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813-78U-0020 City of Zephyrhills Firms v ( Fax-813-780-0021 . <br /> Permit Application _ _ <br /> Date Received - Contact for Permit I <br /> ..� r ra <br /> Owner's Name { Q5,4 . - 3-.),.. s-k 0-, tt P Owner's Phone Number I x � 3 I7' IQ- ' <br /> / <br /> Owner's Address 3 1 1 � , -3-.),.. 3c C- U hC '-L ? 2- (' k' ( 1,5 f'( 3 3 5 Lt 3 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> tygnq.:. .v1 fir.. °�`�.�1.'u' �#a'��. ,. Me ; , ` �f7 3"l .. - M IAVAM,W SM 1.443ta-, °, ri.��. - .:.. :: <br /> Job Address Lot* <br /> Sub Division Parcel # <br /> n Bio -Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> El Comm Exhaust Kitchen Hood /Duct I I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum n Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> I(.itriy) I Semi l I""' other <br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum <br /> Fire Alarm ❑ ❑ V 1 n Sparklers <br /> Hood Cleaning ❑ ❑ ❑ I I I Sprinkler System Installations <br /> Hood Suppression El ❑ ❑ ❑ I I I I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> n Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> I I Other: I I <br /> Contractor Company s %CLI, �_ I' ■ 1 IL `' • <br /> —L <br /> Signature k/ ,— .X.. <br /> n Registered am= -Fee Current MU <br /> Address 'TWA JCL k ,, MA C ` _ License # I E. 1(34 <br /> ELECTRICIAN 1 Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I ( License # <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N J <br /> Address ( <br /> 1 License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I License # <br /> OTHER Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address J I 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 />