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813 - 780 -0020 City of Zephyrhills Fire Fax- 813- 780 -0021 <br /> • <br /> Permit Application <br /> Date Received I I Phone Contact for Permit I I <br /> __. .., -, <br /> Owner's Name l i tin 1 re_ 1 1 t 1 t, Q A, L.5 h QiO LA. 1 �- . Owner's Phone Number 4 o -- is 3 1 L kL <br /> Owner's Address Zb (5 S .?eCil.s 1 A L PAU N ..e. i 42.-rx P E. CAS SIic - 1 2_ <br /> Fee Simple Titleholder Name '..�xss � - LeI \)1� Titleholder Phone <br /> - G (� f" Number . 4 f 153) SL'L <br /> Fee Simple Titleholder Address ILA I5 5 • -Ind iit�.l t c <br /> s - r t -P+MZ -V. Ate- A e i-S g s C Z I <br /> Job Address 4< P1 5 11-12_2_ L Pt 1.1.E ' t VU 1 ephti r l l ` H 33st'�') Lot# <br /> Sub Division Parcel # <br /> n Bio-Hazard Waste Storage - ANNUAL n Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> I Comm Exhaust Kitchen Hood /Duct [I Hood Installation <br /> n Controlled Burn n LP /Natural Gas - Installation <br /> ( I Emergency Generator < 30 kw LP /Natural Gas - ANNUAL Sale (Al <br /> [I Emergency Generator > 30 kw El Places of Assembly- ANNUAL a r <br /> 1 1 Fire Protection Maintenance - ANNUAL n ::::11 eratia Bum ") .6 1Qtrly1 'Semi Other <br /> Sprinkler L-1 ❑ I <br /> Fire Alarm ❑ ( <br /> I I Sprinkler System Installations j`; (� <br /> Hood Cleaning 7 I I ❑ ❑ ❑ I 1 Standpipes (Sprinkler Sys) / <br /> Hood Suppression ❑ ❑ ❑ I 1 1 1 Torch Roofing/Tar Kettle JJJ <br /> / At 7 9 <br /> r7 Fire Alarm Installation F Waste Tire Storage ANNUAL <br /> .____ <br /> I — I Fire Pumps <br /> n Fire Works <br /> n Flammable Application- ANNUAL ' ( Valuation of Project <br /> Fuel Tanks <br /> L Other W P F ®` I <br /> Contractor NW" WWII company ¥ Ke. M PrCL-g P�-S C—�te. � Q , <br /> Signature Registered Y / N I Fee Current 1 Y / N I <br /> Address I I License # I <br /> ELECTRICIAN Company <br /> Signature Registered Y / N I Fee Current I Y / N I <br /> Address I I License # ( <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I I License # I <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I I License # I <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 - days for review after submittal date. Parcel # - obtained from Property Tax Notice (http: / /appraiser.pascogov.com) <br />