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813- 780 -0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received J I <br /> Phone Contact for Permit <br /> Owner's Name �'4 O P X Ca>l to neAt I Owners Phone Number ' 'y I b Z <br /> Owners Address 9 `In I (')qv_ -4--A r iVi - Tr Am Pc L_ ` a <br /> Fee Simple Titleholder Name Titleholder Phone Number l I I <br /> Fee Simple 'Titleholder Address I <br /> I �'S.PNx`- 0.�kJ,Yf1 -�, m`i:;:'.&:. +�.'XA .x " ^i$aau`de'T':" -r"rr✓ ,ar<::.k Gt,S '" €6 %.t= +4 -�d^5 an.. `-a`. s`E'��"'a!"'t6�n3`,°" .' Y' J3 ;;s5e3b'.`�a"�+':,3f:.i'++$'s.. r .+#:' A.�vzCS$",.' <br /> Job Address --- 7--Do. 3i I \-L-L.- TLVD Z h' ( ,it3, VL 335q1 Lot# I <br /> Sub Division Parcel # <br /> ^i„'.Fb , :^S a°"�a"xs*t& tx{� <'x.. =.?? �3e-v :,;b.'t�:: a.... "s.r"G- ?= a`KP`9,':: _ "Sf .: v!:`r .ro;""?'.ka/F ?,':' .. ;P'a "A.. $`4"r "z :' A."+%'r:'a_."..e.'"..:a '' -cam:. 3rR'.E.i - %Fits . '.�, 9t �'`p _;" y _ <br /> n Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> I Emergency Generator < 30 kw I ( LP /Natural Gas - Installation <br /> I I Emergency Generator> 30 kw I I LP /Natural Gas - ANNUAL Sale <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> r.. 'Why! jSemil FiTi I Other <br /> Sprinkler IV ❑ ❑ I I Recreational Burn <br /> CL(91 r� Fi re Alarm n ❑ ❑ ❑ I I I I Sparklers ` � Hood Cleaning n ❑ ❑ El I I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I 1 1 I Standpipes (Sprinkler Sys) <br /> I I Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste lire Storage ANNUAL <br /> I I Fire Works <br /> 1 1 Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> ri Fuel Tanks <br /> In Other: I <br /> .i_ . .a?.s , p+t fv +., ta1, � .m- r.±- 1fx <br /> Contractor <br /> Signature <br /> / Company N J Cf <br /> Registered Y / N Fee Current Y / N <br /> Address I rS <br /> I License # I I <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current 1 Y / N I J <br /> Address 1 I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I I License # , <br /> MECHANICAL Company I <br /> Signature Registered Y/ N j Fee Current I Y/ N I <br /> Address I I License # I I <br /> OTHER Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address License # <br /> Directions: . :l r- <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 /> • <br />