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8137780-0020 City of Zephyrhills Firs Fax- 813 - 780-0021 _ <br /> Permit Application - ' -- <br /> Date Received Phone Contact <br /> Owners Name r ■ Q O- 6a43 04— k_' � V.Aq� 1 owner' - Number -t i2 f t :6410 <br /> Owner's Address I ` 3 2 -kG2...\ �C‘S G ` 7 e\i∎lkk i ‘ cl..- <br /> Fee Simple Titleholder Name 1 1 ■ - • ' - Phone Number I 1 1 1 1 <br /> Fee Simple lltleholder Address <br /> Job Address Lot # ° I <br /> Sub Division 1 1 - - # 1 <br /> ❑ Bio- Hazard Waste Storage - ANNUAL Fumigation Tent <br /> n Comm Exhaust Kitchen Hood/Duct ❑ Hazardous Material (Tier 11 or RQ Facility) ANNUAL <br /> ❑ Controlled Bum ❑ Hood Installation <br /> ❑ Emergency Generator < 30 kw LP/Natural Gas-Installation <br /> ❑ Emergency Generator > 30 kw n LP/Natural Gas - ANNUAL Sale <br /> ED Fire Places of Assembly- ANNUAL t, ( <br /> Fire Protection Maintenance - ANNUAL l_s i\- <br /> Sprinkler ❑ ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ • 1 1 n spate <br /> Hood Cleaning ❑ ❑ - 1 1 n Sprinkler System Installations 1 I .� <br /> Hood Suppression LJ ❑ ❑ 13 1 ❑ Standpipes ( Sprinker Sys) `/ [ <br /> ❑ Are Alarm installation <br /> Ei Torch Roofing/Tar Kettle . + <br /> Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I Valuation of Project <br /> Fuel Tanks <br /> • er: I <br /> -. ...9N.. wwwwww Wr ■r.. rw.--uru <br /> ContractorVr �/ <br /> Company I <br /> Signature 111M-4Milliampa_Lia.,„/„„„, Registered Y/ N I Fee Current I Y/ N I <br /> ! " License # I <br /> Address 4 h. a _ _44:1 <br /> ELECTRICIAN Company i <br /> Signature <br /> Registered Y/ N I Fee Current I Y/ N I <br /> Address I -, I License* I <br /> PLUMBER Company I <br /> Signature Registered Y/ N I Fee Current I YIN I <br /> Address I / I License # ( I <br /> MECHANICAL Company I <br /> Signature Registered Y/ N I Fee Current I Y / N I <br /> Address I I License # I <br /> OTHER Company I <br /> Signature Registered Y/ N 1 Fee Current I Y/ N I <br /> Address License # f4: <br /> Directions: <br /> Fill out application completely. <br /> Owner Contactor sign back of applcation, notarized (Or, copy of signed contract with owner) <br /> if over 52500. a Notice of Commencement is required (Mechanical work over 55000) <br /> Supply two (2) sets of drawings with applicable documentation <br /> Allow 10-14 days for review after submittal date. Panel # - obtained from Property Tax Notice (httpJ /appraiser.pascogov.com) <br />