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813 -780 -0020 City ofZephyrhills -Fire. Fax -813 -780 -0021 <br /> Permit Application <br /> Date Received 1 .1 / Phone Contact for Permit 11 I I) <br /> .0 <br /> Owner's Name S TMPLEXC;R T NNF,LL Owners Phone Number 1813 I I 626 I f 5 4 8 2 <br /> Owners Address 4701 Oak Fair Blvd TAMPA FL 33610 <br /> Fee Simple Titleholder Name Titleholder Phone Number I) <br /> Fee Simple Titleholder Address I <br /> r.�.h. s ;= r ;.kw A -:", h Z - • _. fin. . <br /> ,?, _ - � F� . e.r. ';',.=.., ,^ 4,1 , :r., , , , „ , " �.1., a ��jk; n r x ., -. ^ , : .',, b; .. z ,,- : ,, . -° ��,;ar�r..., , tg <br /> Job Address '- 1 O. 1\1- ‘DQ t r\ Z i r hu`cJ 3 35yd Lot* I <br /> Sub Division Parcel # V <br /> I <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> I Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier I1 or RQ Facility) ANNUAL <br /> I - 7 Controlled Bum n Hood Installation <br /> I I Emergency Generator < 30 kw I <br /> LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw ( <br /> LP /Natural Gas - ANNUAL Sale 7,/---. <br /> I I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> Lilil JSemi( F" "" 1 Other 5 <br /> Sprinkler it ❑ ❑ I I Recreational Bum 9 <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression I I ❑ ❑ ❑ I I I 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps <br /> I I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> ri Flammable Application- ANNUAL I <br /> Valuation of Project <br /> I Fuel Tanks <br /> n Other: I <br /> Contractor i / Company . -) ryr K tf <br /> Signature Registered I Y / N J Fee Current Y / N I <br /> Address `r <br /> I License # I <br /> ELECTRICIAN Company <br /> Signature Registered I Y/ N . 1 Fee Current I Y / N 1 <br /> Address I I License # I I <br /> PLUMBER I Company 1 <br /> Signature I Registered I Y/ N j Fee Current I Y/ N 1 <br /> Address I I License # I I <br /> MECHANICAL' I Company I <br /> Signature Registered Y/ N . I Fee Current I Y / N I <br /> Address I I License # I I <br /> OTHER I I Company I <br /> Signature Registered I Y/ N J Fee Current I Y / N I <br /> Address 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 />