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S13-78047020 City of Zephyrhills Fire Fax- 813 -780 -0021 <br /> Permit Application <br /> Date Received ) <br /> P hone Contact for Permit I <br /> 1 , , (F /.2 I ?f'2"" � S. /1 �.,r... <br /> Owners Name �, _ 5 � C�SG J Owners Phone Number <br /> Owner's Address I& (>q // &Or 2e, /y //s /%L ,) <br /> Fee Simple Titleholder Name Titleholder Phone Number <br /> Fee Simple Titleholder Address 1 <br /> a;: aaw. "vt // v , :,, gra " l arc ort .; / 16,3:1 a, #t.. MILL ; , ," li40: ;.,... 13 i..,w.:;;�w:. <br /> T � C. // Of ✓d 2 . "— C. Lot # <br /> Job Address ii+s �SGJ `—YY <br /> Sub Division Parcel # <br /> iwmixtmirore- ., .i. ., ..�.> sau+.nr, a >'a �v.. : %� , mew. a t�; i�y,:' � •. <br /> t: �.-.?-' �' �.,.....,.•�«av�.:.v.�. �..� <br /> x aw�7�a "',• <br /> " ,: <br /> I I Bio -Hazard Waste Storage - ANNUAL r ---- 1 Fumigation Tent <br /> n Comm Exhaust Kitchen Hood /Duct n Hazardous Material (Tier II or RQ Facility) ANNUAL <br /> Controlled Bum n 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 /> 1 Fire Protection Maintenance - ANNUAL 7 Places of Assembly- ANNUAL <br /> IUtnyl ISemII fGLV Other <br /> Sprinkler ❑ ❑ ❑ n Recreational Bum <br /> Fire Alarm 1 El 0 12 I ( I I Sparklers <br /> Hood Cleaning n ❑ ❑ ❑ ( I Sprinkler System Installations <br /> Hood Suppression n ❑ ❑ ❑ 1 1 1 Standpipes (Sprinkler Sys) <br /> n Fire Alarm Installation I 1 Torch Roofing/Tar Kettle <br /> I I Fire Pumps I Waste Tire Storage ANNUAL <br /> I I Fire Works <br /> Flammable Application - ANNUAL I ( Valuation of Project <br /> Fuel Tanks <br /> n Other: 1 <br /> s "raay: ,,, ?mart. ....- ,- z..er,� . <.w.r:4�. _,,. t<. w. a.:: r :- .�,., ..�..e:t€::�,:,Diu' , .;+ asses .<e",..., »:z.ae2' ",&.;4:«.t":2' <br /> Contractor - _ <br /> Company I <br /> Signature ./G— Registered Y / N I Fee Current 1 Y / N <br /> Address I I License # <br /> ELECTRICIAN Company <br /> Signature Registered Y / N 1 Fee Current I Y / N <br /> Address <br /> I License # <br /> PLUMBER Company <br /> Signature Registered Y / N . 1 Fee Current I Y / N <br /> Address I License # <br /> MECHANICAL Company <br /> Signature Registered Y / N _ Fee Current I Y / N J <br /> Address I <br /> I License # <br /> OTHER <br /> Company <br /> Signature Registered Y / N j Fee Current I Y/ N j <br /> Address License # <br /> a'- t, ;.v;ar_a•.,.. _..Nrex,c :�;wuaa <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 />