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' 813 - 780 -0020 City of Zephyrhills Fire Fax - 813 - 780 -0021 • <br /> Permit Application <br /> Date Received 1 C <br /> J/ / / / y // / may /-J� Phone Contact for Permit j °x ..T us :;i . »u <br /> .�.w .,. .r.,. f. ' Me.. �- ucL4'SLf <br /> Owner 7 a � y� 3 V is Name r ^ ' l.{ c 7/ CJ'T-0 tom' to Owner Phone Number 1 tJ r 3 7 / 1- I ` <br /> Owner's Address V/ (..PS L/ t -/L <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address <br /> xi` "'.W: c ZetI ;:s, RNIM ,era' IRM N ,,, ::_s,.1M' rw W);Rr . z r ltlMn .» `, i `�., g, lgrWA` ::Fl.<.. i ,. t —r7." : - tVO t'rijn a ;w :. M Va„ . <br /> m <br /> / <br /> Job Address y` 6° 6 V I l/ L L L V Lot # <br /> V <br /> Sub Division Parcel # <br /> 3 ? ,,... s .. E 0«s MtiEW ,NLt €f v:4iF vi` ' 'waa ... ru § .,. r4Z1V2a=4WN MMT F,FMaRN ,»' ` ,'. - ...�� "A•4e MRK«;'5:as augA ,a .at:a ,a., .. r=n_. ,' <br /> El 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 /> FT Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation \ <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sal i <br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly -ANNUA ` <br /> �LItrly1 Semi) Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm ❑ ❑ ❑ I I n Sparklers g 1 ( C.- 11 <br /> Hood Cleaning El ❑ ❑ ❑ I 1 1 1 Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ I I n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle <br /> n Fire Pumps I 4 Waste Tire Storage ANNUAL <br /> FT Fire Works <br /> 17 Flammable Application- ANNUAL I I Valuation of Project <br /> n Fuel Tanks <br /> n Other: I I <br /> ._A. VMIBM Z S...a.zE PML;KM:a CNE .IaktPE.WLAIV. atfeM ln2Mt rd Yf C4WE .a-"..:M, na',T: e :_ ZFMMA ., .,:.a`;?,k,U :M.MM 2NEZat Ma'ahcT EZVV ,,JAMa <br /> Contractor Company I <br /> Signature Registered Y / N l Fee Current I Y / N <br /> Address I I License # ( <br /> ELECTRICIAN Company I <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 I Y / N <br /> Address License # <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> ' <br /> Address I ( ) ( License # <br /> OTHER <br /> r) --- Company <br /> ^ <br /> Signature — �' Y Wv Registered Y / N I Fee Current 1 Y / N <br /> Address License # 1 <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 />