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813-780-0020 City of.ZephyrhillsFir ( Fax - 813- 780 -0021 <br /> Permit Application <br /> Date Received -2)/� pp /2 O <br /> Phone Contact for Permit <br /> Owner's Name L71, ZL0 1Ve,R V7,-7—/ r Owner's Phone Number 2/ 3 .S4S <br /> . C i_ggi <br /> Owner's Address R2 Z K 9738 171/-e79 <br /> l fl 3.6 <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address I <br /> r . -�--� �} J ... Wa t ". ... :�"_ s. r.:z�, 3_.: . ... , �•. �.� <br /> Job Address C � OK E (�TT! , r---0 /4 4- &lC�L 2LV'D Lot# <br /> Sub Division Parcel # <br /> Bio- Hazard Waste Storage - ANNUAL I I Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct 1 I Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> n Controlled Bum Hood Installation <br /> n Emergency Generator < 30 kw I LP /Natural Gas - Installation <br /> I I Emergency Generator > 30 kw I LP /Natural Gas - ANNUAL Sale <br /> I Fire Protection Maintenance - ANNUAL n Places of Assembly- ANNUAL <br /> 1Utrly1 !Semi' fl Other <br /> Sprinkler El ❑ ❑ ❑ I Recreational Bum <br /> Fire Alarm n ❑ ❑ ❑ I l Sparklers <br /> Hood Cleaning I./I ❑ .©' ❑ I I I I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 ( I Standpipes (Sprinkler Sys) <br /> I Fire Alarm Installation ( I Torch Roofing/Tar Kettle <br /> I Fire Pumps I I Waste Tire Storage ANNUAL <br /> Fire Works <br /> Flammable Application- ANNUAL I ( Valuation of Project <br /> 1 I Fuel Tanks <br /> 1 I Other: I <br /> `sa 1: y�3Ta`.,..a,. `.a -u:.e ?`-v w »s. -e lvra >K -.ei ,. e ... .: .-., *R, %a.'n�: .,.s ;. .%-s 9. t ..; • r�+L'.c. „his. 4�.:^. ..,,se?',;.5 �.s >;hr N.'S "Sr.[ ;..iFS r..S_r..t�. ,K ..e:'f�?« i _..,.. ..>.... s - Y3Y1'i+�" <br /> .._fir... <br /> Contractor ,c1-r''' Company �`///L7�i�' ` , <br /> Signature - _ Registered Y / N Fee Current Y / N <br /> Address I I I License # <br /> ELECTRICIAN Company I <br /> Signature Registered Y/ N I Fee Current I Y/ N I <br /> Address I I License # I <br /> PLUMBER Company I <br /> Signature Registered Y / N I Fee Current I Y/ N 1 <br /> Address I License # I I <br /> MECHANICAL Company <br /> Signature Registered Y / N J Fee Current I Y / N 1 <br /> Address I I License # I I <br /> OTHER Company I <br /> Signature Registered Y / N J Fee Current I Y / N I <br /> Address 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 />