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813-780 -0020 City of Zephyrhills � ,1, Fax- 813 -780 -0021 Permit Application /ft Phone Contact for Permit 1 V i Date Received r Owner's Name pi l I 6 4 / 'e. (p r k'Lc Owner's Phone Number 15k l 3 ( h l p), ,s,2' S Owners Address t Q 1 f ' f� t /y RCS . /e t �J h + r ' ' (5 L ;33-5-`11a- Fee Simple Titleholder Name Titleholder Phone Number I Fee Simple Titleholder Address I Job Address L a 5 1 -c+ r r , 5 {,,A • , Lot # Sub Division , Parcel # 03 - 340 -.1 -n a • thS - crag) I—I Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent n Comm Exhaust Kitchen Hood/Duct I—I Hazardous Material (Tier 11 or RQ Facility) ANNUAL I - I Controlled Bum Hood Installation El Emergency Generator < 30 kw I LP/Natural Gas - Installation I1 Emergency Generator> 30 kw ED LP/Natural Gas - ANNUAL Sale F✓Iq" Fire Protection Maintenance - ANNUAL I—I Places of Assembly- ANNUAL r"'xi eII • Other Sprinkler E ❑ ❑ ❑ [ ] Recreational Bum Fire Alarm ❑ ❑ I I Sparklers vil‘- Hood Cleaning _ ❑ ❑ ❑ I I rI Sprinkler System Installations 1/ Hood Suppression E- ❑ ❑ ❑ I I I Standpipes (Sprinkler Sys) Fire Alarm Installation El Torch Roofing/Tar Kettle Fire Pumps FT Waste Tire Storage ANNUAL • Fire Works Flammable Application- ANNUAL I 1 Valuation of Project Fuel Tanks Q Other: I Contractor Company rr ` 1 �404 1• S Signature '' % Registered R� % Fee Current Y / Address ' s" - ACM e N ...a_ti 1 j blip Q 1` 3 License # t - �LQ ELECTRICIAN Company ( Signature Registered Y/ N 1 Fee Current 1 Y / N I Address License # ( I PLUMBER Company I Signature Registered Y/ N I Fee Current I Y/ N I Address ! I License # I I MECHANICAL Company ' I Signature Registered Y / N 1 Fee Current I Y/ N 1 Address I I License # ( I OTHER Company Signature Registered Y / N I Fee Current I Y / N I Address License # Directions: ,. .a Fill out application completely. Owner & Contractor sign back of application, notarized (Or, copy of signed contract with owner) If over 52500, a Notice of Commencement is required (Mechanical work over $5000) Supply two (2) sets of drawings with applicable documentation . Allow 10-14 days for review after submittal date. Parcel # - obtained from Property Tax Notice (httpJ /appraiser.pascogov.com)