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813 -780 -0020 City of Zephyrhills Fire• Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received Phone Contact for Permit <br /> Owner's Name S trr\ QLP›p CA f'Lnt\e.A I Owner's Phone Number i 3 I(q c I .5-1 <br /> Owner's Address (--\10‘ r)Qv 't{ s -TrA +(1_ t_ "'%(.10 <br /> Fee Simple Titleholder Name Titleholder Phone Number J 1 1 1 <br /> Fee Simple Titleholder Address I <br /> k ...... °" kri''9 y... ,- 1.,10b','.§.'', `. ' E""Yk .* "Ta^a.Ys • 3'. fi P' '=k k, 't.�Ja ."n+y 'v',, c`? S, ,,,,, , , P icfak v ,. ,1 $£'» 'i9 :? ,- d _ ^ s. r <br /> Job Address 7 Co L An C �� �� ( ? - 51 V A , Z-(1\ ry 3 Lot # I <br /> Sub Division Parcel # <br /> -r ..,`::*.,*°,- ;,��.,c'ad.�.;,- .w.aa�.,✓.';e= ;:::» sip* �zs :a<,r.€...r;a^,.- Easa,-- z.vrua. ..::. �a.�s .w, <„ <br /> I I Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> n Controlled Bum I I Hood Installation <br /> I I Emergency Generator < 30 kw I I LP /Natural Gas - Installation <br /> n Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> / ILI 'emiI Other <br /> Sprinkler I I ❑ 1 1 Recreational Bum .]f 1 <br /> Fire Alarm n ❑ ❑ ❑ 1 1 I 1 Sparklers 1 l <br /> Hood Cleaning IT ❑ ❑ ❑ 1 I I I Sprinkler System Installations <br /> Hood Suppression 1 1 ❑ ❑ ❑ I 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL ! ( Valuation of Project <br /> r7 Fuel Tanks <br /> n Other: I <br /> 5;z?'..i(3 -� .$:?§xS.v „??S.i ki.A:.✓ k..rt..,n =o. <E- .. dY` s::, e,..” a,.: ui.' xtoFF'' W.,, Kx^ 2?'_<?" 5.,.+.«< Sk2: a.. ...it.:aa,.wN�Y.4?t:e:l'<.N.. d1L.;'.Y7Y3+6kA,.E4's ^ ttie __nN't�i2:x ?k$Y.^4 i'.`#'tzm "�`Idt <br /> Contractor ilf r ' � ^ = <br /> Company CY►a t\ I <br /> Signature Registered Y / N JS Fee Current Y / N <br /> Address I s <br /> I License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y / N J Fee Current I Y / N <br /> Address ( I License # I I <br /> PLUMBER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N <br /> Address I <br /> 1 License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current 1 Y/ N <br /> Address I <br /> 1 License # I <br /> OTHER <br /> Company I <br /> Signature Registered Y/ N I Fee Current 1 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 (http: / /appraiser.pascogov.com) <br />