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813 - 780 -0020 City of Zephyrhills Fire # q386 Fax- 813 - 780 -0021 ' Permit Application
<br /> Date Received J l' 21 09 I Permit Contact for Pert I l
<br /> Owner's Name aess, . to S4,0161/7" e/' Owner's Phone Number V 1 2I',.Z 9.<-3Z
<br /> Owner's Address .-C—s?/( -4z '7i..v?) 7 ,7Aftii�� le
<br /> Fee Simple Titleholder Name / / Titleholder Phone Number
<br /> Fee Simple Titleholder Address I I
<br /> . ",`.,' . ..: ::.re:,',.s ;"...:. t o e la% "`ONME1 tatelt 7 "E,M „ / rl �; !� t ,:. ":4 ,� . ,°°s .», 'Zr:, , , RIZtl ...::, i ,.,,.V :: ... t,.�?? 5 s:
<br /> Job Address Save/ 6/ti -- ,7 ,, G 7 ,A y/ / - Lot #
<br /> Sub Division 1 ( Parcel # l / -02( .21 - oak , /6z..67-0.25-0
<br /> .'•x Y.'.., s., ,' :z : :,' , M..a. rZ •0WfitiaaR,i 400.43 4 ;% ..5 ...,_¢3r:h,' +t,. .a ..x.aa "A s....,' `„ z.:ms,wa...:,:z..om, aa'tv.omai .._..�. em.i_.ts,oc: ,,,.,..r?r 4.0 pA at".xiara ...,,a...
<br /> El Bio- Hazard Waste Storage - ANNUAL n Fumigation Tent
<br /> Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier 11 or RQ Facility) ANNUAL
<br /> n Controlled Bum n Hood Installation
<br /> I I Emergency Generator < 30 kw n LP /Natural Gas - Installation
<br /> I — I Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale
<br /> n Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL
<br /> IUtriyI (Semis Other
<br /> Sprinkler n ❑ ❑ ❑ I I Recreational Bum
<br /> Fire Alarm n ❑ ❑ ❑ I I I 1 Sparklers
<br /> Hood Cleaning n ❑ ❑ ❑ I 1 n Sprinkler System Installations
<br /> Hood Suppression D ❑ J I n Standpipes (Sprinkler Sys)
<br /> n Fire Alarm Installation n Torch Roofing/Tar Kettle
<br /> n Fire Pumps n Waste Tire Storage ANNUAL
<br /> n Fire Works
<br /> n Flammable Application- ANNUAL
<br /> 1 I Valuation of Project
<br /> El Fuel Tanks
<br /> Other: I
<br /> mom a_15:z,u. Nge ., uua:. ,aklia.' . �'"" KfilfaaSaalaMEZEM.Zgan a a , ..... ';o.. '�..K.. ._..,_...,.a..d1xe3... d'&ntR Z? M5/MMIw,: "e:'.,,, "' ?'`k ...geM MI `f aie,;s:.
<br /> Contractor Company S'LU 3/ 1.339 I
<br /> Signature O Registered Y / N / Fee Current I Y / N
<br /> Address I I License # I
<br /> ELECTRICIAN Company I
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License # I I
<br /> PLUMBER Company I
<br /> Signature Registered Y / N I Fee Current I Y/ N J
<br /> Address I I License # I I
<br /> MECHANICAL Company
<br /> Signature Registered Y/ N I Fee Current I Y/ N I
<br /> Address I I License #
<br /> OTHER Company I
<br /> Signature Registered Y/ N j Fee Current I Y/ N I
<br /> Address J License #
<br /> Directions:
<br /> ,.w.....su�..:.;;u �..w.....,. w.. .�..axv:v , ,.u....a,>.3.i..s .whssxv.w:o .+a..,„..........o., s..v3.aws .n.ue•' ....,.w.ca. s:...a..,v�Td.a: u,3�'' _....w ., to ?..x. .<.,";c e.,.e.u:aae. ..e._....aw:. 1 w...aa....t..:: ...aa,�s;; xxt :. t'
<br /> ns:
<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)
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