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3 A <br /> V A A r•- 4 ', OL- " , 4 vt, { g ' }t 1. � <br /> x I <br /> n, L5 <br /> City ofZephyrhillsF1i°e• - $ 1 Fax - 813 - 780 -0021 <br /> 813-780-00 Permit Application � 1 <br /> Phone Contact for Permit <br /> Date Received w.... ^ .1 g ! 1 7 a' 2-5 ©O <br /> OP r 1 S r- Owner's Phone Number <br /> Owner's Name 6r � � � <br /> Owner's Address <br /> 3 3 -7 35- cAPr/ /ZOJ1) 1 l <br /> Titleholder Phone Number ` <br /> Fee Simple Titleholder Name <br /> • <br /> Fee Simple - Titleholder Address rIH P� <br /> „ �r��s <br /> �s_w *_ - ..�. e }f 0 e- C Lot f <br /> Job Address , 6 PP 4 5� <br /> 1 <br /> Paroei # 1 <br /> Sub Division <br /> 1 zt r• , w , 1 .0 � z Fumigation Tent <br /> Bio-Hazard Waste Storage - ANNUAL � ANNUAL <br /> Hazardous Material (Tier II or RQ Facility) <br /> 1 Comm Exhaust Kitchen HoodlDuct Li Hood Installation <br /> 1 1 - Controlled Burn ' tural Gas - installation <br /> LP /Na <br /> Emergency Generator < 30 kw I I c LP/N- -I Gas-ANNUAL Sale y <br /> 1 Fire Protection Maintenance - ANNUAL Emergeny Generator> 30 kw .7r rr "c <br /> 4 Places of Assembly - ANNUAL <br /> ��'r M <br /> )(amyl 'Ibemil � ME <br /> ❑ ❑ 12 C Recreational Bum 0 F <br /> Sprinkler C 1 <br /> ❑ ❑ ❑ Sparklers �� ,�"�, -i"'� �� " <br /> Hood Alarm A� M " ,..) <br /> ❑ ❑ ❑ ❑ C Sprinkler System Installations <br /> Hood Cleaning <br /> F —I Standpipes (Sprinkler Sys) ' '" c � ( )1 Hcod Suppression ID ID ID C j.,. <br /> Torch Roofing/Tar Kettle <br /> Fire Alarm Installation <br /> f I <br /> 1 Fire Pumps Waste Tire Storage ANNUAL <br /> 1 I Fire works Valuation of Project • 1 I Flammable Application- ANNUAL <br /> Fuel Tanks <br /> '1 1 Other s- <br /> Company <br /> Signature � a f` f „ /'L l Registered Y / N 1 Fee Current Y / N <br /> ignatu �'Ld L�,�' ll// <br /> • <br /> License # <br /> Address 1 ""' <br /> 1 <br /> ELECTRICIAN Company Registered Y / N 1 Fee Current 1 Y / N <br /> Sicnature <br /> License # <br /> Address <br /> I Company <br /> PLUMBER Registered Y/ N 1 Fee Current L Y / N <br /> Sicnature <br /> Address 1 License # 1 <br /> 1 Company 1 MECHANICAL I Re istered Y / N I Fee Current L Y / N <br /> Sicnature <br /> Address 1 1 -License# 1 <br /> OTHER 1 Company <br /> Registered Y / N Fee Current 1 Y! N <br /> Signature <br /> Addres License # ., u <br /> s <br /> Directions: <br /> Fill out application completely. <br /> Owner & Contractor sign back of application, notarised (Or, copy cif 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 />