ <br /> Date Received c- I Phone to Permit Co t for F/3 1 1 rr 1 i y/fjq' <br /> Owner's Name ( ?GL -r's er6et L` Owner's Phone Number <br /> Owner's Address 3 a 13 : _Alec.) 1416:4,1_ 4(• , Al&,r t8leo' i i / A/S <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> ...wa.,.a , >,..,,a, ,. wn:.: c.'irS L, r y ^ TM,a r .' 'W MEn; ZE? RITTI MIMNSAMESI `; :�* } ...OMMANU ,4' :WtailZW.VMS .: -" ' . rau.ra�.,a,' ...40 y. : & . <br /> Job Address 3$ / 5a 9rar �C�/L�!' �C/ • Lot # <br /> Sub Division Parcel # <br /> s :;h p-nFa. ax.> .. 1`3 as 3xs..'sk n ^u :wum ,a:, nw- .:,4, A.. k: MMKO "•.. "' :" ,snZWEZ abm».n".. tai.€£Y .,F. -... gaiVEM MY :ItVQ4:a0at. -E "' : AMV,v- .k>a!<a <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RO Facility) ANNUAL <br /> Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Icnriyl (Semi] roa Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ 1 1 n Sprinkler System Installations <br /> Hcfent epefeeciea— - ❑ ❑ 1 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Ti Fire Works <br /> n Flammable Application- ANNUAL I 2, 9.723. d'O I Valuation of Project <br /> F - 7 Fuel Tanks <br /> n Other: 1 I <br /> oammzmzxn, .reannwaeanagiot .7''' ' nem,MENNEMEEIAMMSWI:M.MUSIWMIEMMEMUMZ.20E1Ms:MfillMEITZUBESMI:Mag !irat; <br /> Contractor �, Company Fir∎- - "9' ' T✓lC • I <br /> Signature V / / / 1 Registered S N I Fee Current I 6/ N I <br /> Address I V.0 . Q c o Mr f 1..A, p f 1.445 ! 3e1/I License # I 0 13 '51) 3 /a/ •7 <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N J Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N . 1 Fee Current I Y / N I <br /> Address I 1 License # I <br /> OTHER Company I <br /> Signature Registered Y/ N I Fee Current 1 Y/ N I <br /> Address I 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 (http: / /appraiser.pascogov.com) <br />