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813-780-0020 City of Zephyrhills Fire Fax- 813-780 -0021 <br /> Permit Application <br /> Date Received � I Phone Contact for Permit <br /> _ _... <.,, .. ._.. ... ., .v.. .. <br /> c' 9 Owner's Name ^ t A .i.-T LA,' 1 . 0 r 24...-o hly h1 t LL S Owner's Phone Number $I 3 7 5r 8 7 / tsf <br /> Owner's Address /g Z'' New rt' 11)4_, <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I I <br /> Job Address s >Q M Lot # <br /> Sub Division Parcel # <br /> ... k;,Y .,; W.., W ... ::..Q , ':iWia4 , tK' • 6' :-y+. � ft;• V, n. .axe'=..,.,e4a:;gs 3 ..<.,.'„. RVP, MM ^-Jn "..KMVAW4aMZW : AK ;R.,:;a,.w.' udg:.z,. ,..M. .." V,Z:azd?Mv::w.,,. . rea:.,.,..... .i« W w....in.', <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 /> n Controlled Bum I ( Hood Installation <br /> n Emergency Generator < 30 kw n LP /Natural Gas - Installation <br /> n Emergency Generator > 30 kw n LP /Natural Gas - ANNUAL Sale <br /> E l Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> )(Ably' isemiI 1771 Other <br /> Sprinkler n ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I I n Sparklers <br /> Hood Cleaning H 0 ❑ ❑ I 1 n Sprinkler System Installations <br /> Hood Suppression ❑ JR' ❑ I 1 n Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I I Torch Roofing/Tar Kettle <br /> n Fire Pumps n Waste Tire Storage ANNUAL <br /> Fire Works <br /> ( Flammable Application- ANNUAL <br /> 1 I Valuation of Project <br /> n Fuel Tanks <br /> I Other: I I <br /> .dk .xis >:,.awa..mgya,a:: - :. .;:s., : egs.€4Ma ... ;' ..•�w.. <iWER,,..atitE;W . ,, aM,<3*:MEM Mir ...._.. �� td: s.,<, ga:..a'± ..., <.aalMti:*. SM=a. ..w2. . • <br /> Contractor Company t c A44f �j„t- ¥ FCVvt-vz`J <br /> Signature / /1 ' ' Registered Ng NEN Fee Current Num <br /> Address 1 PO &f. 251.) 4S F1 3 , lv -r 7 I License # I G r)-sl uouo l \ ' 7 <br /> ELECTRICIAN Company <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 1 Fee Current I Y / N I <br /> Address I I License # I ( <br /> MECHANICAL Company I <br /> Signature Registered Y / N I Fee Current 1 Y / N <br /> Address I I License # <br /> OTHER Company I <br /> Signature Registered Y / N I Fee Current I Y / N <br /> Address 1 1 License # IJ <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 />