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813-780 -0020 City of Zephyrhills Fire qf q 33. Fax -813- 780 -0021 • <br /> Permit Application <br /> D Received J Phone Contact for Permit <br /> Owners Name \ l �} • � • ? Pl. Owners Phone Number I I I ■ Owner's Address 3 y L `E- c1 �„()1) 6. �. ' • 3 3 5 v a-�. <br /> Fee Simple Titleholder Name lT Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> 7, H, I VAZZ , q.. r1M ; xURFAI ; w `:. -. su m e ,, *L', 4= � ,.� mauF:;;; '^. t,z 4 g „Ai . s �ac l <br /> Job Address <br /> Lot # <br /> Sub Division Parcel # <br /> .+- amivawaz a :, ua -x4n > �n,:.,„ eue ; • a.4.6mazp+�.- , _ m " Ram,. 'i`k nx�'4".xz� M‘-me.xw.r4. 4 ri;- ..izwa: , ;'.. <br /> n Bio-Hazard Waste Storage - ANNUAL n Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> In Controlled Bum rn Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> E <br /> Emergency Generator> 30 kw n LP /Natural Gas - ANNUAL Sale <br /> Fire Protection Maintenance - ANNUAL I Places of Assembly- ANNUAL <br /> �Utriy) 'berm' 177111 Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> I <br /> Fire Alarm ❑ ❑ I I I Sparklers <br /> Hood Cleaning ❑ ❑ ❑ ❑ I I n Sprinkler System Installations <br /> Hood Suppression E ❑ ❑ ❑ I 1 I Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> I Fire Pumps n Waste Tire Storage ANNUAL <br /> n Fire Works <br /> I Flammable Application- ANNUAL <br /> 1 ( Valuation of Project <br /> I I Fuel Tanks <br /> (-i Other: I <br /> F':roi S"....:,- ozw3:$"4,5ar x',t <;'z`m .s». ,:,:..a4,::. 0 ,m.,.,, ... m <br /> Contractor Company � IL ♦IMiI 01 .111M11 <br /> Signature ���� <br /> .`� bQ _ Registered ft 'Pe Current WEN 4 <br /> Address r1,J 2 !n ! tosow irommim License # I F - 1�l Q <br /> ELECTRICIAN Company <br /> Signature Registered Y / N j Fee Current I Y/ N I <br /> Address I I License # <br /> PLUMBER Company <br /> Signature Registered Y / N ] Fee Current I Y / N <br /> Address I I License # I <br /> MECHANICAL Company <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # <br /> OTHER Company <br /> Signature Registered Y/ N 1 Fee Current I Y/ N J <br /> Address <br /> My ., 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 />