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813- 780 -0020 City of Zephyrhills Fire. Fax - 813- 780 -0021 <br /> /Z45--1)? Permit Application <br /> Date Received ' <br /> Phone Contact for Permit <br /> Owners Name �� k <br /> 1 1-e - (\C., U J Owners Phone Number 2 I � 1 1(4 I �, <br /> Owner's Address I L101 Ck— ci • ` � 1.-2,a . l PCA, CL" 331x? I n <br /> Fee Simple Titleholder Name I <br /> } Titleholder Phone Number 1 1 I I 1 <br /> Fee Simple Titleholder Address I <br /> z`"" k�'i'�'.�F' 3E"' •.+'LY.aY::FR `:r '+5:" l C.,.s4 +$t.�Zr°:7= a ain.s.. R - 45 eY°+i. '. <br /> � -. 4s.'•Ev?3^ -:k''. ' °tI'Ay'"<'?°4°{.�Xs' Y�'sn'.4s" .x. �:ua:� ffS�'.':E�<'.F.iY`w: <br /> Job Address 70 5o C', N-LL It V.1 - -e i S vi_33std Lot# I <br /> Sub Division <br /> Parcel # <br /> '- :•sw.:.,-- +.w-zz ?=z?va� , .±..:...,,�y =,,e,.;�s.: ii,_.,.n... ^ :z'.a:�,r.ev- :- a-':. <,;,.5:z.* €taa..a.s_a,. <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> I 1 Controlled Bum n Hood Installation <br /> I - 1 Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw 1 I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL I I Places of Assembly- ANNUAL <br /> I Utrlyl l Semi l I Other <br /> Sprinkler - ❑ ❑ Recreational Burn !� i <br /> Fire Alarm p ❑ ❑ i I n Sparklers 99.5 � <br /> ,x I I ( r <br /> Hood Cleaning ❑ ❑ ❑ Sprinkler System Installations <br /> Hood Suppression I W I IV ❑ ❑ I I Standpipes (Sprinkler Sys) <br /> n ri Fire Alarm Installation L `=�+ I I Torch Roofing/Tar Kettle <br /> Fire Pumps I I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> n Flammable Application- ANNUAL <br /> n I ( Valuation of Project <br /> Fuel Tanks <br /> n Other: I <br /> .... . .. :. . ...o4 ?«sa.'�.: '� �i Y.• ?k.• - xdrxe: ��-: ��". seY" r¢. 2N`. �3: 4�� 'ihvci:i'?h�e41+i'a'f"✓'e ='r.4 4 '_ <br /> Contractor ' Company 3 cr."? <br /> Signature J S I <br /> Registered Y/ N Fee Current Y/ N I <br /> Address I I License # I - <br /> ELECTRICIAN <br /> I Company I <br /> Signature l Registered i Y / N J Fee Current I Y/ N I <br /> Address I I License # I I <br /> PLUMBER I Company I <br /> Signature I <br /> Registered I Y/ N ] Fee Current I Y/ N <br /> Address I I I I <br /> License # <br /> MECHANICAL' <br /> I Company <br /> Signature Registered Y/ N j Fee Current I Y / N j I <br /> Address I I I I <br /> License # <br /> OTHER I <br /> I Company I <br /> Signature Registered Y/ N I Fee Current I Y / N <br /> Address <br /> 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 htt //a <br /> ( p: ppraiser.pascogov.com) <br />